Incidence Of Early Complications Research Articles

Delayed Sternal Closure vs Emergency Sternal Reopening in Adults With Congenital Heart Disease

BackgroundLimited data exist regarding outcomes of delayed sternal closure (DSC) in adults with congenital heart disease (ACHD). MethodsWe reviewed 159 ACHD patients undergoing cardiac operation from 1993 to 2023 who required DSC (open sternum at the end of operation, n = 112) or sternum emergently reopened (n = 47). Regression models were performed to determine factors associated with outcomes. ResultsOf 112 patients undergoing DSC, 87 patients (77.6%) underwent DSC ≤4 days and 25 patients (22.3%) >4 days. The most common operations were valve (n = 35 [31.2%]), aortic (n = 33 [29.4%]), and right ventricular outflow tract procedures (n = 23 [20.5%]). Median time to chest closure was 2 days (interquartile range, 1-5 days). Apart from sex, baseline characteristics were similar between DSC groups. A stepwise increase in early mortality was observed from DSC ≤4 days to DSC >4 days (6.8% vs 32%), as well as the incidence of early complications, except sternal infection. Risk factors associated with early mortality were age (P = .02), DSC >4 days (P < .001), hemodynamic indication (P = .03), and single ventricle (P = .02). On multivariable analysis, lower ejection fraction (P = .04), hemodynamic indication (P = .02), single ventricle (P = .004), and diabetes mellitus (P = .03) were predictors of prolonged time to chest closure. Among hospital survivors, late survival was similar between patients undergoing DSC ≤4 days vs >4 days (P = .48). ConclusionsA brief duration of DSC in ACHD patients is associated with low morbidity and mortality. Higher early mortality and complications were observed among patients who did not achieve chest closure within 4 days.

Comparison between intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) and intraperitoneal onlay mesh repair (IPOM) for ventral hernias

Aim. To evaluate the intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus) versus intraperitoneal onlay mesh (IPOM) for ventral hernias (VHs). Materials and methods. A total of 89 patients with VHs with a defect between 3–12 cm who underwent a surgery from 2018 to 2023 years were enrolled in this study. All of them were randomly assigned to two groups. Group 1 included 45 patients after intraperitoneal onlay mesh repair with closure of fascial defect (IPOM plus), Group 2 – 44 patients after intraperitoneal onlay mesh (IPOM). The distribution of patients by age, sex, body mass index (BMI), hernia type (primary VH, incisional hernia), American Society of Anesthesiologists (ASA) score was studied. Results. The differences in sex, mean age, patient distribution based on hernia type, BMI, ASA score and hernia orifice size were not statistically significant between the two groups. Therefore, both groups were comparable. The operative time in minutes was 73.17 ± 7.43 in Group 1 and 70.93 ± 8.84 in Group 2 (not statistically significant). The pain score 12 hours after surgery was 5.24 ± 0.60 in Group 1 comparing to 5.02 ± 0.45 in Group 2 (not statistically significant). The pain score 8 days after surgery was 2.88 ± 0.31 in Group 1 comparing to 2.75 ± 0.43 in Group 2 (not statistically significant). There was no significant difference concerning the incidence of early complications between the two groups. 41 (91.11 %) patients of Group 1 and 40 (90.9 %) patients of Group 2 were examined during a 22-month follow-up period. No complications were noted. Conclusions. Laparoscopic ventral hernia repair provides satisfactory results in terms of safety and efficacy. Thus, IPOM plus repair is safe, feasible and offers possible advantages over the standard IPOM technique as reported in the literature. Poor outcomes described in the literature are probably related to independent variables such as mesh and suture types as well as closure technique.

Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer.

Transanal endoscopic intersphincteric resection (ISR) surgery currently lacks sufficient clinical research and reporting. To investigate the clinical effectiveness of transanal endoscopic ISR, in order to promote the clinical application and development of this technique. This study utilized a retrospective case series design. Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included. All patients underwent transanal endoscopic ISR as the surgical approach. We conducted this study to determine the perioperative recovery status, postoperative complications, and pathological specimen characteristics of this group of patients. This study included 45 eligible patients, with no perioperative mortalities. The overall incidence of early complications was 22.22%, with a rate of 4.44% for Clavien-Dindo grade ≥ III events. Two patients (4.4%) developed anastomotic leakage after surgery, including one case of grade A and one case of grade B. Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients. The mean distance between the tumor lower margin and distal resection margin was found to be 2.30 ± 0.62 cm. The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens. Transanal endoscopic ISR is safe, feasible, and provides a clear anatomical view. It is associated with a low incidence of postoperative complications and favorable pathological outcomes, making it worth further research and application.

Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures.

Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.

Diagnostic accuracy and safety of percutaneous core needle biopsy of retroperitoneal tumours

BackgroundHistologic subtype of cancer guides treatment sequencing and the extent of surgery for retroperitoneal tumours (RPTs) but concerns persist regarding percutaneous core needle biopsy (CNB). ObjectiveEndpoints were the incidence of early complications, needle tract seeding (NTS) after CNB, diagnostic accuracy. MethodsBetween 2015 and 2022, data from patients with RPT who underwent a CNB and who operated on at Institut Curie were collected. We retrospectively reviewed the medical records and microscopic analysis of both CNB and surgical specimens to evaluate the diagnostic accuracy of CNB (quantified using positive and negative predictive values, PPV/NPV). Results313 patients underwent CNB. In 10/326 (3 %) procedures, minor complications were observed. One of 212 (0.47 %) resected RPSs exhibited a local recurrence compatible with NTS. Microscopic analysis of CNB specimens allowed the classification of tumours between groups of cancers and benign/intermediate mesenchymal tumours in 307/313 (98 %) patients. Among the 204 patients with retroperitoneal sarcoma, the overall concordance between CNB and final pathology following resection was 178/204 (87.2 %). The respective PPVs of solitary fibrous tumour, dedifferentiated liposarcoma, leiomyosarcoma and well-differentiated liposarcoma were 100 %, 98 %, 97 % and 68 %, respectively. The diagnosis of a high-grade (G 2-3) sarcoma resulted in a high specificity (97 %) and PPV (98 %) but low sensitivity (76 %). ConclusionsCNB allowed the classification of RPT in the vast majority of patients with a low morbidity rate. Concordance with final diagnosis was high for sarcomas with the exception of well-differentiated liposarcoma. As a result, CNB results should be integrated with imaging/radiomics by multidisciplinary tumour boards.

Transanal total mesorectal excision: single center study on risk factors for major complications.

Transanal total mesorectal excision (TaTME) as a novel surgical approach for mid and low rectal cancer has gained significant research interest in recent years. The main objective of this study is to identify the risk factors associated with major complications after TaTME and evaluate the perioperative clinical outcomes. A retrospective analysis was performed on the clinical data of patients with mid-to-low rectal cancer who underwent TaTME surgery and were admitted to the First Affiliated Hospital of Xiamen University from January 2018 to May 2023. Univariate and multivariate regression methods were employed to analyze the risk factors influencing the occurrence of major complications (Clavien-Dindo III-V). This study included a total of 179 eligible cases, with no perioperative deaths. The overall incidence of early complications was 25.1%, with a rate of 10.1% for mild complications and 15.0% for major complications. The postoperative anastomotic leakage rate within 30 days was 6.7%. Multivariate analysis demonstrated that male (P=0.030), pathological T ≥ 3 (P=0.018) and manual anastomosis (P=0.009) were independent risk factors for the development of major complications after surgery. In this study, the incidence of early complications and anastomotic leakage rate in TaTME were both relatively low. Male, pathological T stage ≥ 3 and manual anastomosis were independent risk factors for the occurrence of major complications in a cohort of patients with mid and low rectal cancer undergoing TaTME.

Feasibility of articulating laparoscopic instruments in laparoscopic gastrectomy using propensity score matching

Advancements in minimally invasive surgery has led to the development of several surgical instruments, including the ArtiSential®. This new instrument provides a greater range of motion and improved dexterity to laparoscopic procedures, making it an alternative option to traditional straight instruments, and the Da Vinci robot system. The purpose of this study is to compare the postoperative outcomes of a prospective cohort of patients who underwent laparoscopic gastrectomy using articulating instruments with those of a historical cohort of patients who underwent the same procedure using straight instruments. The study was designed as a prospective observational cohort study matched to a retrospective historical cohort using propensity score matching. The primary outcome was the rate of early complications within 90 days of surgery. Other outcomes included the operation time, estimated blood loss, time to first flatus, time to first soft fluid diet, hospital stay, and mortality. After propensity score matching, 41 patients were enrolled in both groups. The mean age was 62.4 ± 12.3 years in the conventional group and 63.5 ± 9.6 years in the artisential group (p = 0.647). Mean operative time was significantly shorter in the artisential group compared to the conventional group (136.1 min vs. 163.9 min, p = 0.032). The time to first soft fluid diet was also significantly shorter in the artisential group (2.2 days vs. 2.8 days, p = 0.030), but there was no significant difference in the time to first flatus and overall hospital stay. The incidence of early complications was lower in the artisential group, but the difference was not significant (24.4% vs 7.3%, p = 0.070). There was no mortality in either group. The use of articulating instruments for laparoscopic gastrectomy did not increase postoperative morbidity compared to straight laparoscopic instruments. The use of articulating instruments may be associated with faster bowel recovery and less early complications.

Early Surgical Complications Following Transanal Endorectal Pull-through for Hirschsprung’s Disease

Objective: The purpose of this study was to examine factors affecting early complications following transanal endorectal pull-through (TERPT) in patients with Hirschprung’s disease. Materials and Methods: Retrospective chart reviews of patients with Hirschsprung’s disease who underwent TERPT/ abdominal assisted TERPT at Siriraj Hospital between January 2009 and December 2019 was carried out. . Results: The overall complication rate was 26% (43/163). The complications were as follows: 14 cases of anastomotic strictures (32.6%), five cases of abscess at anastomosis (11.6%), and three cases of anastomotic leakages (7.0%). In regards to preoperative bowel preparation, when comparing those with and those without post-operative complications, the amount of NSS for rectal irrigation (ml/Kg), duration required (days), and duration of changed diet (days) were the same. Colostomy prior to a pull-through operation could not prevent post-operative complications following endorectal pull-through (p = 1.000). The incidences of early complications following TERPT and abdominal assisted TERPT was the same (p = 0.344). Abdominal assisted TERPT had a higher incidence (4%) of anastomotic leakages whereas TERPT had a higher rate of anastomosis strictures (12%) compared to o abdominal assisted TERPT (5%). The higher the transitional zone, the higher the complication rate. Anastomotic leakages, the most serious complication, rarely occurred following TERPT in the low transitional zone. Conclusion: There was no significant risk factor associated with early surgical complications following TERPT. Abdominal assisted TERPT should be selected properly according to the level of transitional zone. The complications correlate with whether a perfect pull-through operation could be performed or not.

Hybrid Method for Peritoneal Dialysis Catheter Insertion: A New Technique for Improved Outcomes and Reduced Costs

Introduction: Peritoneal dialysis (PD) is a well-established treatment choice for end-stage kidney disease (ESKD). While there are several methods for PD catheter insertion, they each have limitations. In this study, we present a new hybrid method for PD catheter insertion and compare it to the conventional laparoscopic method. Methods: This retrospective study included 171 patients who were undergoing their first PD catheter insertion, and a total of 20% of the enrolled patients had a past medical history of abdominal surgery. Out of these, 101 patients underwent the laparoscopic method and 70 underwent a new invented hybrid method. The study aimed to compare the surgical outcomes, incidence of early and late complications, hospital stay, and medical expenses between the two groups. Results: There were no notable differences in basic demographic features and comorbid conditions between the two groups. The results of our data revealed that the hybrid group had a significantly shorter break-in period and did not require temporary hemodialysis. Additionally, length of hospital stay and medical costs were significantly lower in the hybrid group (all p < 0.05). The incidence of early complications was lower in the hybrid group, while the incidence of late complications was comparable between the two groups. Conclusion: Our study demonstrates that the hybrid method of PD catheter insertion provides a safe and efficient alternative to the traditional laparoscopic method, enabling urgent-start PD and reducing hospital stays and medical expenses. Our findings support the use of the hybrid method as a new standard of care for ESKD patients undergoing PD catheter insertion.

Gender differences in early complications after STEMI and their associations with anxiety and depression.

The female gender is known to be associated with a poor outcome in ST-Elevation Myocardial Infarction (STEMI). Anxiety and depression are more common in women and they may contribute to the increase in early complications after STEMI. We sought to determine the gender differences in early complications after STEMI and their relationship with patients' anxiety and depression. This is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) is used to screen depression (HADS-D) and anxiety (HADS-A). A total of 188 patients (age 56.8±10.5, 69.2% male) with STEMI were included in this study. The incidence of early complications was significantly higher in women than in men (50.0% vs. 14.6%, p<0.001). The prevalence of anxiety and depression was significantly higher in women than in men (60.3% vs. 40.0% and 50.0% vs. 14.6%, respectively). In multivariable analyses, left ventricular ejection fraction (LVEF) level (OR: 0.942; 0.891-0.996, p=0.036), HADS-A (OR: 1.593; 1.341-1.891, p<0.001) and HADS-D (OR: 1.254; 1.057-1.488, p=0.01) scores were found to be independent risk factors for early complications after STEMI. The incidence of early complications and the prevalence of anxiety and depression were significantly higher in women. LVEF level, HADS-A, and HADS-D scores were found to be independent risk factors for early complications.

MP46-17 LONG-TERM FOLLOW-UP IN ROBOT-ASSISTED FEMALE CYSTECTOMY: AN INTERNATIONAL MULTI-CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP46-17 LONG-TERM FOLLOW-UP IN ROBOT-ASSISTED FEMALE CYSTECTOMY: AN INTERNATIONAL MULTI-CENTER STUDY Linda Dey, Monish Aron, Jorge Ballon, Giovanni E. Cacciamani, Mihir M. Desai, Inderbir S. Gill, Abolfazl Hosseini, Arad Hosseini, Etienne Lavallee, Reza Mehrazin, Gus Miranda, Juhana Rautiola, Jordan Rich, John Sfakianos, Viktor Skokic, Gunnar Steineck, Yuan Shuo Wang, and Peter Wiklund Linda DeyLinda Dey More articles by this author , Monish AronMonish Aron More articles by this author , Jorge BallonJorge Ballon More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Arad HosseiniArad Hosseini More articles by this author , Etienne LavalleeEtienne Lavallee More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Gus MirandaGus Miranda More articles by this author , Juhana RautiolaJuhana Rautiola More articles by this author , Jordan RichJordan Rich More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Viktor SkokicViktor Skokic More articles by this author , Gunnar SteineckGunnar Steineck More articles by this author , Yuan Shuo WangYuan Shuo Wang More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately one quarter of all bladder-cancer patients are females, and studies indicate that female patients may have an inferior oncological outcome. Radical cystectomy is the gold standard treatment for aggressive bladder cancer. However, the long-term outcome for females after robot-assisted radical cystectomy (RARC) is not well described in the scientific literature. Objectives: To describe the long-term oncological outcomes and complications after RARC in female patients. METHODS: In total, 270 females undergoing RARC due to urothelial cancer at 3 high-volume centers (Karolinska University Hospital, The Mount Sinai Hospital and USC) during 2004 to 2020 were followed. Data include age, cT-, pT-, N-, and M-stage, smoking, urinary diversion, and surgical strategy for pelvic organ preservation (POP). Outcome data for early and late complications according to Clavien-Dindo, readmission, re-operation, and cause of death were obtained. Median follow-up time was 952 days (inter-quartile range, 279 - 2089 days). RESULTS: Muscle invasive bladder cancer (MIBC; 71.5%) was more prevalent than non-muscle invasive bladder cancer (NMIBC; 24.9%). Fifteen percent received a neobladder and 17.7% underwent POP. Cancer-specific death (CSD) was 20.7% during the follow-up period (Figure 1). No patients with TIS grade cancer died from cancer during follow-up, while higher cT-stage was associated with earlier CSD. For cT-stages 1-4, CSD ceases over time. Complication-free surgery was reported for 52.6% (early) and 82.2% (late) of patients. The incidence of early complications by Clavien-Dindo were 35.1% for I-II and 12.3% for III or higher, respectively. Readmission within 30 days was 22.2% and re-operation within 30 days was 1.5%. CONCLUSIONS: The oncological outcome in our data appear to have no clear differences with published male cystectomy series. Also, the complication rates among women undergoing robot-assisted radical cystectomy seems comparable to other published series. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e639 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Linda Dey More articles by this author Monish Aron More articles by this author Jorge Ballon More articles by this author Giovanni E. Cacciamani More articles by this author Mihir M. Desai More articles by this author Inderbir S. Gill More articles by this author Abolfazl Hosseini More articles by this author Arad Hosseini More articles by this author Etienne Lavallee More articles by this author Reza Mehrazin More articles by this author Gus Miranda More articles by this author Juhana Rautiola More articles by this author Jordan Rich More articles by this author John Sfakianos More articles by this author Viktor Skokic More articles by this author Gunnar Steineck More articles by this author Yuan Shuo Wang More articles by this author Peter Wiklund More articles by this author Expand All Advertisement PDF downloadLoading ...

Feasibility of laparoscopic proximal gastrectomy with piggyback jejunal interposition double-tract reconstruction for proximal gastric cancer: A propensity score-matching analysis.

The feasibility of using laparoscopic proximal gastrectomy (LPG) for the treatment of proximal early gastric cancer (EGC) has not been addressed. This study aimed to comparatively evaluate the effects on LPG with piggyback jejunal interposition double-tract reconstruction (PJIDTR) versus laparoscopic total gastrectomy (LTG) with Roux-en-Y reconstruction (overlap method) using propensity score matching for proximal EGC. We examined the clinical outcomes of LPG with PJIDTR for proximal EGC. We retrospectively collected data from patients with proximal EGC who were treated at Shanxi Cancer Hospital between January 2012 and December 2015. The complication rate, nutritional indicators, reflux oesophagitis incidence and overall survival were compared between LTG and LPG with PJIDTR. Of the 424 patients, 200 were excluded, and 50 of the remaining patients received LPG with PJIDTR. Fifty matched LTG patients were screened. The incidence of early complications was 14% in the LPG group and 16% in the LTG group (P > 0.05). At 1 year after surgery, nutrition indices in the LPG group were significantly better than those in the LTG group (P < 0.05). One year after surgery, the Visick score II rate was 2% and 4%, and the endoscopic oesophagitis rate was 4% and 6% in the LPG and LTG groups, respectively. No tumour recurrence was observed in either group. The 5-year overall survival rates of the two groups were 98% and 90% (P = 0.08). LPG with PJIDTR may be suitable for proximal EGC.

Sarcopenia in chronic liver disease, can we predict complications?

Introduction. Sarcopenia is a common complication of chronic liver disease. Today many studies are devoted to sarcopenia impact on the course of liver diseases. At the same time, many studies are being performed on the correlation of sarcopenia in patients with cirrhosis of the liver and the incidence of early complications after liver transplantation. In this regard, we conducted our own retrospective study of the correlation relationship of sarcopenia in patients with chronic liver diseases. Aim. To determine the correlation between the severity of sarcopenia and the incidence of complications of liver cirrhosis in patients on the waiting list for liver transplantation. Material and methods. In our own retrospective observational study, 87 patients suffering from chronic liver diseases and treated at the Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology were included. The assessment of sarcopenia was carried out using the CT technique for assessing indexed parameters of the patient's muscle mass. Mathematical processing was performed using the FDA-approved Osirix TM software. The study was conducted within the framework of the project "ClinicalTrials: NCT04281797" Results. Body mass index was significantly correlated with the presence of sarcopenia (r pb =-0.48, 95% CI [-0.65;-0.27]). At the same time, the groups of patients with and without sarcopenia differed significantly (p&lt;0.0001), (Hedges g=-0.93, 95% CI [-1.37;-0.48]). In groups of patients with various etiological factors of chronic liver diseases, sarcopenia occurred most often among patients with autoimmune hepatitis, while the uneven distribution of the incidence of sarcopenia in different nosological groups was significant (p=0.028;  2 =14.1). Conclusion. Body mass index plays an important prognostic role in muscle mass loss among patients with clinically advanced liver disease. However, skeletal muscle index and Body Mass Index differ significantly between patients with and without sarcopenia. In addition, our study showed a significant difference in the occurrence of sarcopenia in patients on the waiting list of different etiological groups. Thus, further extensive randomized studies in this direction are needed today.

A multicenter retrospective study on the efficacy of different anti-reflux reconstruction methods after proximal gastrectomy for gastric cancer

Objective: To examine the clinical efficacy of 3 anti-reflux methods of digestive tract reconstruction after proximal gastrectomy for gastric cancer. Methods: The clinical data and follow-up data of gastric cancer patients who underwent anti-reflux reconstruction after proximal gastrectomy in 11 medical centers of China from September 2016 to August 2021 were retrospectively collected, including 273 males and 65 females, aging of (63±10) years (range: 28 to 91 years). Among them, 159 cases were performed with gastric tube anastomosis (GTA), 107 cases with double tract reconstruction (DTR), and 72 cases with double-flap technique (DFT), respectively. The duration of operation, length of postoperative hospital stay and early postoperative complications (referring to Clavien-Dindo classification) of different anti-reflux reconstruction methods were assessed. Body mass index, hemoglobin and albumin were used to reflect postoperative nutritional status. Reflux esophagitis was graded according to Los Angeles criteria based on the routinely gastroscopy within 12 months after surgery. The postoperative quality of life (QoL) was evaluated by Visick score system. The ANOVA analysis, Kruskal-Wallis rank sum test, χ2 test and Fisher's exact test were used for comparison between multiple groups, and further comparison among groups were performed with LSD, Tamhane's test or Bonferroni corrected χ2 test. The mixed effect model was used to compare the trends of Body mass index, hemoglobin and albumin over time among different groups. Results: The operation time of DFT was significantly longer than that of GTA and DTR ((352±63) minutes vs. (221±66) minutes, (352±63) minutes vs. (234±61) minutes, both P<0.01). The incidence of early complications with Clavien-Dindo grade Ⅱ to Ⅴ in GTA, DFT and DTR groups was 17.0% (27/159), 9.7% (7/72) and 10.3% (11/107), respectively, without significant difference among these three groups (χ2=3.51, P=0.173). Body mass index decreased more significantly in GTA than DFT group at 6 and 12 months after surgery (mean difference=1.721 kg/m2, P<0.01; mean difference=2.429 kg/m2, P<0.01). body mass index decreased significantly in DTR compared with DFT at 12 months after surgery (mean difference=1.319 kg/m2, P=0.027). There was no significant difference in hemoglobin or albumin fluctuation between different reconstruction methods perioperative. The incidence of reflux esophagitis one year after surgery in DTR group was 12.9% (4/31), which was lower than that in DFT (45.9% (17/37), χ2=8.63, P=0.003). Follow-up of postoperative quality of life showed the incidence of Visick grade 2 to 4 in DFT group was lower than that in GTA group (10.4% (7/67) vs. 34.6% (27/78), χ2=11.70, P=0.018), while there was no significant difference between DFT and DTR group (10.4% (7/67) vs. 22.2% (8/36, P>0.05). Conclusions: Compared with GTA and DTR, DFT is more time-consuming, but there is no significant difference in early complications among three methods. DFT reconstruction is more conducive to maintain postoperative nutritional status and improve QoL, especially compared with GTA. The risk of reflux esophagitis after DTR reconstruction is lower than that of DFT.

Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m 2.

Patients undergoing bariatric surgery with body mass index (BMI) >50 kg/m 2 are at a higher risk of surgical morbidity when compared with less obese patients, however, there is limited data correlating surgical risk and efficacy with increasing BMI in patients with severe obesity. We hypothesize that regardless of the degree above 50 kg/m 2 their BMI, patients with severe obesity respond similarly to bariatric surgery. We performed a retrospective analysis of patients with BMI >50 kg/m 2 who underwent biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass, or sleeve gastrectomy at a single institution. Outcomes were compared in patients with a BMI between 50 and 60 kg/m 2 to patients with a BMI >60 kg/m 2 and included percent total weight loss as well as early and late complications. Statistical analyses were performed using logistic regression, univariate, and multivariate models. There were 571 patients with BMI >50 kg/m 2 who underwent bariatric surgery at our center, 170 (29.8%) had a BMI >60 kg/m 2 . Percent total weight loss was statistically significant between the BMI 50 and 60 kg/m 2 and BMI >60 kg/m 2 groups at 24 months ( P =0.047) but not at 60 months ( P =0.54). No significant difference was found in the incidence of early complications in a univariate ( P =0.46) or a multivariate ( P =0.06) analysis. The BMI >60 subgroup was associated with a higher rate of late complications in univariate analysis (heart rate=2.37; 1.03-5.47, P =0.04), but not in multivariate analysis ( P =0.78). Efficacy and complication rates of bariatric surgeries are similar in patients with BMI 50 to 60 kg/m 2 and >60 kg/m 2 , providing evidence supporting similar management of patients despite specific subgroups.

Sequential liver and kidney living donors: Making the ultimate gift twice.

There are nearly 150 living donors in the United States who donated more than one solid organ. Using our divisional database, we found 20 individuals who donated a liver and a kidney at different times. We performed a retrospective chart review of these donors, studying their motivating factors, complications and outcomes. The donors included 11 (55%) males and nine females. Thirteen (65%) donated the kidney before the liver. Fourteen (70%) were nondirected donors at the first donation, and four of the six directed donors in the first donation became nondirected in the second donation. Seventeen (85%) were nondirected at the second donation. Common reasons for donating the second time were a good experience with the first donation and knowing that one can donate again. Outcomes and the incidence of early complications were not significantly different after the 2nd versus the 1st donation. All donors recovered and currently are doing well. Our results show a significant number of dual organ donors are nondirected and motivated by their strong desire to help. A positive experience with the 1st donation often was the driving factor for the 2nd. A history of previous organ donation did not negatively impact the 2nd donation.

Clinical outcome of FIGO 2018 stage IB3/IIA2 cervical cancer treated by neoadjuvant chemotherapy followed by radical surgery due to lack of radiotherapy equipment: A retrospective comparison with concurrent chemoradiotherapy.

This study aimed to assess neoadjuvant chemotherapy's clinical outcomes such as efficacy, toxicity, and survival outcomes followed by radical hysterectomy ((NACT-RS) among women with cervical cancer stage IB3 and IIA2, by comparing concurrent chemoradiotherapy (CCRT) and NACT-RS. The study retrospectively reviewed patients with (2018 FIGO) stage IB3 and IIA2 cervical cancer who received preoperative neoadjuvant chemotherapy followed by NACT-RS or concurrent chemoradiotherapy (CCRT). The outcome measures were the 5-year survival and complication rates between the two groups. The median follow-up was 75 months. In total, 218 patients had stage IIA2, 136 patients had stage IB3, 201 patients received CCRT, and 153 patients received preoperative NACT-RS. In the CCRT group, the incidence of early complications (myelosuppression, gastrointestinal and urinary) was higher compared with that in the NACT-RS group (76.1 vs. 26.1%; p < 0.001, respectively). There was no significant difference between the two study groups concerning late complications. Five-year PFS was 79.9% and 85.5% in the NACT-RS and CCRT groups, respectively (p = 0.093). Five-year OS was 86.9% and 85.5% in the NACT-RS and CCRT groups, respectively (p = 0.97). In the multivariate clinicopathologic characteristics analysis for OS, initial tumor size > 4.3 cm (HR 5.11; p < 0.001), AC/ASC (HR 1.89; p = 0.02), histologic grade 2-3 (HR 2.25; p = 0.04), and 2018 FIGO stage IIA2 (HR 8.67; p < 0.001) were independent risk factors. The survival of patients with stage IB3 and IIA2 cervical cancer treated with NACT-RS was similar to that of patients treated with CCRT without increasing side effects.

Colchicine for Prevention of Atrial Fibrillation after Cardiac Surgery in the Early Postoperative Period.

Background. Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery. It has been proven to be associated with an increase in the incidence of early complications and mortality, an increase in the rate of hospital stay duration, and economic costs of their treatment. One of the pharmaceutical drugs recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) for preventing POAF is colchicine (class IIB). However, the results of research on the efficacy and safety of colchicine are ambiguous and, consequently, require further study. Objective. Evaluating the efficacy of short-term colchicine administration in the prevention of POAF in patients after open-heart surgery. Materials and methods. Double-blind, randomized, placebo-controlled clinical trial. The subjects were randomly assigned to two groups: treatment group (n = 50) with subjects receiving 1 mg of colchicine 24 h before the surgery, as well as on days 2, 3, 4, and 5 in the postoperative period; and the control group (n = 51), receiving placebo on the same schedule. The primary endpoint was the frequency of POAF in both groups within 7 days after surgery. Results. The study included 101 patients (82 men, 19 women). Baseline clinical, laboratory, instrumental, and intraoperative data did not differ statistically significantly between the groups. POAF was detected in 9 patients (18%) of the treatment group and 15 subjects (29.4%) of the control group, which had no statistical significance (odds ratio, OR 0.527; 95% Cl 0.206–1.349; p = 0.178). No statistically significant differences were revealed for most secondary endpoints, as well as between the groups for all laboratory parameters. There were statistically significant differences between the groups solely in the frequency of diarrhea: 16 (32%) patients in the treatment group and 6 (11.8%) subjects in the control group (OR 3.529; 95% Cl 1.249–9.972; p = 0.010). Conclusions. We did not detect any statistical differences between the groups in terms of primary endpoints, which could be due to the insufficient volume of the sample of the study. However, we detected some trends of statistical differences among the groups in terms of some parameters. Clinical Trials Registration. ClinicalTrials. Unique identifier: NCT04224545.

Perineal hernia repair after extralevator abdominoperineal excision, how we do it (PERineal Laparoscopic Sling: PERLS Technique).

Recent shift to radical extralevator abdominoperineal excision (ELAPE) approach has seen an increased incidence of post-operative perineal hernia. However, there is no standardised surgical approach for its repair. The aim of this study was to report intra and post-operative results of the perineal hernia repair by the novel trans-abdominal PERineal Laparoscopic Sling (PERLS) Technique in patients who developed post-operative perineal hernia following ELAPE. This is a retrospective analysis of consecutive patients who underwent perineal hernia repair by laparoscopic PERLS approach. All patients had undergone ELAPE with vertical rectus abdominis muscle (VRAM) flap reconstruction during the index surgery for treatment of rectal cancer. Post-operative complications, operative time, conversion rate to open surgery and incidence of recurrent perineal hernia were noted. Seven patients were operated for perineal hernia. The mean operative time was 105min (range: 87 to 131min). One case needed conversion to the open approach. The incidence of early complications was 57.1% including just single Clavien-Dindo I and two Clavien-Dindo II complications, while recurrence rate was 14.3%. PERLS perineal hernia repair is safe, performed in convenient time duration (mean = 105min) and has reasonably less recurrence rate.

A comparative study of mass closure versus layered closure in midline laparotomy incisions

Background: The ideal method of abdominal wound closure remains to be discovered. It should be technically so simple that the results are as good in the hands of a trainee as in those of the master surgeon. The best abdominal closure technique should be fast, easy, and cost effective while preventing both early and late complications. Present study is undertaken to compare the two methods (Mass closure and Layered closure) of laparotomy wound closure in relation to post-operative complications, time for wound closure and cost effectiveness in both groups and also to decide the most effective method among the two procedures. Methods: This prospective comparative study was conducted in department of surgery at Narayana medical college and hospital Nellore from December 2019 to December 2021. On admission, patients suspected of having intraabdominal pathology, a thorough clinical and general assessment was done. Necessary radiological and biochemical investigations were done to support the diagnosis. After confirmation of diagnosis patients were subjected for exploratory laparotomy. The laparotomy wound was closed with either by Mass closure or Layered closure technique. Patients were followed up for 6 months in post-operative period for detection of late complications. Results: Total 30 patients of were studied. Majority of patients were in 61 to 65 age group. Male outnumbered the females. Incidence of early complications like seroma, wound infection is more in layered closure group as compared to mass closure. Mean wound closure time is more in layered closure group. Mass closure technique is more cost effective than layered closure group. Conclusions: Mass closure technique is less time consuming, more cost effective and safe for closure of midline laparotomy incisions.