Failure Of Surgical Treatment Research Articles

Evidences and Controversies About Recurrence of Diabetic Foot Osteomyelitis

Recurrence is one of the most worrying issues when dealing with diabetic foot osteomyelitis (DFO). In accordance with expert opinion in other areas of bone infection, it is accepted that very late relapse of apparently successfully treated osteomyelitis is not uncommon. However, the physiopathology of infections in large bones secondary to hematogenous osteomyelitis, infected prostheses, and open fractures is quite different from what is seen in the feet of patients with diabetes. The anatomy of the bones, the mechanism of infection and alterations in host defenses that are frequently seen in patients with diabetes may condition the onset, clinical course, and outcomes. Apparent eradication, disappearance of inflammatory signs, wound healing, bone healing based on image studies, and no recurrences during follow-up are common terms used for defining the success of therapy for DFO. Failure of initial surgical treatment, readmission to hospital, and new episodes of infection at the same or a contiguous site are considered as recurrence of osteomyelitis. Theoretically, bacteria living in the bone could be the source of clinical recurrence, but is it possible to obtain complete healing while bacteria remain alive in the bone in the feet of patients with diabetes? Can these bacteria grow and spread from the bone to the skin after years of healing? In the author's opinion, this type of long-term recurrence of DFO has not been well documented in the medical literature. It is the aim of this illustrated guide to review the evidence and controversies regarding the recurrence of DFO.

Proactive management of peritoneal metastases from colorectal cancer: the next logical step toward optimal locoregional control

SUMMARY Although surgery for colorectal cancer has improved over the last decade, locoregional recurrence and peritoneal metastases continue as a mechanism of surgical treatment failure in 10–20% of patients. These patients have a dismal prognosis. Clinical information is available in order to identify patients who are at high risk for locoregional recurrence and peritoneal metastases. These patients, once identified, should be offered new treatment options shown to be of benefit in selected patients. Using perioperative chemotherapy at the time of colorectal cancer resection improves locoregional control and diminishes peritoneal metastases. Also, in patients at high risk, a proactive second-look surgery utilizing peritonectomy and hyperthermic intraperitoneal chemotherapy is of benefit, with reasonable morbidity and mortality.

Shoulder stiffness and rotator cuff repair

Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant with an rotator cuff tear (RCT). We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 31 July 2011. Sixteen articles published in peer-reviewed journals were included in this comprehensive review. The management of shoulder stiffness is still controversial. The role of rehabilitation programs (standard versus early passive mobilization) after RCT repair on the development of stiffness is not clear, while the role of arthroscopic capsular release for post-operative stiffness is better defined, although a threshold of decreased the range of movement for which capsular release is advised has not been identified. Several factors have been identified to predispose the development of shoulder stiffness. There is also evidence in favor of surgical management of RCTs even when accompanied by shoulder stiffness, and there are strong evidences that arthroscopic capsular release is reliable and effective in managing shoulder stiffness. The post-operative rehabilitation protocol remains controversial. We are still far from definitive guidelines for the management of pre- and post-operative stiffness, and prospective double-blinded randomized clinical trials are needed to obtain evidence allowing to establish a reliable and effective management plan for shoulder stiffness.

Reasons for failure of surgical treatment in 25 tibial plateau fractures

BackgroundThe management of tibial plateau fracture is challenging. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is essential for a good outcome. PurposeThe study was a retrospective analysis of failed surgical treatment of tibial plateau fractures. MethodsTwenty-five patients with tibial plateau fractures were referred to our hospital after having undergone surgery elsewhere. Because of functional disability, the patients received revision surgery with concomitant treatment of associated soft tissue injuries. The average age at operation was 43.5 years (range, 27–71 years). The average interval between the first treatment and the secondary operation was 10.4 months (range, 6–24 months). From the radiographs and operative findings, we analyzed the factors that cause failure of the index surgical treatments for tibial plateau fractures. ResultsSchatzker classification identified five type II, one type III, four type IV, seven type V, and eight type VI fractures. Among these 25 cases, nonunion was found in seven (28%) patients and malunion in 18 patients (72%). The causes of failed surgeries included inadequate fixation (76%), malreduction (84%), and bone defect (100%). In addition, there were associated soft tissue injuries in nine patients (36%). ConclusionsThe main elements of the surgical management of tibial plateau fractures are anatomical reduction, firm fixation, and bone grafting. Inadequate fixation, malreduction, and bone defects can lead to the failure of surgical treatment. The key to successful surgical treatment is a well-designed surgical scheme tailored on the specific fracture type and soft tissue condition; this can prevent serious complications and resultant malpractice suits.

Angiographic Findings of Primary Versus Salvage Varicoceles Treated with Selective Gonadal Vein Embolization: An Explanation for Surgical Treatment Failure

Gonadal vein angioembolization is a successful means of primary and salvage treatment for symptomatic varicoceles. We aim to investigate angiographic findings during embolization of primary varicoceles vs those with failed surgical ligation. Between 1992 and 2010, 106 cases referred to our interventional radiologists for primary or salvage varicocelectomy were reviewed. These patients underwent venography and gonadal vein embolization using a combination of embolization coils and vascular plugs. All images were reviewed by an interventional radiologist to determine the anatomic etiology of the varicocele. Primary and salvage embolization cohorts were compared using t test and chi-square analyses for continuous and categorical variables, respectively. Angiographic parameters were analyzed using univariate and multivariable regression models to determine significance in predicting primary vs salvage status. Of the 106 patients, 46 patients (57 testicles) underwent primary and 60 patients (62 testicles) underwent salvage embolization. The salvage cohort of patients was younger (P<0.001) and comprised more solely left-sided pathology (P=0.002). An equivalent number of gonadal vein divisions and proportion of patent gonadal veins was found. However, there was a significantly higher proportion (27.8% vs 6.7%) of inguinal collateral vessels and combined presence of inguinal and retroperitoneal collateral veins (8.5% vs 2.1%) identified in the cohort undergoing embolization after failed surgical varicocelectomy. Presence of inguinal collaterals (P=0.008) as well as presence of both inguinal and retroperitoneal collaterals (P=0.038) on multivariable regression analysis revealed both as independent prognosticators of salvage status. Recurrence after surgical varicocelectomy is associated with increased inguinal collaterals. The pitfall presented by this anatomic variant to surgical ligation may be successfully managed with selective gonadal vein embolization.

Mortalidad en pacientes con osteólisis de origen linfático. Revisión de 54 casos

IntroductionOsteolysis of lymphatic origin is a rare disease with a high mortality which is difficult to attribute whether it is due to the disease itself or the therapeutic morbidity. The aim of this study is to review the causes of mortality in our group of patients with osteolysis of lymphatic origin, compared with the group of patients previously reported in the medical literature. Patients and methodsWe reviewed all patients with osteolysis of lymphatic origin and treated in our department who had died in the last 15 years, and we reviewed all published cases of death with this disease since the 1950's. ResultsA total of 57 patients with osteolysis of lymphatic origin had been studied at our institution, of whom three died, two from sepsis, and one from acute respiratory distress syndrome. All of them suffered severe malnutrition from massive lymphatic loss and 2 had bilateral chylothorax. Among the 51 cases reviewed in the literature between 1954 - 2010, 19 had bilateral chylothorax, 15 had right side involvement and only 2 had an exclusive left chylothorax. Eleven patients had complications, such as respiratory distress and pneumonia. Ten of them suffered from pathological fractures, and 10 from chylopericardium and/or chylous ascites. The most common cause of death was respiratory failure in 25 patients, followed by pneumonia and sepsis. The publications do not specify the ultimate cause of respiratory failure. ConclusionsPatients with severe osteolysis of lymphatic origin suffer three main disorders with overlapping comorbidity: the lymphatic malformation of soft tissue, the bone resorption and the chylothorax. While mortality in the first two is exceptional, the mortality of the chylothorax is common, especially when it is bilateral and does not respond to different therapies. Respiratory failure and infection are aggravated by immunosuppression, malnutrition and the non-restrictive use of central catheters. Unlike respiratory failure, which is difficult to control after the failure of medical and surgical treatment, morbidity from infections can be reduced through careful nutritional support, rational antibiotic prophylaxis and a reduction to a minimum in the use of central catheters and total parenteral nutrition.

Salvage of recurrence after failed surgical treatment of hallux valgus

Recurrence of the deformity is unfortunately a common occurrence following surgical treatment of hallux valgus. The underlying reason for recurrence is multifactorial and includes surgeon's factor, patient's factor, and deformity components that were not addressed at the index procedure. Salvage of recurrence can be challenging for both the patient and the surgeon. Successful treatment requires understanding the underlying reason for the failure of initial treatment and correcting bony alignment, restoring the joint congruity, and balancing soft tissues. We present an algorithmic approach to revision hallux valgus surgery.

Analysis of reasons for failed surgery treatment in patients with back pain

Fifty-three patients followed up for back pain and operated on are analyzed. The failed back surgery syndrome was observed in 47% of cases. Surgical results did not depend on the duration of the last exacerbation, the frequency of admissions, the presence of radicular syndrome, the size of intervertebral hernias, and the type of intervention (discectomy or microdiscectomy). Magnetic resonance imaging showed postoperative recurrent hernia in 50% of patients with good surgical results and in 89% of those with its poor results, which suggested that the surgical outcome could be only partially determined by a recurrence. Surgical treatment failures were correlated with the presence of neuropathic pain, anxiety, and depression. The detection of the neuropathic and psychogenic components of pain syndrome and the use of combination therapy with antidepressants and anticonvulsants for back pain will reduce the number of surgical interventions and improve their results.

Endoprosthetic Treatment is More Durable for Pathologic Proximal Femur Fractures

Pathologic proximal femur fractures result in substantial morbidity for patients with skeletal metastases. Surgical treatment is widely regarded as effective; however, failure rates associated with the most commonly used operative treatments are not well defined. We therefore compared surgical treatment failure rates among intramedullary nailing, endoprosthetic reconstruction, and open reduction-internal fixation when applied to impending or displaced pathologic proximal femur fractures. We retrospectively compared the clinical course of 298 patients who underwent intramedullary nailing (n = 82), endoprosthetic reconstruction (n = 197), or open reduction-internal fixation (n = 19) from 1993 to 2008. Primary outcome was treatment failure, which was defined as reoperation for any reason. Treatment groups were compared for differences in demographic and clinical parameters. The number of treatment failures in the endoprosthetic reconstruction group (3.1%) was significantly lower than in the intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%) groups. The number of revisions requiring implant exchange also was significantly lower for endoprosthetic reconstruction (0.5%), compared with intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%). Endoprosthetic reconstruction is associated with fewer treatment failures and greater implant durability. Prospective studies are needed to determine the impact of operative strategy on function and quality of life. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Implant‐Related Outcomes following Hypoglossal Nerve Implant for OSA

Objective: Obstructive sleep apnea (OSA) is a common disorder associated with multiple abnormal health outcomes. Failure of surgical treatment may be secondary to obstruction at the level of the tongue. To assess the non-disease related outcomes of an implantable hypoglossal nerve (CN XII) stimulating system (Inspire, Inspire Medical, Minneapolis, Minnesota). Method: Multicenter academic prospective trial of a unilateral hypoglossal nerve implant system (stimulation lead, sense lead and pulse generator). Implant procedure, technical details of stimulation titration, directed functional examinations, tongue EMG studies, and complications were reviewed from 31 implanted subjects. Results: Follow up averaged 424 days. Serious adverse events included delayed infection with explantation (n = 1), insufficient stimulation with explantation (n = 1), explantation per patient request (n = 1), and acute infection/inflammation (n = 1). Minor local pain/stiffness (n = 7), transient odynophagia (n = 4), stitch abscess (n = 1), local swelling (n = 1), fever (n = 1) were observed. Stimulation thresholds for sensation, morphologic change, and sub-discomfort (1.6 ± 0.6, 2.1 ± 0.7, 2.6 ± 0.8 respectively) did not change at 2, 4 and 6 months post-implant). At over 1 year follow-up, no abnormal findings in speech, swallowing, tongue morphology, or hypoglossal nerve function were observed. Conclusion: Placement of a CN XII implant system is technically feasible. Serious adverse outcomes occurred in 6% (delayed infection, inadequate stimulation requiring explantation). At over one year, placement of a CN XII implant for treatment of OSA demonstrates stable stimulation thresholds and is functionally well tolerated.

Evolução ponderal oito anos após a derivação gástrica em Y-de-Roux

To evaluate the effectiveness of banded Roux-en-Y gastric bypass in promoting weight loss after an eight-year follow-up. Two hundred and eleven obese patients underwent Roux-en-Y gastric bypass with banding by the same surgical team. The study design was longitudinal, prospective and descriptive. The analysis of weight decrease in the postoperative period was based on the loss of excess weight in percentage and BMI. Failure was considered when patients lost <50% of excess weight. The loss of follow-up was 36.5%, therefore, 134 patients were included in this study. The loss of excess weight in global average rate in the postoperative period was: 67.6 ± 14.9% in the first year, 72.6 ± 14.9% in the second year, 69.7 ± 15.1% in fifth year and 66.8 ± 7.6 in eight years. Surgical treatment failure occurred in 15 patients (7.1%) over the period. Banded Roux-en-Y gastric bypass was effective in promoting and sustaining weight loss in the long term, with low failure rates.

Posterior sagittal rectopexy in the treatment of recurrent rectal prolapse in children

Background/purpose Several surgical techniques have been described to treat recurrent rectal prolapse in children after failure of initial surgical treatment. The aim of this study was to evaluate the safety and efficacy of posterior sagittal rectopexy (PSR) in children with recurrent rectal prolapse. Patients and methods Twenty-two patients aged between 1 and 7 years presented with recurrent rectal prolapse after failure of initial surgical treatment. Conservative management was successful in four cases. Eighteen were treated with PSR. The procedure included plication of the dilated rectum and fixation of the rectum to the sacrum. The follow-up ranged between 4 and 18 months. Results Superficial wound infection occurred in two cases, and both healed without any further consequences. Constipation improved in seven out of 12 patients, who had history of constipation before surgery. Partial mucosal prolapse recurrence occurred in three patients. Two improved conservatively after 5 months and 7 months, respectively, and one required mucosal trimming. Normal anorectal continence was noted in all patients older than 3 years at follow-up. Conclusion PSR is a good option in cases of recurrent rectal prolapse in children. The technique is both safe and effective. It is associated with satisfactory functional results. Keywords : children, complications, posterior sagittal rectopexy, rectal prolapse, recurrent

Retropharyngeal infections in children. Treatment strategies and outcomes

Objective To optimize the treatment of retropharyngeal infections in children. Methods Retrospective chart review of 101 consecutive pediatric cases of retropharyngeal infections referred to our center from January 2006 to July 2009. Results Two-thirds of patients were males. Their mean age was 52 months (range: 6–163). Upper airway obstruction was observed in three patients. In another child, the infection evolved towards a diffuse cervical cellulitis. Medical treatment was initially planned in 44% of patients. Failures requiring surgical drainage occurred in 18% of them. In 56% of cases, surgical treatment was immediately instigated. It failed in 16% of patients, requiring a second surgical drainage. There was no difference in the duration of fever and of hospital stay between patients initially treated medically or surgically. Both medical and surgical treatment failures were associated with longer durations of fever ( p = 0.002, and p < 0.0001, respectively) and of hospital stay ( p = 0.0006, and p = 0.0005, respectively). Some characteristics of CT-scan anomalies were correlated with treatment failure. A hypodense core surrounded by rim enhancement, with a largest long axis ≥20 mm, was more frequent in case of medical failure ( p = 0.02). Surgical failure was associated with the same feature, but with a largest long axis ≥30 mm ( p = 0.05). Conclusions The present study suggests that severe complications are rare in pediatric retropharyngeal adenitis, and that CT-scan is a useful tool to choose between medical and surgical treatment.

Prevalence and Impact of Pain at the Greater Trochanter After Open Surgery for the Treatment of Femoro-Acetabular Impingement

Femoro-acetabular impingement can cause pain and degenerative changes of the hip joint. Traditionally, surgical dislocation of the hip joint has been performed for correction of pathologic abnormalities in the proximal part of the femur and the acetabulum. Failures of surgical treatment are often related to postoperative pain in the groin or in the area of the greater trochanter, associated with this surgical approach. The aim of our study was to determine the prevalence and functional impact of pain at the greater trochanter after surgical dislocation of the hip. Fifty consecutive patients in whom femoro-acetabular impingement had been treated with surgical dislocation of the hip at our institution were seen for clinical and radiographic follow-up at one year. The Merle d'Aubigné score was calculated preoperatively and at the time of follow-up. Pain in the groin or at the greater trochanter during activity and at rest was recorded. The mean Merle d'Aubigné score significantly improved from 14.4 points preoperatively to 17 points postoperatively. Preoperatively, eight patients (16%) had pain over the greater trochanter. At one year after surgery, twenty-three (46%) had such pain; these patients were primarily female (seventeen of the twenty-three). The mean Merle d'Aubigné score was 17.4 points for the patients without groin pain and 16.1 points for those with groin pain. The presence or absence of pain at the greater trochanter had no significant influence on the outcome, but groin pain was associated with inferior results. Tenderness or pain over the greater trochanter is frequent after osteotomy of the greater trochanter and has a distinct female predominance. However, it has no significant negative influence on outcome. This is in contrast to groin pain, which is associated with inferior results.

A Collaborative Transdisciplinary “Geriatric Surgery Service” Ensures Consistent Successful Outcomes in Elderly Colorectal Surgery Patients

We hypothesized that a dedicated collaborative transdisciplinary Geriatric Surgery Service (GSS) will improve care for elderly colorectal surgery patients. Patients older than 75years of age who underwent major colorectal surgery were included in this study. The Geriatric Surgery Service employed a transdisciplinary, collaborative model of care. There were frequent quality reviews and a patient-centered culture was ensured. Treatment protocols and checklists were instituted. Perioperative outcome data were collected prospectively between 2007 and 2009. These data were compared to those from similar patients not managed by the service. Success and failure of surgical treatment of the two groups were analyzed using CUSUM methodology. Failure was defined as mortality, prolonged hospital stay for any reason, including morbidity, and failure to regain preoperative function by 6weeks. Twenty-nine patients managed by the GSS were compared to 52 patients who underwent standard treatment. The median age of the patients managed by the GSS was higher but there was no difference in the ASA score and predicted morbidity scores based on the POSSUM model. The GSS achieved lower mortality and major complication rates. A large majority (84.6%) of the patients managed by the GSS returned to preoperative functional status by 6weeks. The GSS was able to produce a trend of successively desired outcomes consistently leading to the CUSUM curve exhibiting a sustained downward slope. This was in contrast to patients not managed by the GSS. The Geriatric Surgery Service, through its transdisciplinary, collaborative care processes, was able to achieve sustained superior outcomes compared to standard management.

Treatment of moderate to severe female stress urinary incontinence with the adjustable continence therapy (ACT) device after failed surgical repair

Treatment of recurrent stress incontinence after a failed surgical procedure is more complicated, and repeat surgeries have higher rates of complications and limited efficacy. We determined the technical feasibility, efficacy, adjustability, and safety of adjustable continence therapy device for treatment of moderate to severe recurrent urinary incontinence after failed surgical procedure. Female patients with moderate to severe recurrent stress urinary incontinence who had at least one prior surgical procedure for incontinence were enrolled. All patients underwent percutaneous placement of adjustable continence therapy (ACT) device (Uromedica, Plymouth, Minnesota). Baseline and regular follow-up tests to determine subjective and objective improvement were performed. A total of 89 patients have undergone implantation with 1-3 years of follow-up. Data are available on 77 patients at 1 year. Of the patients, 47% were dry at 1 year and 92% improved after 1-year follow-up. Stamey score improved from 2.25 to 0.94 at 1 year (P < 0.001). IQOL questionnaire scores improved from 33.9 to 71.6 at 1 year (P < 0.001). UDI scores reduced from 60.7 to 33.3 (P < 0.001) at 1 year. IIQ scores reduced from 57.0 to 21.6 (P < 0.001) at 1 year. Diary incontinence episodes per day improved from 8.1 to 3.9 (P < 0.001) at 1 year. Diary pads used per day improved from 4.3 to 1.9 (P < 0.001). Explantation was required in 21.7% of patients. The ACT device is an effective, simple, safe, and minimally invasive treatment for moderate to severe recurrent female stress urinary incontinence after failed surgical treatment.

Pharmacological management of acromegaly: a current perspective

Acromegaly is a chronic disorder of enhanced growth hormone (GH) secretion and elevated insulin-like growth factor–I (IGF-I) levels, the most frequent cause of which is a pituitary adenoma. Persistently elevated GH and IGF-I levels lead to substantial morbidity and mortality. Treatment goals include complete removal of the tumor causing the disease, symptomatic relief, reduction of multisystem complications, and control of local mass effect. While transsphenoidal tumor resection is considered first-line treatment of patients in whom a surgical cure can be expected, pharmacological therapy is playing an increased role in the armamentarium against acromegaly in patients unsuitable for or refusing surgery, after failure of surgical treatment (inadequate resection, cavernous sinus invasion, or transcapsular intraarachnoid invasion), or in select cases as primary treatment. Three broad drug classes are available for the treatment of acromegaly: somatostatin analogs, dopamine agonists, and GH receptor antagonists. Somatostatin analogs are considered as the first-line pharmacological treatment of acromegaly, although efficacy varies among the different formulations. Octreotide long-acting release (LAR) appears to be more efficacious than lanreotide sustained release (SR). Lanreotide Autogel (ATG) has been shown to result in similar biological control as octreotide LAR, and there may be a benefit in switching from one to the other in some cases of treatment failure. The novel multireceptor somatostatin analog pasireotide, currently in Phase II clinical trials, also shows promise in the treatment of acromegaly. Dopamine agonists have been the earliest and most widely used agents in the treatment of acromegaly but have been found to be less effective than somatostatin analogs. In this class of drugs, cabergoline has shown greater efficacy and tolerability than bromocriptine. Dopamine agonists have the advantage of oral administration, resulting in increased use in select patient groups. Selective GH receptor antagonists, such as pegvisomant, act by blocking the effects of GH, resulting in decreased IGF-I production despite persistent elevation of GH serum levels. Thus far, tumor growth has not been a concern during pegvisomant therapy. However, combination treatment with somatostatin analogs may counteract these effects. The authors discuss the latest guidelines for biochemical cure and highlight the efficacy of combination therapy. In addition, the effects of pharmacological presurgical treatment on surgical outcome are explored.

SYNTHETIC INOSINE ANALOGS IN TREATMENT OF CIN IIII

Genes products of human papillomavirus (HPV) have been identified in more then 99,7% of cervical carcinomas. Several factors may be associated with higher rates of surgical treatment failure, including highgrade CIN, large lesion size, satellite HPVrelated lesions, involved margin, persistent HPV infection. Several pharmaceutical analogs of inosine have been using about 40 years to treat broad spectrum of viral infections. Clinical and experimental studies concerning efficacy and molecular mechanism of Inosine pranobeх are characterized this product as a safe and natural immune stimulating agent with beneficial results in patients with HPV. The purpose of the study is to evaluate the effect and toxicity of the antivirus therapy of Inosine pranobeх in the complex treatment of HPV infected patients affected CIN, CC in situ and recurrence of CIN in HPVpositive women after loop conization. Surgery with the antivirus therapy of Inosine pranobeх exhibited a protective effect on the recurrence of any CIN. Inosine pranobeх is characterized as a natural immune stimulating agent without pleiotropic effects of cytokines. Our data and global clinical studies have confirmed the safety and efficacy in the treatment of CIN Inosine pranobex.

Weight Loss Outcome After Silastic Ring Roux-en-Y Gastric Bypass: 8 Years of Follow-up

An underlying major aim of bariatric surgery is weight loss and its long-term maintenance. In spite of this, most studies regarding weight loss after surgical treatment of morbid obesity show 3-year follow-up results. We evaluated the effectiveness of silastic ring Roux-en-Y gastric bypass (SR-RYGBP) in promoting significant weight loss after an 8-year follow-up at the Londrina State University Hospital. From May 1999 to December 2000, 211 morbidly obese patients were submitted to SR-RYGBP by the same surgical team. The study's design was longitudinal, prospective, and descriptive. The analysis of postoperative weight decrease was based on excess weight loss in percentage (%EWL) and the calculation of body mass index. Therapeutic failure was considered when patients lost <50% of excess weight. Patients lost to follow-up were 36.5%; therefore, 134 patients were included in this study. The average global EWL was 67.6 ± 14.9% on the first postoperative year, 72.6 ± 14.9% on the second year, 69.7 ± 15.1% on the fifth postoperative year, and 66.8 ± 7.6% on the eight postoperative year. Surgical treatment failure occurred in 15 patients (7.1%) over 8years. SR-RYGBP was effective in promoting and maintaining weight loss in the long term with a low failure rate.

Retrospective study of failed surgical treatment of acetabular fractures

Objective To analyze the possible reasons of failed surgical treatment of acetabular fractures. Methods Various methods were used for positive patient identification, including according to Matta's X-ray assessment and Merle d'Aubigne & Postel hip function score of clinical standards for classification of acetabular fracture reduction surgery were not satisfied or not carried out a reduction and fixation,the clinical evaluation of hip joint as a bad, occurrence of femoral head subluxation or dislocation, femoral head necrosis and other serious complications. From February 2000 to February 2008, 22 patients including 14 males and 8 females with an average age of 38.6 years (range, 18-72 years) were considered as failed cases. Results 45.5% of these cases were posterior wall fractures which were not given any fixation, 27.3% of them were posterior column fractures which were not fixed, 13.6% of them whose reduction and fixation of anterior wall fractures were not satisfied, and 9.1% of them were anterior column fractures which needed fixation. One case should take open reduction and iternal fixation instead of THA. The rate of misdiagnosis and mistaken diagnosis were 90% if only X-ray evaluation was made and this rate decreased to 8.3% if computed tomography was taken. The rate of wrong selection of operative approach was 100% in 10 cases of misdiagnosis, and which was 58.3% in 12 cases of correct diagnosis. In the 5 patients with correct diagnosis and selection of operative approach, the reasons of failed surgical treatment were due to imperfect surgical skills in 3 cases, and inappropriate fixation patterns in 2 cases. Conclusion The causes of the failure of surgical treatment for acetabular fracture might include preoperative missed diagnosis and misdiagnose, inappropriate approach, and an unreasonable internal fixation with unskillful technique. Key words: Acetabulum; Fractures, bone; Treatment failure; Retrospective studies