History Of Previous Surgery Research Articles

BHSeP6 Cumulative sum analysis of the robotic inguinal hernia repair learning curve

Abstract Background The use of robotics in hernia surgery is increasing and is associated with a significant learning curve. Continuous, real-time outcome analysis is vital to inform and protect patients, and enable cost-benefit decisions. Methods Prospective data capture of patients undergoing robotic hernia repair during one surgeon’s introduction of robotics into their high-volume practice. Learning curve analysis was conducted using the cumulative sum (CUSUM) method. Results 31 unilateral inguinal repairs were performed between February 2023 and May 2024. Median age was 68 years. 78% had a history of previous abdominopelvic surgery. There was one conversion to open. Median blood loss was 0 ml with no requirement for blood transfusion. 84% of patients achieved complication free recovery; all complications were Clavien-Dindo Grade I. There were no returns to theatre and 1 readmission within 30 days. Median console time was 36 min (IQR 26–52); median time to dock and undock the robot was 13 min, making average operative time 49 min. CUSUM learning curve analysis of console time established three phases: initial training (case 1–5), improvement (case 6–15), and mastery (case 16 onwards). Perioperative outcomes were similar across phases, though console time decreased significantly. Conclusions Perioperative outcomes including length of stay, complications, readmissions, and return to theatre were acceptable in a relatively comorbid patient cohort, supporting the feasibility of introducing robotic hernia surgery into practice. CUSUM analysis established a clear learning curve for robotic inguinal hernia repair with rapid and significant improvement in console time over the first 31 cases.

P0537 Prognostic significance of anastomotic lesions in post-operative Crohn’s disease

Abstract Background Endoscopic evaluation (assessed with the Rutgeerts score, RS) offers prognostic information in the postoperative management of Crohn’s disease (CD). The significance of anastomotic lesions (AL) remains unclear. Two scores have been introduced: the POCER index1 (PI), including circumferential extent and depth of anastomotic ulcers, and the UEDA et al score2 (US), classifying 4 categories of lesions at the anastomosis and peri-anastomosis site. This study aims to evaluate the predictive value of PI and the US in a real- life cohort. Methods We conducted a retrospective study including CD patients undergoing ileo-colonic resection. All patients underwent first endoscopic evaluation within 6-12 months to assess endoscopic recurrence (ER), measured with RS, PI and US. ER was defined as RS ≥ 2, PI ≥ 2 or US ≥ intermediate. Clinical recurrence (CR) was assessed at 18-24 months using the HBI. A second endoscopy at 18-24 months was available for a subgroup of patients. Results We included 177 patients, 75% of them with no previous history of surgery. All patients had underwent prophylactic therapy with biologics. At 6-12 months, ER was observed in 91 (51%), 35 (20%) and 51 (28%) of patients, according to RS, PI and US, respectively. CR was observed in 34 patients (18.6%). Among 98 pts (55%) with a second endoscopy, ER was present in 45 pts (45%). Looking the predictive value for CR, a RS ≥2 showed an AUROC of 0.74 (sensitivity 82.7%, specificity 56.9%); PI ≥2 an AUROC of 0.613 (sensitivity 31%, specificity 82.5%) and US ≥ intermediate an AUROC of 0.668 (sensitivity 50%, specificity 74.6%). About ER, a RS ≥2 showed an AUROC of 0.77 (sensitivity 70.9%, specificity 79.07%), a PI≥2 with an AUROC of 0.65 (sensitivity 38.18%, specificity 93.02%) and US an AUROC of 0.74 (sensitivity 49.06%, specificity 93.03%). We performed a subgroup analysis among 108 patients with exclusively AL. For CR, the RS>=2 showed an AUROC of 0.67 (sensitivity 58%, specificity 74%). A PI >=2 predicted CR with an AUROC of 0.66 (sensitivity of 25%, specificity of 92%), while the US with an AUROC of 0.63 (sensitivity of 16%, specificity of 93.4%). Regarding ER, RS>=2 showed an AUROC of 0.667 (sensitivity 45%, specificity 89%), PI an AUROC of 0.63 (sensitivity 20%, specificity 97%) and the US>= intermediate an AUROC of 0.65 (sensitivity 16%, specificity 100%). Conclusion Grading the anastomotic lesions with specific scores seems to improve the prognostic value of the early endoscopic assessment after resection surgery. References 1)De Cruz P, Hamilton AL, Burrell KJ, Gorelik A, Liew D, Kamm MA. Endoscopic Prediction of Crohn’s Disease Postoperative Recurrence. Inflamm Bowel Dis. 2022 May 4;28(5):680-688. doi: 10.1093/ibd/izab134. PMID: 34231852.2) 2)Ueda T, Koyama F, Sugita A, Ikeuchi H, Futami K, Fukushima K, Nezu R, Iijima H, Mizushima T, Itabashi M, Watanabe K, Hata K, Shinagawa T, Matsuoka K, Takenaka K, Sasaki M, Nagayama M, Yamamoto H, Shinozaki M, Fujiya M, Kato J, Ueno Y, Tanaka S, Okita Y, Hashimoto Y, Kobayashi T, Koganei K, Uchino M, Fujii H, Suzuki Y, Hisamatsu T. Endoscopic Lesions of Postoperative Anastomotic Area in Patients With Crohn’s Disease in the Biologic Era: A Japanese Multi-Centre Nationwide Cohort Study. J Crohns Colitis. 2023 Dec 30;17(12):1968-1979. doi: 10.1093/ecco-jcc/jjad116. PMID: 37450892.

P0736 Analysis of endoscopic recurrence risk factors in Crohn's disease after surgical treatment within 1 year

Abstract Background Inflammatory bowel disease (IBD) treatment options are increasingly available, but there is still no definitive cure. It is estimated that 40% of IBD patients do not respond to treatment, about 80% of Crohn's disease (CD) patients will require surgery in their lifetime, and 50% of patients experience endoscopic recurrence within one year after surgery. This article aims to explore the risk factors for postoperative recurrence in CD, predictive indicators of recurrence, and prevention of recurrence, as well as how patients can better manage themselves after surgery. Methods A retrospective analysis was conducted on the clinical data of 72 patients with Crohn's disease who underwent intestinal resection surgery. All patients underwent endoscopic re examination one year after surgery and were divided into a non recurrence group of 43 cases and a recurrence group of 29 cases based on the Rutgeerts score. Use logistic regression analysis to identify the relevant risk factors for postoperative recurrence. Results Univariate analysis revealed that endoscopic recurrence was associated with smoking (OR 5.226, 95% CI 1.073-25.457, P=0.041), penetrating lesions (OR 5.25, 95% CI 1.052-26.197, P=0.043), small intestine resection (OR 3.088, 95% CI 1.064-8.966, P=0.038), preoperative high CRP (OR 1.029, 95% CI 1.001-1.029, P=0.045), and the presence of visceral obesity during surgery (OR 7.536, 95% CI 1.979-28.692, P=0.03). Multivariate regression analysis showed that visceral obesity is an independent risk factor for endoscopic recurrence in patients undergoing Crohn's disease surgery (OR 5.925, 95% CI 1.167-30.087, P=0.032). However, the patient's gender, BMI at the time of surgery, muscular dystrophy, presence of anal fistula, history of previous intestinal surgery, and the course of the disease during this surgery were not found to be related to postoperative recurrence. Conclusion Patients with Crohn's disease who undergo laparoscopic intestinal resection and have visceral obesity during surgery have a higher risk of endoscopic recurrence one year after surgery. These patients need close follow-up and timely adjustment of medication to control the risk of recurrence.

Editorial Comment to Salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection for radiorecurrent prostate cancer in a patient with a previous history of rectal cancer surgery

Editorial Comment to Salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection for radiorecurrent prostate cancer in a patient with a previous history of rectal cancer surgery

Determinants of Success in Revision Cochlear Implant Surgeries: A Comprehensive Evaluation of Patient, Surgical, and Radiological Factors.

Background/Objectives: This study aims to evaluate factors influencing revision cochlear implant surgeries, including patient demographics, surgical techniques, and radiological findings. The main aim was to identify factors influencing surgical success to inform clinical treatment and enhance patient outcomes. Methods: This cross-sectional study included adult patients over the age of 18 who underwent revision cochlear implant surgery due to implant-related complications. Data were collected from systematic chart reviews of electronic medical records, including demographics, surgical techniques, radiological output from standard high-resolution CT and MRI, and intraoperative data. The primary outcome was surgical success, defined by improved auditory function, stable device positioning, and absence of postoperative complications. Statistical analyses, including multivariate logistic regression, were conducted to identify independent predictors of surgical success. Results: A total of 188 patients were included, with a mean age of 45.67 years. Younger age, shorter duration of implant use, modified surgical techniques, and absence of co-morbidities are key factors contributing to surgical success. Modified surgical techniques were associated with better outcomes (39.29% vs. 68.75%, OR: 2.78, 95% CI: 1.25-6.14, p = 0.012). Radiological patterns significantly affected outcomes, with normal findings associated with higher success rates. In contrast, abnormalities such as electrode migration (OR: 2.14, 95% CI: 1.12-4.09, p = 0.021) and ossification (r = -0.51, β = -0.44, adjusted R2 = 0.25, p < 0.01) were correlated with poorer results. Smoking status, when comparing smokers to non-smokers, was associated with unfavorable outcomes (20.00% vs. 45.83%, OR: 2.01, 95% CI: 1.01-4.01, p = 0.048), and a history of previous surgeries (21.43% vs. 37.50%, OR: 1.95, 95% CI: 1.03-3.71, p = 0.033) was significantly associated with unfavorable outcomes. Conclusions: Statistically, significantly better outcomes are positively correlated with the duration of the first cochlear implant experience and negatively with prior otologic pathology and nonauditory environmental influences on surgical success. Younger age, modified surgical techniques, and normal radiological findings were related to better outcomes; complications such as electrode migration and ectopic ossification were strong predictive factors for surgical failure. These findings underscore the need for tailored surgical approaches and early intervention to enhance outcomes in revision cochlear implant surgeries.

Investigating the Results of One Anastomosis Gastric Bypass After Primary Metabolic and Bariatric Restrictive Procedures.

Previous studies showed a high conversion rate and failure of restrictive procedures, including sleeve gastrectomy (SG), adjustable gastric banding (AGB), gastric plication (GP), and vertical banded gastroplasty (VBG) in a long-term follow-up. The current study aims to evaluate the efficacy and safety of a revisional one anastomosis gastric bypass (OAGB) for weight loss and treatment of obesity-related problems after primary metabolic and bariatric restrictive procedures. A retrospective study on prospectively collected data was conducted on a sample of 151 patients who experienced insufficient weight loss or weight regain after primary restrictive surgeries and underwent OAGB as a revisional procedure. A total of 151 patients with a history of previous restrictive metabolic and bariatric surgery who underwent a revisional OAGB were included in this study. The restrictive procedures consisted of SG (n = 79), AGB (n = 45), GP (n = 15), and VBG (n = 12). Total weight loss percent (%TWL) after the revisional OAGB was 27.03 ± 9.12, 27.74 ± 10.05, 24.62 ± 9.87, and 24.34 ± 8.05 after 12, 24, 60, and 84 months, respectively. After 24 months of follow-up, TWL was significantly higher in the GP group compared to the AGB group. However, weight loss outcomes were not significantly different after 60 months of follow-up. The revisional OAGB was associated with a significant resolution of obesity-related problems, including type 2 diabetes (55.55%), hypertension (50%), dyslipidemia (77%), and obstructive sleep apnea (100%) after 2 years of follow-up. There was no serious complication after the revisional OAGB in the short- and long-term follow-up. OAGB is an efficient and safe option as a conversion surgery after restrictive procedures.

Clinical Outcomes of Isolated ACL Reconstruction Versus Combined ACL and ALL Reconstruction With Indication Guided by Intraoperative Ultrasound: A Propensity Score-Matched Study of 260 Patients With a Minimum 2-Year Follow-up.

Additional anterolateral ligament (ALL) reconstruction has been associated with improved clinical outcomes and reduced failure rates in anterior cruciate ligament (ACL) reconstruction. Despite the excellent clinical results reported, there is still a heated debate about its indications. Currently, the indications are mainly based on the patient's clinical criteria and not the imaging diagnosis of the injury of this ligament. To compare the clinical outcomes of patients undergoing isolated ACL reconstruction and combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion. Cohort study; Level of evidence, 3. A retrospective analysis of prospectively collected data was performed. Patients undergoing primary ACL reconstruction between January 2017 and January 2022 were included. Patients were excluded if they had a previous history of ipsilateral knee surgery or if they underwent other concomitant procedures, including multiligament reconstruction surgery or osteotomy. The decision to perform an ALL reconstruction in addition to isolated ACL reconstruction was based on ultrasound diagnosis of this lesion. At the end of the study period, further knee injury and any other reoperations or complications were recorded and compared between patients who had isolated ACL reconstruction (no-ALLR group) and combined ACL and ALL. Propensity score matching was performed between groups. A multivariable analysis using the penalized Cox model was performed to explore the relationship between the graft rupture, surgical procedure type, and potential explanatory variables. A total of 339 patients met the predefined eligibility criteria; 146 ACL reconstructions were performed in an isolated manner (no-ALLR group) and 193 were combined with ALL (ALLR group). After matching, 130 patients were allocated to each group. The mean follow-up was 36.7 months. The overall graft failure rate was 4.6% (6.9% in the no-ALLR group and 2.3% in the ALLR group; P = .076). The adjusted Cox regression showed that graft failure rate was nonsignificantly different between the groups (adjusted hazard ratio [HR], 0.36 [95% CI, 0.096-1.364]; P = .133). Younger age (≤20 years) was associated with graft failure (adjusted HR, 0.29 [95% CI, 0.121-0.719]; P = .007). Combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion has an equivalent ACL graft failure rate to isolated ACL. Intraoperative ultrasound diagnosis of an ALL injury may be an indication for the addition of an ALL reconstruction.

Knee pain and function in retired male intercounty GAA players: an exploratory study.

Knee injuries are common among elite intercounty Gaelic games players (collectively GAA players). The primary aim was to examine knee pain, function, and quality of life in retired elite male GAA players. Secondary objectives were to (i) report the incidence of previous knee surgery and total knee replacement, (ii) assess medication usage, and (iii) investigate any associations between a history of knee injury and/or knee surgery and knee pain, function, and quality of life among retired elite male GAA players. One hundred retired male senior intercounty GAA players were surveyed on their history of severe knee injury and previous knee surgery (68 completed survey; 47 Gaelic football, 20 hurling, 1 dual player). The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess level of function and pain. Forty-seven (69%) of the retired players described experiencing at least one severe knee injury during their intercounty career. Fourteen (21%) participants retired due to a significant knee injury. Mean KOOS-SP score was 75.5 (SD 17). The Global Physical Health and Global Mental Health mean scores were 44 and 51. There was a low negative correlation between KOOS-SP scores and a history of severe knee injury (r = -0.35, p = 0.001). Moderate negative correlation between Global Mental Health scores and a history of severe knee injuries (r = -0.36, p = 0.386) and a very weak negative correlation between the number of surgeries during a participant's intercounty career and Global Mental Health score (r = -0.089, p = 0.234). Severe knee injuries and knee surgery are common among male intercounty GAA players. These injuries lead to self-reported reduced performance and retirement and are potentially associated with worse health-related outcomes post-intercounty career. Further well-designed studies, including among retired women GAA players, are required to assess the relationship between knee injuries and long-term athlete outcomes. Improved injury prevention efforts, enhanced rehabilitation of knee injuries, and post-retirement care may mitigate the adverse effects associated with severe knee injuries among male GAA players.

CATALYZE: A DEEP LEARNING APPROCH FOR CATARACT ASSESSEMENT AND GRADING ON SS-OCT ANTERION IMAGES.

To assess an new objective deep learning model cataract grading method based on Swept-Source Optical Coherence Tomography (SS-OCT) scans provided by the Anterion® (Heidelberg, Germany). Single centre study at the Rothschild Foundation, Paris, France. Prospective cross-sectional study. All patients consulting for cataract evaluation and consenting to study participation were included. History of previous ocular surgery, cornea or retina disorders, and ocular dryness were exclusion criteria. Our CATALYZE pipeline was applied to Anterion® image providing layer-wise cataract metrics and an overall Clinical Significance Index of cataract (CSI). Ocular scatter index (OSI) was also measured with a double-pass aberrometer (OQAS®), and compared to our CSI. Five hundred forty eight eyes were included, 331 in the development set (48 with cataract and 283 controls) and 217 in the validation set (85 with cataract and 132 controls) of 315 patients aged 19-85 years (mean ± SD: 50 ± 21 years). The CSI correlated with the OSI (r2 = 0.87, P <0.01). CSI area under the ROC curve (AUROC) was comparable to OSI AUROC (0.985 vs 0.981 respectively, P>0.05) with 95% sensitivity and 95% specificity. Our deep learning pipeline CATALYZE based on Anterion® SS-OCT is a reliable and comprehensive objective cataract grading method.

Salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection for radiorecurrent prostate cancer in a patient with a previous history of rectal cancer surgery

IntroductionSevere adhesions render salvage robot‐assisted radical prostatectomy challenging in the treatment of patients with prostate cancer who have previously undergone colorectal cancer surgery.Case presentationA 76‐year‐old Japanese man who had previously undergone low anterior resection for rectal cancer presented with an elevated prostate‐specific antigen level, indicating a recurrence of prostate cancer that had been treated with intensity‐modulated radiation and androgen deprivation therapies. During the salvage robot‐assisted radical prostatectomy with pelvic lymph node dissection, severe adhesions were noted between the posterior aspect of the prostate and the intestine. The adhesions were successfully dissected under digital rectal examination and transrectal ultrasound guidance.ConclusionSalvage robot‐assisted radical prostatectomy after rectal cancer can be challenging. The use of transrectal ultrasound and digital rectal examination can facilitate the procedure. Screening for prostate cancer prior to colorectal cancer surgery could potentially allow for simultaneous resections.

Retrospective evaluation of post-surgical orchialgia in men undergoing no-scalpel vasectomy.

Vasectomy is a form of permanent contraception in men that is safe and effective. Complications are relatively uncommon, although patients may experience postoperative pain. Current literature quotes a broad range in the incidence of chronic orchialgia following no-scalpel vasectomy from 0.6-26%, while pain negatively affecting quality of life is about 1-2%. We sought to evaluate our incidence of post-vasectomy pain and surgical management for this pain. A retrospective chart review was performed for all men who underwent a vasectomy at Men's Health Clinic Manitoba during a 22-month period. The presence of pain or complications was collected at a three-month followup appointment. Patients with pain were then followed every 6-8 weeks for continued assessment and management. A total of 350 men underwent elective no-scalpel vasectomy during this period. The majority of patients had no previous history of orchialgia (98%) or history of previous scrotal surgery (93%). At three months post-vasectomy, 38/350 (11%) of patients had ongoing pain and one patient required surgery (epididymectomy) for management of post-vasectomy pain syndrome three months following vasectomy. Our retrospective analysis of 350 men who underwent no scalpel vasectomy shows a significant proportion of post-vasectomy pain at the three-month followup appointment, although most cases are resolving or minor and only one patient has required surgical management. This highlights the importance of counseling men undergoing vasectomy regarding the risks of post-procedure orchialgia and the small proportion of men who will require additional surgical intervention.

A Rare Anatomical Variation: Intrathoracic Liver Caudate Lobe: A Case Report

We present a case with an intrathoracic caudate lobe in a 45-year-old woman who referred with a complaint of nonspecific chest pain. She denied previous history of trauma or surgery. Computed tomography (CT) pulmonary angiography showed a paravertebral, soft tissue mass which raised suspicion of a pleural tumor. In the coronal plane, the mass was protruding to the abdomen and had similar density with liver. Magnetic resonance imaging confirmed the diagnosis.

Lateral forehead flap in oral reconstruction: A case report

Introduction: Lateral Forehead flap is very versatile as it represents a good choice for reparation of different types of nose and oral cavity defects and provides an optimal, aesthetic, and functional outcome. In era of free transfer tissue, the use of loco-regional flaps, alone or in combination may prove to be the only practical solution in the absence of resources or other options. Case presentation: A-65 years old male with multiple comorbidities underwent a wide resection with adequate margin of the lower lip and small segment of the upper lip due to a locally advanced squamous carcinoma. After long consideration, the last resort was the pedicled lateral forehead flap. Information was sourced from patient’s case notes and operating theatre report. Results: The donor defect was covered with a split-thickness skin graft harvested from the right thigh area. The flap survived and both functional and aesthetic outcome were satisfactory. The site of the donor defect result was also acceptable. No complications were noted in our case study beside a small tip necrosis and breakdown of the suture line. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in cases with previous history of radiotherapy or surgery. Decision making of a particular reconstructive option should be done taking in consideration the available resources, surgical team expertise along with the patient's general condition. The pedicled forehead flap still useful when other options are inappropriate or have not been successful.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Viral Hepatitis B and C Prevalence and Related Risk Factors Among Prisons in Duhok City, Kurdistan Region, Iraq.

Background Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major public health problems worldwide. Public health services are still confronted with the problem of HBV and HCV infections, which calls for targeted preventative measures, especially for critical groups such as prisoners. Therefore, the study aims to measure the prevalence of HBV and HCV infections and to investigate their risk factors among prisoners in Duhok City, Kurdistan, Iraq. Methods A cross-sectional study was performed at the two main prisons inside Duhok city. There were a total of 1,013 inmates: at the Zerka jail, there were 945 male inmates, and at the Etiti jail, there were 50 adult females and 18 adolescent male inmates. Data collection was performed by a direct interview using a structured questionnaire on sociodemographic characteristics and risk factors. Serum samples were tested for HBV surface antigen (HBsAg) and HCV antibody (HCV-Ab) by enzyme-linked immunosorbent assay. Results The mean age of the participants was 35.9 years. The prevalence of HBV and HCV infections was 1.28% and 0.09%, respectively. HBV infection was significantly associated with occupation and marital status. The main risk factors were previous history of surgery and tooth extraction. Conclusions In conclusion, the prevalence of HBV was low while that of HCV was very low. It is usually recommended to take steps to screen for and treat HBV and HCV in patients.

Seropositivity of antibody to hepatitis B core antigen among hepatitis B surface antigen-negative vaccinated individuals aged 5–12 years in North West Ethiopia

BackgroundInfection with the hepatitis B virus (HBV) is still a major global public health concern, especially in Ethiopia. Evidence suggests that some children in Ethiopia who have received hepatitis B vaccinations are still contracting HBV. ObjectiveThe main aim of this study was to detect antibodies to hepatitis B core antigen (anti-HBc) among vaccinated hepatitis B surface antigen (HBsAg)-negative individuals in North-West Ethiopia. Methods and materialsA community-based cross-sectional study was conducted among 158 children aged 5–12 years from April 2021 to November 2021. A simple random sampling technique was used to recruit study participants. After 3–5 ml of venous blood was drawn from each study participant, a serum sample was utilized to determine hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antibodies (anti-HBc) by enzyme-linked immunosorbent assay (ELISA). Logistic regression with a 95 % CI was used to show the statistical association. ResultsThe total seropositivity of anti-HBc among vaccinated HBsAg-negative participants was 8/158 (5.1 %) (95 % CI: 2.0–9.0). Multivariable logistic regression revealed that children who had a previous history of blood transfusion were six times (AOR: 6.135, 95 % CI: 4.063, 10.752) (P < 0.006) more likely to develop anti-HBc. Moreover, children who had a previous history of surgery were five times (AOR: 5.116, 95 % CI: 3.123, 8.718) (P < 0.002) more likely to become anti-HBc seropositive. ConclusionThere was a significant seroprevalence of anti-HBc in our study area, suggesting possible exposure to the virus despite immunization.

A Case Report of Left Paraduodenal Hernia in a young boy

Internal hernia is a relatively uncommon condition and is a rare type of intestinal obstruction. Paraduodenal hernia (PDH) is the most frequent type of congenital hernia, especially on the left side. Although acute intestinal obstruction due to internal hernias is rare, it can be fatal if it is not identified and treated right away. The clinical diagnosis of paraduodenal hernia is difficult due to its rarity and variable symptoms. Here, we present the case of a 14-year-old boy who had been experiencing intermittent abdominal pain for a week duration. The pain had been worse during the previous two days, and the boy also experienced nausea and repeated vomiting episodes. He was otherwise healthy and had no history of previous abdominal operations. A left paraduodenal hernia was diagnosed based on the findings of a computed tomography scan, which showed a dilated small bowel loop occupying the left hypochondrial region anterior to the pararenal region. Due to the complicated nature of the disease, the patient had an exploratory laparotomy, during which herniated jejunal loops were reduced and hernial sac wide opened to prevent a recurrence. The patient tolerated the procedure, and recovery was uneventful. This case sheds light on the importance of considering the diagnosis of left paraduodenal hernia in patients with abdominal pain, particularly among those who have not undergone abdominal surgery previously. Early detection and treatment can prevent life-threatening complications such as intestinal perforation and peritonitis.

Evaluation of the Effect of Menisci on Tibial Slope and the Correlation With Body Mass Index.

Background One of the important factors affecting the biomechanics of the knee joint is the posterior tibial slope which is the tibial plateau's anatomical inclination toward the posterior of the sagittal plane. This inclination, which affects anterior-posterior stability, is important for the kinematics of the knee joint. Changes in the tibial slope may cause a deficit in the stability and function of the knee joint. We aimed to examine the inclination of the posterior horn of the meniscus and posterior tibial slope in healthy individuals and investigate the effect of body mass index on these measurements. Methodology A total of 34 magnetic resonance images and lateral knee radiographs were evaluated in this study. The study included individuals aged 15 to 78 without a history of previous injury or surgery of their knee. Results In the measurements made on magnetic resonance images, a statistically significant difference was found between 25% lateral meniscus slope (mean ± SD = 28.08 ± 1.88) and 25% medial meniscus slope (mean ± SD = 27.31 ± 1.41) (p = 0.05). At the same time, a statistically significant difference (p = 0.011) was found between 25% medial combined slope (mean ± SD = 29.05 ± 3.80) and 25% lateral combined slope (mean ± SD = 30.62 ± 2.99). There was no statistically significant difference between tibial and meniscus slopes, body mass index, gender, and age. Conclusions Our study results have shown that the 25% lateral meniscus and combined slopes are greater than the 25% medial meniscus slope.

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated. We aimed to determine if robotic assisted surgery and Pfannenstiel extraction decreased the rate of radiologically detected incisional hernias compared to standard laparoscopy with extra-corporeal anastomosis. The secondary outcomes aimed to evaluate incidence of port site hernias in 8mm robotic ports for which routine closure is not followed. Our single centre retrospective cohort study included patients who had minimally invasive right hemicolectomy and had cross-sectional imaging at least 1-year later. Patient demographics, body mass index, history of smoking or previous surgery was recorded. At imaging, evidence of new extraction site or port site-site hernia, contents and clinical impact was noted. A total of 100 patients (50 robotic and 50 laparoscopic) were included. Baseline characteristics appeared equally distributed. 16% (8 patients) who had laparoscopic surgery developed midline extraction site hernias which was significantly higher to RAS group (0 patients). 3 patients developed hernias at the site of robotic ports and this was more commonly at the right iliac fossa port. RAS, by simplifying intra-corporeal anastomosis has potential to eliminate incisional hernias, particularly when Pfannenstiel extraction is used. The potential for 8mm robotic ports to develop clinically significant hernias cannot be ignored and meticulous closure can prevent patient harm.