Incidence Of Serious Postoperative Complications Research Articles

Comparison of Open Surgery versus Minimally Invasive Surgery in Non-severe Adult Degenerative Scoliosis: A Systematic Review and Meta Analysis.

A systematic review and meta-analysis. This study aimed to evaluate the clinical efficacy of minimally invasive surgery (MIS) and open surgery in correcting ADS. Adult degenerative scoliosis (ADS) is a scoliosis secondary to degenerative changes in the intervertebral discs and facet joints in adults. Severe low back pain, radicular pain, and intermittent claudication are often present and require surgical treatment. PubMed, EMbase, The Cochrane Library, China national knowledge infrastructure (CNKI) Database, Wanfang Data, Weipu Database, and China Biomedical Document Service System (CBM) were systematically searched for studies that focused on the clinical efficacy of minimally invasive surgery and open surgery to correct ADS. This meta-analysis included 11 studies, involving 1527 patients (581 in the MIS group and 946 in the open surgery group). Regarding surgery and outcome indicators, the operative time in the open surgery group was shorter, the MIS group had less intraoperative blood loss, shorter hospitalization time, and lower incidence of serious postoperative complications. In terms of imaging parameters, although there was no significant difference in Cobb angle improvement and sagittal balance, the open surgery group exhibited better lumbar lordosis improvement and pelvic tilt improvement. In terms of clinical scores, including changes in the ODI index and VAS scores for low back and leg pain, similar improvements were appreciated across both groups. In mild to moderate ADS, we found that the advantages of open surgery include greater improvement in lumbar lordosis and pelvic tilt angle and shorter operative time. The advantages of minimally invasive surgery are less intraoperative blood loss, shorter hospital stay, and fewer serious postoperative complications. There is no significant difference between the two surgical methods in terms of Cobb angle, clinical pain and SVA improvement.

Association between preoperative frailty and surgical Apgar score in abdominal cancer surgery: a secondary analysis of a prospective observational study

IntroductionThe surgical Apgar score is useful for predicting postoperative morbidity and mortality. However, its applicability in frail patients with minimal hemodynamic variation remains unknown. This study aimed to investigate the association between frailty and surgical Apgar score.MethodsThis secondary analysis included 210 patients ≥ 65 years of age undergoing elective major abdominal surgery for cancer. Frailty was assessed using the Fried Frailty Phenotype Questionnaire and defined as a total score of ≥ 3. The surgical Apgar score (range, 0−10; including mean blood pressure, heart rate, and blood loss volume) was compared between patients with or without frailty using the Mann–Whitney U test. Postoperative severe complications and length of postoperative stay were compared between patients with surgical Apgar scores ≤ 7 and > 7.ResultsAmong the included patients, 45 were classified as frail. The median [1st quartile, 3rd quartile] surgical Apgar scores in patients with and without frailty were 7.0 [7.0, 8.0] and 8.0 [7.0, 8.0], respectively (P = 0.03). Patients with surgical Apgar score ≤7 had a higher incidence of serious postoperative complications (P = 0.03) and longer hospital stays (P < 0.001) compared with patients with surgical Apgar score >7.ConclusionFrail patients have lower SAS, and patients with lower SAS have higher postoperative complication rates and longer hospital stays in patients who underwent cancer surgery.

The Clinical Features of Late Postoperative Cholangitis After Hepaticojejunostomy Brought on by Conditions other than Cancer Recurrence.

Postoperative cholangitis and anastomotic strictures (AS) are long-term complications of biliary-enteric anastomosis (BEA). We retrospectively reviewed data of patients who underwent bile duct resection with or without hepatectomy and investigated the risk factors for postoperative cholangitis, benign AS, and incidence of Clavien-Dindo (C-D) >Grade III complications. Overall, data of 189 patients (115 men and 74 women) were retrospectively analyzed. The median patient age was 73 years. Thirty-five patients (18.5%) developed postoperative cholangitis, and 16 (8.4%) developed postoperative AS. Male sex and serious postoperative complications (C-D ≥ Grade III) were independent risk factors for cholangitis. The incidence of serious postoperative complications was 32.3%. Hypertension, preoperative biliary drainage, C-reactive protein-albumin ratio ≥.22, and bile duct resection with hepatectomy were potential risk factors for serious postoperative complications. The incidence rates of postoperative cholangitis and AS after BEA were 18.5% and 8.4%, respectively. Male sex and serious postoperative complications (C-D ≥ Grade III) were independent risk factors for postoperative cholangitis.

The comparison between endoscopic and surgical treatment of delayed iatrogenic bile duct injury by propensity score matching

Objective: To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2. Methods: The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged (M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test,χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results: There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675,P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group(P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%,P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups(P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups(P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5,P=0.037). Conclusions: For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.

Application of MFI-5 in severe complications and unfavorable outcomes after radical resection of colorectal cancer

BackgroundFrailty is considered a characteristic manifestation of physiological decline in multiple organ systems, which significantly increases the vulnerability of elderly individuals with colorectal cancer (CRC) and is associated with a poor prognosis. While studies have demonstrated that the 11-factor Modified Frailty Index (mFI-11) can effectively predict adverse outcomes following radical resection of CRC, there is a lack of research on the applicability of the 5-factor Modified Frailty Index (mFI-5) within this patient population.MethodsIn this retrospective analysis, we examined a cohort of CRC patients aged 65 years and above who had undergone radical resection. For each patient, we calculated their mFI-5 score, considering a score of ≥ 2 as an indication of frailty. We conducted univariate and multivariate analyses to assess the association between the mFI-5 and adverse outcomes as well as postoperative complications.ResultsPatients with an mFI-5 score ≥ 2 exhibited a significantly higher incidence of serious postoperative complications (53% vs. 30%; P = 0.001) and experienced a longer hospital stay [19.00 (15.00–24.50) vs. 17.00 (14.00–20.00); P < 0.05]. Notably, an mFI-5 score greater than 2 emerged as an independent risk factor for severe postoperative complications (odds ratio: 2.297; 95% confidence interval: 1.216 to 4.339; P = 0.01). Furthermore, the mFI-5 score displayed predictive capabilities for severe postoperative complications with an area under the receiver operating characteristic (ROC) curve of 0.629 (95% confidence interval: 0.551 to 0.707; P < 0.05).ConclusionThe mFI-5 demonstrates a high level of sensitivity in predicting serious complications, prolonged hospital stays, and mortality following radical resection of colorectal carcinoma. As a practical clinical assessment tool, the mFI-5 enables the identification of high-risk patients and facilitates preoperative optimization.

Interval time between neoadjuvant chemotherapy and surgery in advanced gastric cancer doesn't affect outcome: A meta analysis.

The efficacy of neoadjuvant chemotherapy for advanced gastric cancer is not yet firmly confirmed, but the exciting results demonstrated in several clinical studies have led neoadjuvant chemotherapy as the important treatment methods in guidelines. The 4-6 weeks interval time is currently the most commonly used in clinical treatment, but there are insufficient studies to support this time and the optimal interval has not yet been identified. The aim of this meta-analysis was to investigate the short-term life quality and long-term prognostic impact of the interval time between the end of neoadjuvant chemotherapy and surgery in patients with advanced gastric cancer. We conducted a systematic literature search in PUBMED, Embase and Cochrane Liabrary for studies published or reported in English from January 2006 to May 2022. We summarised relevant studies for the time to surgery (TTS), included as retrospective studies and prospective studies. The primary study outcome was the rate of pathological complete response (pCR), and the secondary outcomes included R0 resection rate, incidence of serious postoperative complications, 3-year progression free survival time (PFS) rate and overall survival time (OS) rate. TTS were classified in three groups: 4-6 weeks, <4 weeks and >6 weeks. The ratio ratios (ORs) were calculated and forest plots and funnel plots were made to analysis by using fixed-effect and random-effect models in Review Manager 5.2. A total of five studies included 1,171 patients: 411 patients in shorter TTS group (<4 weeks), 507 patients in medium TTS group (4-6 weeks) and 253 patients in longer TTS groups (>6 weeks). And The results of our meta-analysis indicate that there are no significant difference between the three groups. The pCR, R0 resection rate, incidence of serious postoperative complications, 3-year PFS and OS were similar between three groups. Although there many studies exploring the suitable TTS in advanced gastric cancer, but we have not find the evidence to prove the TTS is the risk factor influencing the outcome. https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022369009.

Influence of Preoperative Handgrip Strength on Length of Stay after Lumbar Fusion Surgery.

Preoperative sarcopenic status can affect length of hospital stay and patient outcomes after surgery. The aim of this study was to investigate the impacts of preoperative handgrip strength (HGS) on length of stay (LOS) and outcomes after lumbar fusion surgery. HGS was measured preoperatively, and the cut-off value for low HGS was <28 kg for men and <18 kg for women. Perioperative patient outcomes were compared between patients with low and normal HGS. A total of 225 patients, consisting of 86 and 139 patients in the low and normal HGS groups, respectively, fully satisfied the study criteria for analysis. A longer LOS (median 10 vs. 8 days, p = 0.013) and a higher incidence of serious postoperative complications (15.1 vs. 3.6%, p = 0.002) were observed in the low HGS group. In the multivariate analysis, a low HGS (odds ratio (OR) = 1.917, 95% confidence interval (CI) = 1.046–3.513, p = 0.035) was significantly associated with a longer LOS after surgery. Preoperative HGS below the reference values by sex appeared to be an independent factor associated with longer LOS after lumbar fusion surgery.

The influence of summer closure on serious postoperative complications in bariatric surgery

IntroductionBariatric surgery is an effective method of treating obesity, with gastric bypass and sleeve gastrectomy being the most common techniques used worldwide. Despite the technical challenges in these methods, little is known about the effects of summer closure on the incidence of serious postoperative complications in surgeries performed shortly after summer vacation. This has therefore been studied in our large cohort.Materials and methodsA retrospective cohort study based on data from the Scandinavian Obesity Surgery Registry was conducted. Patients who underwent a primary gastric bypass or sleeve gastrectomy operation between 2010 and 2019 were included. The rate of serious complications within 30 days after surgery for patients who underwent surgery the first month after summer closure was compared to those who underwent surgery during the rest of the year using the χ2 test and adjusted logistic regression.ResultsThe study included 42,404 patients, 36,094 of whom underwent gastric bypass and 6310 of whom received sleeve gastrectomy. Summer closure was associated with an increased risk for serious postoperative complications in gastric bypass surgery (adjusted odds ratio (adj-OR) = 1.17; 95% confidence interval (CI): 1.01–1.36). No statistically significant association was seen for sleeve gastrectomy (adj-OR = 1.17; 95% CI: 0.72–1.91), nor in overall complication rate.ConclusionsSummer closure increases the risk of serious postoperative complications in gastric bypass surgery. No statistically significant association was found for sleeve gastrectomy surgery.

Analysis of treatment outcomes of patients with colorectal cancer in the COVID-19 pandemic

Introduction. The COVID-19 pandemic has made adjustments to the health care system. Among other things, it has led to shortened hospital stays. In the surgical treatment of patients with colorectal cancer (CRC), the possibility of reducing the bed-day is limited. The aim of the study was to evaluate the results of treatment of CRC patients during and before the pandemic new coronavirus infection. Material and methods. We analyzed the results of treatment of patients with CRC who were treated at the Oppel Hospital Surgery Clinic in 2015 and 2020. Group A included 58 patients treated in 2020, Group B included 44 patients treated in 2015. Patients with stage II disease predominated in both groups: in group A — 31 patients (53.4%), in group B — 19 (43.2%). Results. The average period of hospitalization in the patients of the group A was 12 days, in the group B — 16 days in the patients with uncomplicated postoperative period, in case of complications — 31 days. In group B 47.7% of surgical interventions were performed using laparoscopic techniques, in group A this index was 74.1%. In Group A complications in the early postoperative period were detected in 8 patients (13.8%). In group B complications were diagnosed in 10 patients (22.7%). The incidence of anastomosis failure tended to decrease in group A. In group B six patients (85.7%) who developed this complication required repeated surgical treatment, and in group A only two patients (50%). Discussion. The results demonstrate the effectiveness of the recommendations for perioperative management of patients with CRC and prevention of anastomosis failure. Conclusion. Based on the results obtained, we can say that the quality of surgical care for patients with CRC was avoided during the pandemic. The implementation of research recommendations in this area has helped to reduce the incidence of serious postoperative complications (anastomosis failure).

Clinical application of a three-dimensional reconstruction technique for complex liver cancer resection.

To explore the utility of three-dimensional (3D) visualization technology in liver resection for patients with complex liver cancer. In this retrospective cohort study, we collected and analyzed clinic pathological data from 105 patients who underwent complicated liver cancer resection at the authors' unit between January 2014 and June 2019. Observation indicators included general demographic information, operative time, intraoperative blood loss, blood transfusion volume, postoperative liver function, complication rate, hospital stay, and in-hospital mortality. Compared with the complex liver cancer control group, operative time (257.1 ± 63.4min versus [vs] 326.6 ± 78.3min; P < 0.001), intraoperative blood loss (256.4 ± 159.1mL vs 436.1 ± 177.3mL; P < 0.001), blood transfusion volume (213.3 ± 185.2mL vs 401.6 ± 211.2mL; P < 0.001), and length of hospital stay (9.7 ± 3.1days vs 11.9 ± 3.3days; P = 0.001) were significantly reduced in the complex liver cancer reconstruction group. Although there was no statistical difference in total postoperative complication rate between the two groups, the incidence of serious postoperative complications in the reconstruction group was significantly lower than that in the control group (3/54 [5.6%] vs 10/51 [19.6%], respectively; P = 0.038). Regarding laboratory investigations, the time to recovery of liver function in the complex liver cancer reconstruction group was shorter than that in the complex liver cancer control group. The use of 3D visualization technology was highly influential in formulating meticulous, individualized surgical strategies for complex liver cancer liver resection with safety and reduced perioperative risk.

Analysis of risk factors of severe postoperative complications in elderly patients with colorectal cancer aged over 80 years

Objective: To investigate the risk factors of severe postoperative complications in elderly patients with colorectal cancer aged over 80 years old. Methods: A retrospective case-control study was conducted to collect and analyze the clinicopathological data of patients (≥80 years old) who underwent radical colorectal cancer surgery at department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2010 to December 2018. A total of 269 patients were included in the study, including 160 males and 109 females. The average age was 83 (80-94) years. Among them, the pathological TNM stage was 16 in stage I, 76 in stage II, 167 in stage III, and 10 in stage IV. According to Clavien-Dindo classification, the postoperative complications of grade III and above were defined as serious complications. To analyze the relationship between the patient's clinical data, such as general information, the surgeon's experience (whether to complete more than 500 radical colorectal cancer surgery), intraoperative conditions and the occurrence of severe complications. Univariate analysis was conducted with the chi-squared test. Multivariate logistic regression analysis was used for statistically significant variables in univariate analysis. Results: Of the 269 patients, 34 (12.6%) had severe complications after surgery. The incidence of postoperative complications ranged from high to low, respectively, for pulmonary infection (8/269,3.0%), intestinal obstruction (8/269, 3.0%) and anastomotic leakage (7/269, 2.6%). One patient died of pulmonary embolism and one patient died of multiple organ failure, with a perioperative mortality rate of 0.7% (2/269). On univariate analysis, the occurrence of severe postoperative complications was associated with age (χ(2)=8.181, P=0.004), American society of anesthesiologists grade (χ(2)=7.945, P=0.005), preoperative albumin level (χ(2)=9.088, P=0.003), operation experience (χ(2)=9.395, P=0.002). Multivariable logistic regression analysis showed that age ≥85 years old (OR=4.415, 95% CI: 1.702-11.453, P=0.080), preoperative albumin <35 g/L (OR=2.544, 95%CI: 1.083-5.974, P=0.032), and less-experieced group (OR=2.475, 95% CI:1.082-5.661, P=0.032) was independent risk factor for severe postoperative complications. The incidence of serious postoperative complications was similar in patients undergoing laparoscopy and laparotomy [10.1% (17/169) vs. 17.0% (17/100), χ(2)=2.741, P=0.098]. Conclusion: Adequate preoperative evaluation, appropriate perioperative nutritional support and experienced specialists are the key factors to ensure the successful perioperative period of elderly patients with colorectal cancer aged over 80 years old. In addition, more attention should be paid to the elderly patients aged ≥85 years.

Robotic Surgery for Pancreatic Serous Cystadenoma: Analysis of 148 Cases

To investigate the clinical efficacy of robotic surgery for pancreatic serous cystadenoma. There were 148 patients with pancreatic serous cystadenoma underwent robotic surgery from April 2015 to June 2019 in our department, the clinical data including intraoperative data, perioperative complications, and histopathological results were retrospectively analyzed. Among the 148 patients, there were 39 cases (26.4%) of the tumors located in pancreatic head, 15 cases (10.1%) in pancreatic neck and 94 cases (63.5%) in pancreatic body and tail. Pancreaticoduodenectomy, distal pancreatectomy, central pancreatectomy, and enucleation were performed in 26 cases (17.6%), 71 cases (48.0%), 24 cases (16.2%) and 27 (18.2%) cases, respectively. The incidence of serious postoperative complications were 7.7%, 2.8%, 0, 0, respectively, and grade B pancreatic fistula were 7.7%, 7.0%, 41.7%, 14.8%, respectively. 90-day mortality was 0. Compared with pancreaticoduodenectomy, enucleation of the pancreatic head tumor had shorter operation time ( P<0.001), less intraoperative blood loss ( P<0.001), and shorter length of hospital stay ( P<0.001). Compared with central pancreatectomy+pancreaticojejunostomy, Rong central pancreatectomy had shorter operation time ( P=0.007) and length of hospital stay ( P=0.040). Robotic surgery for pancreatic serous cystadenomaisis safe and feasible. Rong central pancreatectomy for serous cystadenoma in middle segmental pancreas could achieve feasible results.

Pancreatoduodenectomy with portal vein resection favors the survival time of patients with pancreatic ductal adenocarcinoma: A propensity score matching analysis.

Portal vein (PV) involvement is common in patients with pancreatic ductal adenocarcinoma (PDAC). To the best of our knowledge, pancreatectomy combined with PV resection (PVR) is the only radical therapy for patients with PV involvement. However, there remains a debate on whether patients with PV involvement could benefit from PVR or not. The present study aimed to compare the survival outcomes between patients receiving pancreatoduodenectomy (PD) with PVR and those receiving PD alone. A total of 377 patients with PDAC were enrolled, 138 patients with PV involvement were placed in the PVR group, while the other 239 patients were in the non-PVR group. To reduce selection bias and estimate the causal effect, 123 pairs of propensity score matched (PSM) patients were selected and compared for the survival outcomes. Before PSM, the survival of patients in the PVR group was worse compared with those in the non-PVR group (mean survival, 25.1 vs. 29.3 months; P=0.038). After balancing the baseline characteristics using the PSM method, the significant survival difference between the two groups was insignificant (mean survival, 25.9 vs. 31.2 months; P=0.364). Tumor stage, body mass index, serum albumin, R1 resection, lymph node metastasis, carbohydrate antigen (CA)125 and CA19-9 were significant independent prognostic factors. The incidence of serious postoperative complications was similar between the two groups. PVR is safe and effective for patients with PDAC. Patients with PV involvement could achieve the similar survival outcome as patients without PV involvement, through radical resection combined with PVR, without increasing the risk of serious complications.

Management of fracture shaft of humerus by dynamic compression plate versus interlocking nail: A prospective comparative study

Background and purpose: Simple humeral shaft fracture can be treated non operatively, with good results in most cases but the non-operative treatment requires a long period of immobilization, which carries a risk of prolonged shoulder joint stiffness and may be inconvenient for the patient. Furthermore, nonunion after conservative treatment of these fractures does occur in up to 10% of the cases and treatment of this condition can be very difficult. Now there is growing interest in treating even simple humeral shaft fractures by dynamic compression plate (DCP) or interlocking nail (ILN) in order to avoid these problems and to allow earlier mobilization and rapid return to work. Methods: 40 patients of fracture shaft of Humerus were included in the study.20 were managed by Interlocking Nail and 20 were managed by dynamic compression plate.Patients were called for follow up after every four weeks after the stitch removal and on each follow up visit, functional and radiological assessment done by predesigned performa. The functional results assessed at the end of 6 months and 1 year postoperatively on the bases of ASES Score (table 2), for 13 activities of daily living requiring full shoulder and elbow movement.Results: At the end of study, 23 (92%) cases in DCP group had acceptable (either good or more than good) results compared to 22(88%) cases of IMN group, having similar results. The mean interval between admissions to surgery, average operating time, duration of hospital study after surgery was less in DCP group while incidence of serious post-operative complications was more in IMN group. There was no statistically significant difference between the two groups with regards the average time taken for radiological union, although the mean radiological union in DCP group occurred 1.6 weeks earlier compared to the IMN group.Interpretation:On the basis of this study, we found that DCP can be considered a better surgical option for the management of fracture of the shaft of humerus in our setting as it offers a shorter admission to surgery interval; shorter operating time and shorter hospital stay after surgery besides the lower incidence of more serious complication like the radial nerve palsy and infection otherwise comparable to IMN in all other variables of interest in our study.

Surgical treatment of pulsatile tinnitus caused by the sigmoid sinus diverticulum: a preliminary study.

The sigmoid sinus diverticulum (SSD) is an increasingly recognized cause of pulsatile tinnitus (PT). Surgical reconstruction of the sigmoid sinus wall has been found to be highly effective for SSD; however, surgical techniques still need to be refined to reduce the incidence of serious postoperative complications. Moreover, scrutinizing more cases of SSD is desirable for establishing the diagnostic criteria and standardizing the surgical technique. This study was retrospectively undertaken in 28 patients who were diagnosed with SSD upon computed tomography angiography (CTA) and digital subtraction angiography findings at Beijing Tongren Hospital in China. A majority of patients (20/28) presented with SSD and accompanying sigmoid sinus wall dehiscence (SSWD). Twenty-five patients opted to undergo sigmoid sinus wall reconstruction, and 3 patients refused surgery. Following surgery, 17 patients experienced complete resolution of PT, 3 patients experienced partial resolution, and 5 patients experienced no change in PT. No serious complications were found postoperatively. A comparative analysis of the preoperative and postoperative CTA findings suggested that completely resolving SSD and the accompanying SSWD resulted in the elimination of PT. In conclusion, SSD is generally accompanied by SSWD. Sigmoid sinus wall reconstruction is a safe and effective approach for the treatment of SSD. During surgery, completely resolving both SSD and SSWD is advisable, and maintaining the normal diameter of the sigmoid sinus is imperative.

Clinical analysis of thoracoscopic lobectomy in the treatment of peripheral lung cancer with single utility port

背景与目的胸腔镜肺叶切除术在肺癌治疗领域的价值与可行性已被广泛接受。本研究探讨单操作孔肺叶切除术治疗周围型肺癌的临床效果。方法回顾性分析2011年2月-2013年1月苏州大学附属第一医院心胸外科经单操作孔胸腔镜肺叶切除术治疗的周围型肺癌患者87例（单操作孔组），用同期经传统“三孔法”肺叶切除术治疗的周围型肺癌作为对照（“三孔法”组）。比较两组患者的手术时间、术后下床活动时间及住院时间、术中出血量、术后总引流量、术后拔管时间、清扫淋巴结数量及术后并发症、术后疼痛的发生情况。结果两组患者手术过程顺利，单操作孔组与三孔法组手术时间（151.03±25.97）min vs (156.27±26.49）min、淋巴结清扫数目（13.06±1.36）枚vs（12.61±1.56）枚、术中出血量（188.62±47.03）mL vs（179.60±28.96）mL及术后并发症发生率（18/87）vs（21/75）差异无统计学意义（P > 0.05)；术后下床活动时间（11.17±8.69）vs（13.76±7.43）h、术后住院天数（7.18±1.95）天vs（7.92±2.03）天、拔除引流管时间（3.85±1.21）天vs（4.43±1.43）天及总引流量（671.49±178.31）mL vs（736.93±170.39）mL的差异有统计学意义（P < 0.05），两组患者术后视觉模拟评分法（vision analogue score, VAS）评分变化差异有统计学意义（P < 0.01）。结论单操作孔肺叶切除术治疗周围型肺癌可以达到与传统“三孔法”全腔镜肺叶切除术相同的效果，是一种有发展前途的手术方式。

Clinical significance of MRI-aided measurements in the transsphenoidal approach in Chinese adults

To determine the optimal direction for approaching sellar tumors, we developed an anatomical model of the most common approach, the transsphenoidal approach, in Chinese adults by analyzing MRI-aided measurements. Craniocerebral MRI of 75 Chinese adults with pituitary tumors and 238 healthy Chinese adults were obtained to analyse the angle between the direction of the transsphenoidal approach and the reference line linking the glabella and the external occipital tubercle, the approach depth, and the distance between the internal carotid arteries (ICA) at the cavernous sinuses segment. The mean angle (± standard deviation [SD]) between the direction of the transsphenoidal approach and the reference line in patients with sellar tumors was 40.51 ± 2.98°, similar to the angle in the healthy control group (41.18 ± 3.35°) ( p > 0.05). The mean depth (± SD) calculated via the transsphenoidal approach in the sellar tumor group was 86.01 ± 4.99 mm, which was similar to the control group (85.34 ± 4.96 mm) ( p > 0.05). However, the mean distance (± SD) between the bilateral ICA at the cavernous sinuses in the patients with sellar tumors was 22.68 ± 5.03 mm, greater than in the control group (15.89 ± 3.11 mm) ( p < 0.01). Thus, during sellar tumor resection via the transsphenoidal approach, the patient’s head should be first positioned to allow the line linking the glabella and the external occipital tubercle to be perpendicular to the horizontal plane, and then inclined backwards at an angle of about 40°. The floor of the sella, at a depth of about 85 mm, can then be reached vertically by introducing a speculum via a single nostril. The operative field should be limited to about 1 cm from the midline. By adopting this method, the optimal angle and depth of the transsphenoidal approach can be determined without complicated equipment. Moreover, this technique is simple and accurate enough to maintain the correct approach, locate the lesion, and reduce the incidence of serious postoperative complications, including bleeding caused by rupture of the ICA.

Glaucoma drainage implants in Asian eyes

Objective Previous studies have suggested that there are racial differences in the outcome of conventional filtration surgery. This study aims to evaluate the outcome of glaucoma drainage implants in Asian eyes with complicated glaucoma and to determine whether there are racial differences in the results of such implant surgery compared to previous reports in non-Asian patients. Design The study design was a retrospective review of all patients with more than 6-months’ follow-up after glaucoma implant surgery at the Singapore National Eye Centre between January 1993 and August 1996. Participants A Total of 83 Asian patients with uncontrolled complicated glaucoma participated. Intervention A total of 29 patients received Molteno implants and 54 received Baerveldt implants. Main outcome measures The surgical outcome was assessed in terms of final intraocular pressure (IOP), visual acuity outcome, and incidence of complications. Success was defined as final IOP less than 22 mmHg with no medications and qualified success as an IOP less than 22 mmHg with medication. Results With mean follow-up of 13.41 months, success in IOP control was achieved in 73.5% of patients and qualified success in 12%. Visual acuity remained stable or improved in 85.5%. There were no patients who encountered intraoperative complications, and the incidence of serious postoperative complications was low. The most frequently observed short- and long-term postoperative complication was hyphema in 14 eyes (16.9%) and bullous keratopathy in 7 eyes (8.4%), respectively. Conclusions Glaucoma drainage implants have good outcome and visual stabilization in Asian eyes with success rates for IOP control comparable to those reported in previous studies in non-Asian eyes.

Complications of Baerveldt glaucoma drainage implants.

To report the incidence and identify risk factors of postoperative complications after Baerveldt glaucoma drainage implantation. A retrospective review of the medical records of all patients at the Bascom Palmer Eye Institute, Miami, Fla, who underwent placement of a Baerveldt glaucoma drainage implant from October 1, 1992, through October 31, 1996, to determine demographic characteristics, preoperative and postoperative intraocular pressures, and complications. Variables were analyzed using the Student t test and Fisher exact test to determine the association between delayed postoperative suprachoroidal hemorrhage and various potential risk factors. A total of 107 eyes of 103 patients were identified. Suprachoroidal hemorrhage occurred in 4 eyes (4%), with onset ranging from 3 to 33 days after implantation. Two eyes (2%) had choroidal effusions requiring surgical drainage, and 20 eyes (19%) had low choroidal effusions requiring only close observation. Tube blockage was observed in 5 eyes (5%). Four eyes (4%) had aqueous misdirection, 2 eyes (2%) had corneal decompensation, and 1 eye (1%) each had endophthalmitis, tube migration, corneal ulcer, hyphema, and implant migration. Patients who were older (P=.04) or had postoperative choroidal effusions (P=.03), low intraocular pressure immediately after the tube opened (P=.03), hypertension (P= .08), or atherosclerosis (P=.09) were more likely to develop suprachoroidal hemorrhage. A lower incidence of serious postoperative complications was observed in Baerveldt implantations in this study when compared with a recent report. Risk factors for serious complications were similar to trabeculectomy.

Lumbar Spinal Stenosis: Diagnosis, Management, and Treatment

Spinal stenosis presents with the patient complaining that walking a certain distance causes leg pain or leg weakness. The underlying cause is narrowing of the spinal canal, resulting in nerve root compression. The resulting claudication or leg pain is actually vascular in origin. The nerve roots cannot receive the necessary blood supply because of the mechanical compression, and that restriction is the cause of the leg pain and why the characteristic claudication leg pain presents in a fashion similar to the claudication symptoms seen with peripheral vascular disease. If the problem is severe enough, the treatment is decompression of the appropriate nerve roots. Usually decompression can be performed without any instrumentation or fusion. For certain conditions, however, these additional surgical modalities are necessary to provide the patient with a lasting good result. Several medical, social, psychological, and nutritional factors should be evaluated preoperatively. The goal of the surgery is to allow the patient to walk longer distances and, therefore, to be a more functional member of society. With appropriate treatment and preoperative medical evaluation, we find that roughly 85% of patients are significantly helped with surgical treatment, 12% feel that they are not significantly better, and 3% feel they are worse. The incidence of serious postoperative complications has been surprisingly low.