Favorable Postoperative Outcomes Research Articles

Outcomes of secondary sulcus intraocular lens implantation in unilateral anterior persistent fetal vasculature.

To evaluate the surgical results of sulcus intraocular lens (IOL) implantation in children with unilateral anterior persistent fetal vasculature (PFV) underwent primary vitrectomy combined with lensectomy and preservation of the peripheral anterior capsule. Twenty-two eyes of 22 children with unilateral anterior PFV who underwent sulcus secondary IOL implantation were analyzed. Main outcome measures were preoperative and postoperative visual acuity, and complications both intraoperatively and postoperatively. Review of 22 consecutive patients identified best-corrected visual acuity (BCVA) improvement from 1.37±0.84 to 0.73±0.57 logarithm of the minimal angle of resolution (logMAR) after IOL implantation (P<0.001) with a mean follow-up was 16.55±5.86mo. Average age at secondary IOL implantation was 41.05±15.41mo. Three eyes (13.64%) achieved BCVA of 0.3 logMAR at the final visit. Transient intraocular pressure rise (4 eyes; 18.18%), postoperative increased inflammation (3 eyes; 13.64%) and postoperative hypotony (2 eyes; 9.09%) were common complications. Properly preservation of the anterior lens capsule during the primary surgery facilitated secondary sulcus IOL implantation in pediatric patients with anterior PFV, with favorable postoperative visual outcomes and compatible percentage of complications.

Crystalloid Administration Is Associated with the Recovery of Pediatric Elective Roux-en-Y Hepaticojejunostomy.

Intraoperative fluid administration is important for postoperative recovery and might be associated with postoperative complications. This retrospective review included 471 patients who underwent Roux-en-Y hepaticojejunostomy. Patients were separated into two groups based on whether they received low (<15.27 mL/kg/h) or high (>15.27 mL/kg/h) volumes of corrected crystalloid fluids. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 192 matched patients, clinical outcomes, including postoperative complications and length of hospital stay, were compared. Higher use of diuresis (p = 0.027) was found in the high fluid group. Receiving low volumes of crystalloids was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.31-1.07; p = 0.047) and first bowel movement (OR, 0.56; 95% CI, 0.38-0.98; p = 0.013). However, the occurrence of renal complications did not show significant differences between the groups. A lower postoperative complication rate (OR, 0.54; 95% CI, 0.42-0.94; p = 0.016) was noted in patients with low crystalloids compared with high crystalloids. The total length of hospital stay was longer in patients with high crystalloid fluid (9.21 ± 3.24 days) than patients with low volumes (7.83 ± 2.58 days; p = 0.012). Low crystalloid fluid administration was associated with favorable postoperative outcomes.

Impact of Tumor Location on Postoperative Outcome of Intraductal Papillary Neoplasm of the Bile Duct.

The concept of intraductal papillary neoplasm of the bile duct (IPNB) has been proposed to be the biliary equivalent of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. While the classification of IPMNs is based on their location of duct involvement, such classification has not been fully evaluated for IPNBs. The aim of this study is to investigate the value of IPNB classification based on its location. A total of 306 consecutive patients who underwent surgical resection with a diagnosis of bile duct tumor were enrolled. Among these patients, 21 were diagnosed as having IPNB. The IPNBs were classified into two groups as follows: extrahepatic IPNB, which located in the distal or perihilar bile duct, and intrahepatic IPNB, which located more peripherally than the hilar bile duct. The clinicopathological features of the two groups were then compared. Extrahepatic IPNB tended to show more invasive characteristics than intrahepatic IPNB (presence of invasive component: 40.0 vs. 9.1%, p = 0.084). Moreover, patients with extrahepatic IPNB showed significantly poorer relapse-free survival (RFS) than those with intrahepatic IPNB [5-year RFS rate (%): 81.8 vs. 16.2, p = 0.014]. Patients with intrahepatic IPNB show more favorable pathological characteristics and postoperative survival outcomes than those with extrahepatic IPNB.

Comparing Off-clamp and On-clamp Robot-assisted Partial Nephrectomy: A Prospective Randomized Trial

To determine whether performing robot-assisted partial nephrectomy without warm ischemia "off-clamp" results in favorable postoperative renal functional outcomes compared with the on-clamp method. We conducted a prospective trial of 80 patients who underwent robot-assisted partial nephrectomy. They were randomized in a 1:1 ratio to undergo the procedure with renal artery clamping or without clamping. The groups were compared across demographics, operative information, perioperative outcomes, and postoperative renal function. We assessed renal function by estimated glomerular filtration rate and renal scintigraphy both preoperatively and at 3 months postoperatively. Patients in the on-clamp and off-clamp groups were similar in age, gender, body mass index, comorbidities, clinical tumor size, nephrometry score, and laterality. Off-clamp procedures were lengthier at an average 178.0 minutes vs 156.0 minutes for on-clamp (P = .011). Estimated blood loss, rates of pelvicalyceal repair, postoperative complications, and positive margins were not different. At a median 3-month follow-up, no significant differences were seen in change in postoperative estimated glomerular filtration rate or percent split renal function between both groups. In this prospective study, off-clamp robot-assisted partial nephrectomy resulted in similar perioperative outcomes compared with the on-clamp technique. No benefit was demonstrated in the preservation of renal function. Urologists may safely employ either an on-clamp or off-clamp strategy depending on surgeon preference and patient-specific factors including baseline renal insufficiency, multiple masses, or solitary kidney.

Sequential Enlargement of Posterior Fossa After Duraplasty for Chiari Malformation Type 1

ObjectiveThere are several material options for duraplasty in surgery for foramen magnum decompression (FMD). We retrospectively analyzed surgical results and the impact of sequential alteration of posterior fossa (PF) size in patients with Chiari malformation type 1 after duraplasty using local fascia.MethodsThe patients with Chiari malformation type 1 who underwent FMD with duraplasty using local fascia at our institution between 2004 and 2015 were included in the study. Some pediatric patients who underwent FMD without duraplasty and patients with insufficient follow-up data were excluded. Improvement of clinical signs, regression of syrinx, and temporal alteration of PF size were analyzed with perioperative magnetic resonance imaging. Postoperative clinical outcomes were evaluated at the final follow-up using the Chicago Chiari Outcome Scale. Correlations between the PF size alteration and size of dural patch or Chicago Chiari Outcome Scale were statistically analyzed.ResultsTwelve patients were included in this study. The mean age of the patients was 31.9 (range, 18–48) years. Syrinx was incorporated in 11 patients and regressed postoperatively in all patients. The PF was significantly enlarged sequentially over time (P < 0.05). The degree of enlargement was positively correlated with size of the fascial patch (r = 0.540). Postoperative clinical outcomes at final follow-up were positively correlated with the degree of PF enlargement (r = 0.678).ConclusionsThe PF was enlarged sequentially over time after duraplasty using local fascia. The degree of enlargement was positively correlated with the size of the fascial patch and the likelihood of a favorable postoperative outcome.

The Defective Allele of Aldehyde Dehydrogenase 2 Gene is Associated with Favorable Postoperative Prognosis in Hepatocellular Carcinoma.

Background: The Aldehyde dehydrogenase 2 (ALDH2) mutant genotypes contain an allele encoding defective ALDH2 with reduced efficacy of alcohol metabolism leading to accumulation of highly toxic and carcinogenic acetaldehyde. It can induce unpleasant “Asian flush syndrome” and associate with increased risk of cancers. However, to date, little is known about ALDH2 genotypes in relation to the postoperative prognosis of hepatocellular carcinoma (HCC).Methods: From 2002 to 2012, 419 HCC patients receiving surgical resection of HCC were enrolled for ALDH2-rs671 genotyping and outcome correlation.Results: Of the patients included, 202 were ALDH2-rs671 “GG” (wild type) and 217 were mutant (defective) “AA” + “GA” genotype. Kaplan-Meier analysis indicated that “GG” genotype significantly associated with shorter metastasis-free (P = 0.034) and overall (P = 0.005) survival, but not recurrence-free survival (P = 0.281). Univariate followed by multivariate Cox proportional hazard analysis showed that “GG” genotype was an independent clinical predictor for shorter time-to-distant metastasis (adjusted P = 0.019) and shorter overall survival (adjusted P = 0.001). Subgroup analysis showed that in patients with negative hepatitis B surface antigen, Edmonson's histology grade < 3, and aspartate transaminase > alanine transaminase, the ALDH2-rs671-GG genotype was associated with both shorter time-to-metastasis and shorter overall survival.Conclusions: HCC patients carrying a defective allele of ALDH2 had a favorable postoperative outcome.

Clinico-electroencephalographic variants in pharmacoresistant mesial temporal lobe epilepsy

Focal epilepsy secondary to mesial temporal sclerosis (MTS) is one of the main causes of refractory epilepsy. It is typically associated with frontotemporal discharges in the electroencephalogram (EEG), a characteristic image in the magnetic resonance scan and a probability of post-operative remission above 70%. To identify different patterns of ictal propagation in surface EEG recordings in patients with refractory epilepsy and MTS, and to analyse their relation with the post-operative outcome. We conducted a retrospective review of the medical records of patients with refractory epilepsy secondary to MTS evaluated in the Epilepsy Surgery Programme of the Hospital de Clinicas, Montevideo (n = 30). The propagation of ictal rhythms was analysed in time windows of three seconds, and propagation maps were produced for each seizure. Six patterns were identified: ipsilateral temporal (type 1; 37%), bilateral frontotemporal with (type 2A; 22%) or without (type 2B; 17%) extension to suprasylvian regions, alternating temporal (type 3; 13%), unilateral suprasylvian (type 4; 7%) and bilateral at onset (type 5; 3%). The type 1 pattern was associated with classic clinical features and a favourable post-operative outcome. The clinical variants were associated with extratemporal EEG propagation. Patients with reflex seizures continued with post-operative seizures. Overall, no unambiguous relation was found between the ictal EEG pattern and the post-operative outcome. The ictal EEG pattern does not allow for a surgical prognosis in patients with epilepsy secondary to MTS. The history of reflex seizures in these patients may be a red flag suggesting a less favourable surgical outcome.

Implementation of early recovery after surgery (eras) protocol in chronic pancreatitis patients undergoing Frey’s procedure: a prospective study

Introduction: Enhanced recovery after surgery (ERAS) has been successfully employed in various gastrointestinal surgeries with favourable postoperative outcomes. However, pancreatic surgeons are reluctant to embrace the ERAS concept. The evidence for ERAS protocol in chronic pancreatitis (CP) patients undergoing Frey’s procedure is limited. Method: All patients who underwent Frey’s procedure for CP between April 2017 to December 2018 were included in the prospective study. Patient with a recent acute episode of pancreatitis (<4 weeks) and requiring concomitant mutivisceral resection were excluded. Twenty-two components of ERAS protocol were implemented. The prospective data were compared with patients who underwent Frey’s procedure before implementation of the ERAS protocol (January 2016 to March 2017). Result: Of the 26 patients who underwent Frey’s procedure during the study period 5 patients were excluded. Remaining patients (n=21, Group B) were compared with patients (n=23, Group A) who underwent Frey’s procedure before implementation of ERAS protocol. The compliance was 100% for all ERAS components except for the avoidance of postoperative opioids. More number of patients in Group A received intraoperative opioids than group B (p=0.01). Group B patient had early drain removal (4.07 Vs 1.07 days, p=0.00) early urinary catheter removal (2.4 Vs 1.53 days, p=0.002), early bowel movement (mean= 2.4 days, p=0.002) and tolerated oral semisolid diet earlier (mean=3.4 days, p=0.039) than Group A patients. Postoperative complications (p=0.234), duration of ICU stay (p=1), postoperative hospital stay (p=0.241) and readmission rate were comparable between both groups. Conclusion: Implementation of ERAS protocol in CP patients undergoing Frey’ procedure is feasible and safe. ERAS protocol reduced intraoperative opioids requirements with early recovery of bowel movement and tolerance to semisolid diet. However, compliance for the avoidance of postoperative opioids was poor.

Propensity-Matched Analysis of Sigmoidectomies for Diverticular Disease.

Background and Objectives:The role for the robotic-assisted approach as a minimally invasive alternative to open colorectal surgery is in the evaluation phase. While the benefits of minimally invasive colorectal surgery when compared to the open approach have been clearly demonstrated, the adoption of laparoscopy has been limited. The purpose of this study was to evaluate clinical outcomes, hospital and payer characteristics of patients undergoing robotic-assisted, laparoscopic, and open elective sigmoidectomy for diverticular disease in the United States.Methods:This is a retrospective propensity score–matched analysis. The Premier Healthcare Database was queried for patients with diverticular disease. Patients with diverticular disease who underwent robotic-assisted, laparoscopic, and open sigmoidectomy for diverticular disease from January 2013 through September 2015 were included. Propensity-score matching (1:1) facilitated comparison of robotic-assisted versus open approach and robotic-assisted versus laparoscopic approach. Peri-operative outcomes were assessed for both comparisons.Results:There were several outcomes advantages for the robotic-assisted approach when compared to laparoscopic and open sigmoidectomy for diverticular disease that included significantly fewer conversions to open (P = .0002), shorter hospital length of stay, fewer postoperative complications—ileus, wound complications, and acute renal failure—and more patients discharged directly to home.Conclusions:The robotic-assisted minimally invasive approach to elective sigmoidectomy for diverticular disease results in favorable intra-operative and postoperative outcomes when compared to laparoscopic and open approaches.

Anesthetic Management of a Rare Penetrating Traumatic Brain Injury Caused by a Pickaxe: A Case Report

Penetrating traumatic brain injuries (TBI) are frequent neurosurgical emergencies, associated with a high mortality rate and we almost no previous report on a penetrating pickaxe TBI. Herein, we report and discuss the anesthetic challenges encountered in the surgical extraction of a pickaxe from a patient with TBI. We present the case of a 34-year-old man who presented with a penetrating pickaxe TBI at his left temporal region, signs of raised intracranial pressure and normal vital signs. Anesthetic management began within 3 hours of admission and consisted of general anesthesia and rapid sequence intubation. Surgical extraction of a 14 cm long wing of the pickaxe was achieved with good hemostatic control. His postoperative course was marked by complete blindness of the right eye till one year of follow-up. The authors highlight the need of a prompt multidisciplinary management with close perioperative monitoring of haemostatic control and signs of raised intracranial pressure as key factors for a favourable postoperative outcome.

Functional Results of Cervical Rib Resection for Thoracic Outlet Syndrome: Impact on Professional Activity

The aim of this study is to report long-term functional results following cervical rib (CR) resection for thoracic outlet syndrome (TOS). This monocentric study included all cases of resection of CR for TOS performed between January 2004 and December 2016. Data were retrospectively collected from the hospital electronic database including preoperative symptoms and the evaluation of occupational well-being, intraoperative data, and early clinical evaluation and occupational well-being during the postoperative period. Patients were categorized as neurogenic TOS (NTOS), arterial TOS (ATOS), arterial and neurogenic TOS (ANTOS), venous TOS (VTOS), or asymptomatic according to preoperative evaluation. We evaluated the improvement in work life between the preoperative and the postoperative period. Further assessment was a negative Roos or elevated arm stress test (EAST) during the postoperative period. Thirty-three patients with a median age of 38.5years (30-46) were included. Thirty-six procedures were performed: 33% to treat ATOS (12/36), 39% for NTOS (14/36), 19% for ANTOS (7/36), 3% for VTOS (1/36), and 6% (2/36) for asymptomatic lesions. There were 9 cases of subclavian artery aneurysms leading to additional arterial repair. Due to distal embolization, a cervical sympathectomy was associated in 5 procedures. First rib resection was associated in 4 procedures (11%) and C7 transverse process resection was performed in 15 procedures (42%). The technical success rate was 100% and intraoperative complications were observed in 4 patients (11%) with favorable postoperative outcomes. During the early postoperative period, 3 Claude Bernard-Horner's syndrome and 1 asymptomatic subclavian dissection were detected. Late complications included 2 bypass thromboses (6%) at 6weeks and 16months. Postoperative EAST improved in 16 limbs (44%). Prior to the procedure, only 27% (9/33) patients had normal work lives. After the procedure, 64% (21/33) of patients were able to return to their normal work activity. CR resection for TOS seems to be a safe procedure leading to good short- and long-term clinical results with a favorable impact on recovering a normal work life in these young patients.

Development of a robot-assisted kidney transplantation programme from deceased donors in a referral academic centre: technical nuances and preliminary results.

To report the development of the first robot-assisted kidney transplantation (RAKT) programme from deceased donors, examining technical feasibility and early perioperative and functional outcomes at a referral academic centre. A RAKT programme was developed in 2016 at our institution following structured modular training. Specific inclusion/exclusion criteria for both living and deceased donors were set. Data from patients undergoing RAKT from January 2017 to April 2018 were prospectively collected in an a priori developed web-based data set. RAKT followed the principles of the Vattikuti Urology Institute-Medanta technique, with specific technical modifications based on clinical recipient characteristics, as well as surgeon's skills and preference during the learning curve. Technical feasibility of RAKT from deceased donors and evaluation of perioperative and early functional outcomes were the main study endpoints. In all, 17 RAKTs were performed during the study period. Of these, six were from living donors and 11 were from deceased donors. All RAKTs were successfully completed without need of conversion. The median (interquartile range [IQR]) console time was 190 (160-220) min and the median (IQR) estimated blood loss was 120 (110-140) mL. The median times to complete venous, arterial and uretero-vesical anastomoses were 21, 22 and 21 min, respectively. The median (IQR) length of stay was 8 (6-12) days. At a median (IQR) follow-up of 8 (6-11) months, five (30%) complications were recorded. Of these, four (24%) were minor (Clavien-Dindo Grade I-II) and one major (Clavien-Dindo Grade IIIb, requiring graft nephrectomy). Overall, two patients were still on dialysis at last follow-up. A significant improvement in graft function was recorded progressively at all postoperative time points. Our preliminary experience outlines that: (i) the development of a RAKT programme is feasible in centres experienced in robotic surgery and open kidney transplantation; (ii) RAKT from deceased donors is feasible from both a technical and logistical perspective; and (iii) RAKT from deceased donors appears to achieve favourable early postoperative and functional outcomes. Larger studies with longer follow-up are needed to confirm these findings and compare the outcomes of RAKT from deceased donors with those from living donors.

SURGICAL OUTCOMES OF 3D PRINTED MUSCULOSKELETAL METAL IMPLANTS: A SYSTEMATIC REVIEW

Introduction: Additive manufacturing, also known as 3D printing (3DP), is becoming increasingly available to surgeons throughout the world due to recent advancements in technology. 3D printing can produce complex free-form structures that would be impossible using conventional subtractive manufacturing. This offers the possibility to create implants that are better suited to the irregular anatomic shapes found in the human body. The present study aims to examine the surgical outcomes associated with the use of 3D printed metal implants and uncover the value of 3D printing in musculoskeletal surgery. Methods: A systematic review of published literature was performed in June 2017 using the PRISMA protocol. Online bibliographic databases such as MEDLINE, Embase, Scopus, CINAHL, and Cochrane were used to identify studies involving surgical implantation of 3D printed metal implants in musculoskeletal surgery. References from relevant studies were scanned for additional articles. Two reviewers independently screened results. Full-text articles were analyzed for eligibility. A total of 24 studies were included for data abstraction. Results were collected and qualitatively analyzed. Results: Of the 25 articles included, there were 17 case reports, 4 case series, 2 retrospective cohorts and 3 prospective cohorts. Of these articles, the majority of 3DP was done with electron beam melting (EBM) with Ti6Al4V. Orthopaedic, neurosurgical, plastic, and maxillofacial surgery articles were included in the review. All studies concluded that 3D printed implants had favourable post-operative outcomes. Some advantages included the reduction of operative time, improved osseointegration through custom implant porosity, improved fixation, decreased stress shielding, better cosmetic appearance, improved functional outcome, and limb salvage. Additional cost and time required to design and print the implants were reported as potential drawbacks to 3D printing. Discussion/Conclusions. The applications of 3D printing in musculoskeletal surgery are promising and have the potential to alter future surgical practice. However, there is a lack of quality research in the literature assessing the use of 3D printed implants. Further research is needed to evaluate the use of 3D printing in musculoskeletal surgery to understand its potential effects on surgical practice.

Analysis of the therapeutic effect of stent-assisted embolization and surgical clipping for the treatment of middle cerebral artery bifurcation aneurysms

Objective: To compare the clinical effects of stent-assisted embolization and surgical clipping in the treatment of middle cerebral artery bifurcation wide-necked aneurysms. Methods: From July 2014 to March 2017, the clinical and imaging data of 45 patients with Hunt-Hess 0-Ⅲ grade middle cerebral artery bifurcation wide-necked aneurysms were divided into stent-assisted embolization group (20 patients from PLA Rocktet Army Hospital) and surgical clipping group (25 patients from Peking University International Hospital). The total occlusion rates of aneurysm, operation-related adverse events, clinical outcomes, and results of follow-up imaging from the two groups were compared. Results: The total occlusion rates in the stent-assisted embolization group and surgical clipping group were 90.0% (18/20) and 92.0% (23/25), respectively, and the difference was not statistically significant (P=0.815). The favorable six-month postoperative outcomes defined as the modified Rankin Scale ≤2 were 94.7% (18/19) in the stent-assisted embolization group and 91.3% (21/23) in the surgical clipping group (P=0.667). Fewer patients experienced the operation-related adverse events in the stent-assisted embolization group (15.0%, 3/20), as compared to that of the surgical clipping group (24.0%, 6/25), but the difference were not significant (P=0.453). After 2-24 months (median 7 months) of the operation, the follow-up imaging indicated that in the stent-assisted embolization group, 2 out of the 19 patients had residual or recurrent aneurysms.While in the surgical clipping group, residual or recurrent aneurysms were identified in 2 out of the 23 patients 2-14 months (median 3 months) after the surgery; the frequency was not statistically different between the two groups (P=0.841). Conclusion: Stent assisted embolization is a safe and effective treatment for the low grade middle cerebral artery bifurcation wide-necked aneurysms.

Predictors of seizure outcome following resective surgery for drug-resistant epilepsy associated with focal gliosis.

The authors studied the clinical characteristics and postoperative outcomes of drug-resistant epilepsy associated with focal gliosis. From their epilepsy surgery database, the authors selected the patients with drug-resistant epilepsy and MRI-defined focal gliosis who underwent focal resective surgery. All patients underwent standard presurgical evaluation. Intracranial electroencephalography (EEG) was performed in patients with discordant presurgical data, ill-defined lesions, and lesions close to eloquent regions. Completeness of resection was defined on the basis of extraoperative and intraoperative electrocorticography studies. Favorable postoperative outcome was defined as Engel class I outcome during the last 2 years of follow-up. Sixty-six patients fulfilled inclusion criteria. An initial precipitating injury was present in 38 (57.6%) patients, mainly in the form of perinatal injury (n = 10), trauma (n = 10), and meningoencephalitis (n = 8). Gliosis involved a single lobe in 38 (57.6%) patients and 2 adjacent lobes in 14 (21.2%) patients; the remaining 14 (21.2%) patients had multilobar gliosis. In patients with unilobar or bilobar gliosis, the posterior region of the head was involved in 34 (65%) patients and the frontal lobes in 12 (23%) patients. During a median follow-up of 4 years (range 2-9 years), 41 (62.1%) patients had favorable outcome. On multivariate analysis, the presence of a well-defined aura (p = 0.019), electrocorticographically defined completeness of resection (p = 0.024), and normal postoperative EEG findings at 1 year (p = 0.003) were predictive of favorable postoperative seizure outcome. Focal gliosis is a common etiology for drug-resistant extratemporal epilepsy in developing countries and is most often located in the posterior region of the head. The majority of these patients have perinatal injuries or neurological infections as initial precipitating injuries. Patients with focal gliosis have good postoperative seizure outcomes after well-planned resective surgery.

Laparoscopic hepatectomy for elderly patients: Major findings based on a systematic review and meta-analysis.

Background:As the general population continues to age, there is an increase need for surgical management of elderly patients. Compared to open hepatectomy (OH), laparoscopic hepatectomy (LH) offers earlier mobilization, less blood loss, and shorter postoperative hospital stay. However, whether these advantages of LH over OH are retained in elderly patients remains to be clarified. Therefore, in this study, we sought to evaluate the feasibility, safety, and potential benefits of LH for elderly patients.Methods:A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared LH and OH. Studies comparing LH in elderly and LH in nonelderly patients were also identified. Outcomes of interest included conversion rate, operative time, intraoperative estimated blood loss, length of hospital stay, rate and type of morbidity, mortality rate, margin status (R0), and long-term oncologic outcomes.Results:Nine studies met our inclusion criteria for this analysis. Of these, 5 compared LH and OH in elderly patients, 3 compared LH in elderly and nonelderly patients, and 1 included both outcomes. Compared to those with OH, elderly patients who underwent LH had similar operative times [weighted mean difference (WMD) = 1.15 minutes; 95% confidence interval (CI): −28.28–30.59, P = .94], less intraoperative blood loss (WMD = −0.71 mL; 95% CI: −1.29 to −0.16, P = .01), a lower rate of transfusion [risk ratio (RR) = 0.61, 95% CI: 0.40–0.94, P = .02], comparable R0 rates (RR = 1.01; 95% CI: 0.96–1.07, P = .70), less postoperative complications (RR = 0.61, 95% CI: 0.48–0.76, P < .01), and shorter hospital stay (WMD = −3.22 days; 95% CI: −4.21 to −2.23, P < .01). The limited long-term outcomes indicated that survival status was comparable between LH and OH for elderly patients. The pooled outcomes for elderly versus nonelderly patients indicated that the safety and effectiveness of LH over OH in elderly patients was not inferior to those in nonelderly patients.Conclusion:Our results indicate that LH is a feasible and safe alternative to OH in elderly patients, providing a lower rate of morbidity and favorable postoperative recovery and outcomes.

Transanal Total Mesorectal Excision vs Laparoscopic Total Mesorectal Excision in the Treatment of Low and Middle Rectal Cancer: A Propensity Score Matching Analysis.

Transanal total mesorectal excision is a novel and promising technique in the treatment of low and middle rectal cancer. This study aimed to compare the safety and feasibility of transanal total mesorectal excision versus laparoscopic total mesorectal excision. This was a retrospective study using propensity score matching analysis. This study was conducted in a single high-volume university hospital. Patients with low and middle rectal cancer who underwent total mesorectal excision with curative intent between 2007 and 2017 were recruited. Laparoscopic total mesorectal excision and transanal total mesorectal excision had been performed. Intraoperative, pathological, and 30-day postoperative outcomes were compared between the transanal and laparoscopic groups. Overall, 105 patients were selected from the whole sample of 316 patients with rectal cancer. After propensity score matching analysis, 46 patients for each group were compared. Laparoscopic total mesorectal excision was associated with a higher conversion rate to open surgery (19.6% vs 0%, p = 0.002). Transanal total mesorectal excision showed a longer distal resection margin (15 mm vs 25 mm; p < 0.001), and similar results regarding the completeness of mesorectal excision and circumferential resection margin involvement, compared to laparoscopy. There were no statistically significant differences between the 2 groups in terms of postoperative complications. The study was limited by its retrospective design and the small size of the sample. Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes.

The Effect of Bilateral Treatment Plan Symmetry on Postoperative Dosimetric Outcomes in Prostate Low-Dose-Rate Brachytherapy: A Single-Institution Study

Favorable postoperative dosimetric outcomes in prostate low-dose-rate (LDR) brachytherapy are impacted by a multitude of preoperative treatment factors. The aim of this study was to evaluate the long-standing hypothesis that preoperative bilateral plan symmetry has a profound impact on postoperative dosimetric quality.

The phenotype of idiopathic normal pressure hydrocephalus-a single center study of 429 patients

IntroductionIdiopathic Normal Pressure Hydrocephlaus (iNPH) is, despite a vastly improved knowledge of the disorder since its first description still underdiagnosed and undertreated. Because of this, there is a need for further large studies describing the typical symptomatology and reversibility of symptoms in iNPH, which was the aim of this study. MethodsIn all, 429 patients (mean age 71 years) were included. Detailed pre- and postoperative examinations of symptoms and signs were analyzed. A composite outcome measure was constructed. ResultsSixty-eight % improved after surgery. Preoperatively, 72% exhibited symptoms from three or four of the assessed domains (gait, balance, neuropsychology and continence) while 41% had symptoms from all four domains. Ninety % had gait disturbances, of which 75% had broad-based gait, 65% shuffling gait and 30% freezing of gait. These disturbances coexisted in most patients preoperatively, but were more likely to appear as isolated findings after surgery. Impaired balance was seen in 53% and retropulsion in 46%. MMSE <25 was seen in 53% and impaired continence in 86%. Improvements were seen in all symptom domains postoperatively. ConclusionsThe iNPH phenotype is characterized by a disturbance in at least 3/4 symptom domains in most patients, with improvements in all domains after shunt surgery. Most patients present with a broad-based and shuffling gait as well as paratonia. Present symptoms in all domains and a shuffling gait at the time of diagnosis seem to predict a favorable postoperative outcome, whereas symptom severity does not.

Redo mitral valve surgery

This study is based on the findings of a single surgeon’s practice of mitral valve replacement of 167 patients from April 2005 to June 2017 who developed symptomatic mitral restenosis after closed or open mitral commisurotomy. Both clinical and color doppler echocardiographic data of peri-operative and six months follow-up period were evaluated and compared to assess the early outcome of the redo mitral valve surgery. With male-female ratio of 1: 2.2 and after a duration of 6 to 22 years symptom free interval between the redo procedures, the selected patients with mitral valve restenosis undergone valve replacement with either mechanical valve in 62% cases and also tissue valve in 38% cases. Particular emphasis was given to separate the adhered pericardium from the heart completely to ameliorate base to apex and global contraction of the heart. Besides favorable post-operative clinical outcome, the echocardiographic findings were also encouraging as there was statistically significant increase in the mitral valve area and ejection fraction with significant decrease in the left atrial diameter, pressure gradient across the mitral valve and pulmonary artery systolic pressure. Therefore, in case of inevitable mitral restenosis after closed or open commisurotomy, mitral valve replacement is a promising treatment modality.