Incision Surgery Research Articles

Comparison of Mean Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery Using Frown Vs Chevron Incision

Purpose: To compare the mean surgically induced Astigmatism(SIA) in Manual Small Incision Cataract Surgery (MSICS) using frown (inverted U) versus inverted V (chevron) incision. Study Design: Quasi experimental study. Place and Duration of Study: Hayatabad Medical Complex from 27th July 2018 to 27th January 2019. Methods: This study included 148 patients who were distributed into the Frown group (F) and Chevron group (C) by convenient sampling. Each group had 74 patients through block operative randomization. To eliminate bias, all the surgeries were performed by one surgeon having more than 5 years’ experience of MSICS. Pre-operative and Post operative keratometric readings were taken. SIA calculator was utilized, and data was analyzed through SPSS 26. Means and standard deviation for continuous variables like age and surgically induced astigmatism were calculated. Results: In Group F, mean surgically induced astigmatism was 1.14±0.65D and in Group C it was 0.87±0.55D. The independent T test revealed that the mean SIA was significantly lower in the Chevron group compared to the Frown group.The post operative visual acuities showed that the proportion of patients with postoperative 6/6 vision in the Chevron group was more as compared to group F. Conclusion: Chevron (inverted V) incision induces less postoperative mean surgically induced astigmatism than Frown (inverted U) incision in Manual Small Incision Cataract Surgery. These findings may have implications for cataract surgery techniques and may help in reducing postoperative astigmatism.

Intensive Care Unit Transfer in Patients With Deep Neck Infections.

Background: Deep neck infection (DNI) involves the deep neck spaces and may lead to airway compromise. An intensive care unit (ICU) is a specialized unit of the hospital that provides intensive care. ICU care is required for patients with severe DNI, although the risk factors for need of ICU care in patients with DNI have not been investigated. Methods: The clinical and laboratory parameters of 350 patients aged >18 years who were diagnosed with DNI between October 2018 and October 2023 were evaluated. Of these patients, 62 were transferred to the ICU. Univariate and multivariate analyses were applied to assess the risk factors for need of ICU care. Results: Univariate analysis revealed that older age [odds ratio (OR) = 1.0324, 95% confidence interval (CI): 1.0155-1.0496, P = .0001], a higher C-reactive protein (CRP) level (OR = 1.0076, 95% CI: 1.0049-1.0103, P < .0001), and blood glucose level (OR = 1.0057, 95% CI: 1.0023-1.0091, P = .0011), involvement ≥3 spaces (OR = 2.2366, 95% CI: 1.2827-3.8998, P = .0046), and mediastinitis (OR = 4.7134, 95% CI: 2.3537-9.4391, P < .0001) were significant risk factors for ICU transfer in patients with DNI. In multivariate analysis, older age (OR = 1.0216, 95% CI: 1.0032-1.0403, P = .0210), higher CRP level (OR = 1.0063, 95% CI: 1.0033-1.0092, P < .0001), and mediastinitis (OR = 2.6103, 95% CI: 1.1974-5.6905, P = .0158) were independent risk factors of ICU transfer in patients with DNI. The ICU group had a longer hospital stay (23.98 ± 8.53 vs 7.44 ± 4.24, P < .0001) and higher rate of tracheostomy (P < .0001) than the non-ICU group. However, there were no significant differences in the rate of incision and drainage open surgery or pathogens between the groups (all P > .05). Conclusions: Elder patients and those with advanced CRP levels and mediastinitis are more likely to be transferred to the ICU, leading to prolonged hospital stays and a higher risk of tracheostomy. Clinicians should assess the patient's need for ICU transfer and timely manage the airway according to the aforementioned laboratory parameters and complications carefully.

WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis

Abstract Background In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections. Method Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusion The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.

Comparative Study of the Surgical Treatment of Congenital Club Foot between McKay and Turco Procedure

Background: Congenital clubfoot is one of the common congenital disorders. Surgery plays an important role in the treatment of patients with this deformity. Comparative studies after surgical treatment might be beneficial. Hypothesis: Surgical treatment of congenital idiopathic club foot by McKay procedure gives better results than Turco procedure. Objectives: To compare the outcome of surgical treatment of congenital idiopathic club foot between McKay procedure and Turco procedure. Methods: This is a prospective interventional study carried out at Orthopaedic Department of Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, during the period of January 2007 to December 2008. 25 patients with 36 feet were selected in which Group-I consisted of 13 patients with 19 feet treated with surgery by Mckay's procedure and Group- II consisted of 12 patients with 17 feet treated with surgery by Turco's procedure. All the ethical considerations were fulfilled. A questionnaire was designed and prepared by the researcher himself. Diagnosis was confirmed by detailed medical history, clinical examinations and relevant investigations. Then through Turco or cincinnati incision surgery was done in two groups. Statistical analysis were done by SPSS (Statistical Package for the Social Science). Results: There were satisfactory results (Excellent + Good) in 17 feet (89.47%) and unsatisfactory results (fair + poor) were in 2 feet (10.53%) in Mckay's procedure. Where as satisfactory results (Excellent + Good) were in 9 feet (52.94%) and unsatisfactory results (fair + poor) were in 8 feet (47.06%) in Turco's procedure. Conclusion: Operative treatment of congenital clubfoot deformity is always an accepted method of treatment. The final outcome of the results shows that in Mckay's procedure satisfactory results was found in 89.47% which is more than Turco's procedure 52.94%.

The Efficacy and Safety Assessment of Sequential Liposuction Modified Double Ring Areola Incision in Moderate and Severe Breast Ptosis Correction.

A total of 42 cases of moderate and severe breast ptosis were treated with sequential liposuction modified double ring areola incision surgery (experimental group), and 45 cases were treated with traditional double ring areola incision alone surgery (control group). They were followed up for 6 months after the operation. The scar formation and breast ptosis repair were observed, and postoperative complications and patient satisfaction were monitored. Better results such as improved postoperative breast appearance were achieved in the sequential liposuction modified double ring areola incision group compared with the double ring areola incision alone group. After treatment, the distance between the midpoint of the inframammary fold and the nipple, the distance between the suprasternal fossa, and the nipple of the two groups were lower than those before treatment. The distance between the midpoint of the inframammary fold and the nipple showed no difference between the two experimental groups. The distance between the suprasternal fossa and the nipple of the experimental group were lower compared with the control group. Lower complication rates and higher satisfaction rates were observed in patients treated with sequential liposuction modified double ring areola incision. The patients in the experimental group were more satisfied with breast symmetry, breast shape, and breast size than those in the control group. The treatment with sequential liposuction modified double ring areola incision was effective and safe compared with double ring areola incision alone. It could improve the breast shape of patients, improve the satisfaction of patients, and reduce the occurrence of complications.

An esthetic flap design for surgical endodontics in the anterior zone.

To describe an esthetic flap design for surgical endodontics in the anterior zone and to discuss the treatment outcome. Traditional flaps used in apical surgery in the anterior region are created with horizontal and vertical incisions. These incisions do not completely avoid scarring, and may sometimes cause esthetic defects. We describe an envelope flap with no vertical incision for apical surgery in anterior that mainly consists of oblique incision in interproximal papilla. The approach achieve rapid would healing while avoiding scar formation. The present report describes successfully treated cases of surgical endodontics in the esthetic zone using an envelope flap that the author recommend in order to achieve better esthetic results.

Comparison of the postoperative effects of the erector spinae plane block and local infiltration analgesia in patients operated with lumbotomy surgery incision: Randomized clinical study.

Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees. Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours. There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 ± 165.23 µg in the intraoperative ESPB group and 296.67 ± 110.59 µg in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 ± 14.47 mg vs 57.23 ± 15.5 mg and additional analgesic-paracetamol: 2.1 ± 1.06 vs 4.27 ± 1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 ± 8.1 in the LIA group, while it was 19.33 ± 8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05). In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review.

Among refractive errors, astigmatism is the most common optical aberration, where refraction changes in different meridians of the eye. It causes blurred vision at any distance and includes corneal, lenticular, and retinal astigmatism. Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism, for example, a large size surgery incision. The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery. Nowadays, three surgical approaches can be used. By placing a sutureless clear corneal incision on the steep meridian of the cornea, a preoperative corneal astigmatism less than 1.0 D can be corrected. Single or paired peripheral corneal relaxing incisions (PCRIs) provide 1.0-3.0 D corneal astigmatism correction. PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism, if more than 2.0 D, the risk of overcorrection and irregular astigmatism is increased. When toric intraocular lenses (IOLs) are unavailable in markets, PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism. Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism. Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D. These approaches can be used alone or in combination.

Complications and putative risk factors for cecal or colonic surgery in dogs: 79 cases (2002-2015).

To evaluate the complication rate, mortality rate and putative risk factors for cecal or colonic surgery in dogs. A multi-institutional retrospective study including dogs that had undergone surgery that involved the cecum or the colon. Medical records from three referral hospitals were reviewed for patient demographics and clinical data. The association between putative risk factors and survival to discharge or complications was assessed using univariable and multivariable analysis. Seventy-nine dogs met the criteria to be included in this study. Fifty-five dogs had full thickness incision surgeries, while 24 dogs had partial thickness surgeries. The complication and mortality rates for full thickness and partial thickness cecal/colonic surgeries were not statistically different. The dehiscence rate of colonic anastomosis in this study was four of 47 (8.5%). On univariate analysis, performing full thickness procedures out of hours had an association with increased complications and mortality. On multivariable analysis, no factors were associated with survival to discharge or complications. There was no association of board-certified surgeon presence in surgery with complications or mortality. The performance of full thickness cecal/colonic surgery is not associated with a statistically significant increased risk for complications or mortality compared to partial thickness procedures, with a possible increased risk of complications and mortality in full thickness procedures out of hours.

Comparative Study between Single Incision versus Two Separate Incisions in Conservative Breast Surgery and Excising the Sentinel Lymph Node in Upper Outer Quadrant Early Breast Cancer (Retrospective Study)

Abstract Background Single incision technique is an oncoplastic surgery aimed to remove both the breast tumour and sentinel lymph node through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. However, this procedure is more difficult, since visualization and the resection space are limited, demanding greater experience from the surgeon. Objective To compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complications. (seroma formation and wound infection). Patients and Methods This is a retrospective cohort study to compare between single incision in excising upper outer breast tumour and sentinel lymph node versus two separate incisions in conservative breast surgery as regard locoregional recurrence, cosmetic outcome and post operative complication. Results Lymphedema occurred in 3 patients 1 from Group A and 2 from group B but this shows no statistical significance. None of the previously stated complications resulted in delay of post- operative adjuvant therapy and all patients were sent to receive their appropriate therapy according to schedule. None of them have had any other problem such as delayed wound healing or compromised final cosmetic outcome. In our study only one patient from group B had malignant recurrence during follow up visits through 3 year after the surgical removal of the tumor but this has no significance proving that single incision technique is safe from oncological point of view like double incision technique. Conclusion The single incision technique was shown to be providing comparable post operative parameters with better cosmetic results suggesting that the single incision technique is superior to double incision in selected cases.

Clinical Treatment Efficacy and Incidence of Complications in Asymmetric Double Eyelid Repair Surgery

Objective: It’s to analyze the clinical treatment efficacy and incidence of complications in asymmetric double eyelid repair surgery. Methods: Fifty patients who underwent asymmetric double eyelid repair surgery at our hospital from March 2022 to March 2023 were selected. Using a random number table, the patients were divided into two groups of equal size. The observation group (n=25) underwent small incision fat removal and continuous buried suture repair, while the control group (n=25) underwent traditional incision surgery. The treatment efficacy (excellent, effective, ineffective) and one-year postoperative complication incidence (conjunctival blockage, eye swelling, bruising) were compared between the two groups, as well as clinical data (operation time, healing time, incision length). Results: The total effective rate in the observation group (96%) was higher than that in the control group (64%); the one-year postoperative complication incidence in the observation group was lower than that in the control group (P&lt;0.05); the operation time, healing time, and incision length in the observation group were all less than those in the control group (P&lt;0.05). Conclusion: Double eyelid repair surgery demonstrates significant clinical efficacy and a low incidence of complications in treating asymmetric double eyelids, warranting further promotion.

An intelligent controlled release hydrogel with photothermal effect for the treatment of bone defects

To solve the difficulty of natural healing in patients with severe bone defects, and the challenges of insufficient autologous bone graft material and large incisions in conventional surgery, we were designed an intelligent co-regulated hydrogel system with NIR response. The goal is to be able to prevent inflammation and bacterial adhesion, thereby promoting repair and development of the bone defect area. The hydrogel system consisted of hyaluronic acid, carboxymethyl chitosan and Pht-loaded PDA-encapsulated ZIF-8 NPs (Pht@ZIF-8@PDA) by Schiff base reaction. Compared to high-temperature photothermal therapy (PTT), which destroyed surrounding healthy cells, the present study was based on a new strategy of mild photothermal therapy (42.5 ± 1.2 °C) and leaded to a better promotion of osteogenesis. NIR activated the photothermal properties of PDA in scaffolds, intelligently released Pht and Zn2+, inhibited Escherichia coli and Staphylococcus aureus (inhibition rate ≥ 96 %), and promoted bone regeneration in the rat model. Meanwhile, it could promote bone regeneration by upregulating osteogenic factors and stimulating the expression of proteins related to BMP/SMAD signaling pathway. The research highlights the potential applications of synergistically modulated hydrogels, which opens up a new application path for this material in bone tissue engineering, regenerative medicine, and other related fields.

Comparative study of the effects of ibuprofen, acetaminophen, and codeine in a model of orofacial postoperative pain in male and female rats.

Pain management is a primary goal after oral surgeries, but little is known about sex differences in the sensitivity to analgesics. This study aimed to compare the efficacy of three drugs with analgesic potential on heat and mechanical hyperalgesia, spontaneous pain and locomotion on male and female rats subjected to a model of orofacial postoperative pain. Male and female Wistar rats were submitted to intraoral incision or sham surgery, and on postoperative day 3, the effect of the ibuprofen (30 and 100mg/kg), acetaminophen (100 and 300mg/kg) and codeine (3 and 10mg/kg) was assessed on responses to heat and mechanical facial stimulation, facial grooming, and locomotion. Ibuprofen reduced heat and mechanical hyperalgesia and grooming behavior in male and female rats in a non-sedative dose; acetaminophen dose-dependently reduced the mechanical hyperalgesia and abolished the heat hyperalgesia and the grooming behavior but caused sedation in both sexes; codeine dose-dependently reduced the mechanical hyperalgesia in male and female rats, and reduced the heat hyperalgesia, but females were less sensitive than males. It reduced spontaneous facial grooming in both sexes, but induced hyperlocomotion in females. Ibuprofen presented the most favorable profile, since it reduced over 50% heat and mechanical hyperalgesia in male and female rats, and significantly reduced spontaneous pain, without causing sedation or affecting locomotion. The identification of sex differences in the sensitivity and safety profile of frequently used analgesics can help guide the choice of more effective individualized therapies for pain control.

Evaluation of the effect of intraoperative tropisetron on postoperative rebound pain after brachial plexus block: a randomized controlled trial.

Postoperative rebound pain after peripheral nerve block increases patient suffering and delays recovery after surgery. We tested whether the 5HT-3 receptor antagonist and α7nAChR agonist tropisetron could prevent postoperative rebound pain. A total of 115 patients were randomized to receive 5-mg/5-mL tropisetron or the same volume of normal saline. Pain intensity was measured with the numerical rating scale of pain (NRS). Rebound pain was defined as a change from mild pain (NRS ≤ 3) measured in the postanesthesia care unit to severe pain (NRS ≥ 7) within 24 hours after peripheral nerve blockade. Logistic regression was used to identify relevant factors associated with postoperative rebound pain. Tropisetron did not affect the NRS score or the incidence of rebound pain after peripheral nerve block. Logistic regression revealed that preoperative pain, bone surgery, and length of incision were risk factors for postoperative rebound pain, and patient-controlled analgesia was protective against postoperative rebound pain. Tropisetron does not affect the incidence of rebound pain after peripheral nerve block. Patients at high risk of postoperative rebound pain should be identified for appropriate management. Registration site: www.chictr.org.cn (ChiCTR2300069994).

Impact of breast-conserving surgery incisions on aesthetics, satisfaction, and complications: A prospective study.

e12603 Background: Breast-conserving (BCS) is favored for its aesthetics benefits and minimal invasiveness. Ensuring tumor safety is essential, but so are post-surgery appearance, satisfaction, and complications. Incision selection for BCS influences both operability of procedures and postoperative results. This study aims to investigate the impact of different incisions on the aesthetic outcome, patient satisfaction, and postoperative complications of BCS. Methods: A prospective single-center cohort study was conducted from July 2020 on breast cancer patients who underwent BCS. The Breast-Q questionnaire and the Aesthetic Items Scale (AIS) were used to assess breast aesthetics and satisfaction outcomes at different times before and after surgery. Complications evaluated include incision dehiscence, subcutaneous hydrops, and nipple-areolar complex (NAC) ischemia, which were recorded once postoperatively and classified according to the Clavien-Dindo classification. Results: A total of 429 patients were enrolled in this study: 247 with a periareolar incision, 30 with a crescentic periareolar incision, 41 with a curvilinear incision, and 111 with a radial incision. Compared to traditional radial incisions, the periareolar and crescent incisions showed significantly better results in psychological well-being, sexual well-being, satisfaction with breasts, and AIS scores at 1-, 3-, and 6-months post-operation. The crescentic incision demonstrated a notable advantage in physical well-being: chest at the 6-month. In contrast, no significant difference was observed between the curvilinear and radial incisions in terms of these outcomes. The overall complication rates for periareolar, crescentic periareolar, curvilinear, and radial incisions were 11.3%, 16.7%, 9.8%, and 7.2%, respectively, indicating no significant differences. Similarly, the rates of NAC ischemia for the periareolar (5.7%) and crescentic (3.3%) incisions did not significantly differ. All complications were graded in categories I to III, and the distribution showed no statistically significant differences among the four groups. Conclusions: Among various incisions, periareolar and crescentic incisions demonstrated superior outcomes in postoperative follow-up, with a comparable incidence of complications to other incisions. These findings may provide valuable surgical decision-making guidance for achieving optimal aesthetic and clinical outcomes in BCS.

Clinical Evaluation of Dural (Spinal) Membrane Repair Materials

To select high-quality and cost-effective dural (spinal) membrane repair materials, in order to reduce the cost of consumables procurement, save medical insurance funds, and optimize hospital operation and management. Taking the BS06B disease group (spinal cord and spinal canal surgery without extremely severe or severe complications and comorbidities, mainly diagnosed as congenital tethered cord syndrome) as an example, a retrospective analysis was conducted on the relevant data of surgical treatment for congenital tethered cord syndrome conducted in our hospital from January 2021 to June 2023. Safety and efficacy indicators in clinical application (incidence of postoperative epidural hemorrhage, incidence of postoperative purulent cerebrospinal meningitis, incidence of cerebrospinal fluid leakage, surgical duration, and postoperative hospital stay) were compared. There was no difference in safety and effectiveness between different brands of dura mater repair materials. For the repair of small incisions in dura mater surgery, high-quality and cost-effective dura mater repair materials can be selected to reduce hospital costs and control expenses for the disease group.

Chronic sensory contact with subordinated conspecifics promotes splenic glucocorticoid resistance in experimentally wounded C57BL/6N male mice

Chronic psychosocial stress induced by the chronic subordinate colony housing (CSC, 19 Days) paradigm promotes functional splenic in vitro glucocorticoid (GC) resistance, but only if associated with significant bite wounding or prior abdominal transmitter implantation. Moreover, sensory contact to social defeat of conspecifics represents a social stressor for the observer individual. As the occurence and severity of bite wounding is not adequately controllable, the present study aimed to develop an animal model, allowing a bite wound-independent, more reliable generation of chronically-stressed mice characterized by functional splenic in vitro GC resistance. Therefore, male C57BL/6N mice received a standardized sterile intraperitoneal (i.p.) incision surgery or SHAM treatment one week prior to 19-days of (i) CSC, (ii) witnessing social defeat during CSC exposure in sensory contact (SENS) or (iii) single-housing for control (SHC), before assessing basal and LPS-induced splenic in vitro cell viability and GC resistance. Our results indicate that individually-housed SENS but not CSC mice develop mild signs of splenic in vitro GC resistance, when undergoing prior i.p.-wounding. Taken together and considering that future studies are warranted, our findings support the hypothesis that the combination of repeated standardized i.p.-wounding with chronic sensory stress exposure represents an adequate tool to induce functional splenic in vitro GC resistance independent of the occurrence of uncontrollable bite wounds required in social stress paradigms to induce a comparable phenotype.

Refractive Results, Visual Outcomes, and Predictive Error in Patients Undergoing Cataract Surgery with Manual Small Incision Surgery

Refractive Results, Visual Outcomes, and Predictive Error in Patients Undergoing Cataract Surgery with Manual Small Incision Surgery

Incomplete bowel obstruction caused by sigmoid colon cancer in an inguinal hernia: a case report

BackgroundMost colon cancers that develop in the intestinal tract within the inguinal hernia sac are identified by incarceration. However, treatment methods for these cases vary depending on the pathology. Cases showing perforation or abscess formation require emergency surgery for infection control, while cases with no infection generally involve oncological resection, with laparoscopic surgery also being an option. We encountered a case of Incomplete bowel obstruction secondary to sigmoid colon cancer within the hernial sac. We report the process leading to the selection of the treatment method and the surgical technique, along with a review of the literature.Case presentationA 79-year-old man presented to our hospital complaining of a left inguinal bulge (hernia) and pain in the same area. The patient had the hernia for more than 20 years. Using computed tomography, we diagnosed an incomplete bowel obstruction caused by a tumor of the intestinal tract within the hernial sac. Since imaging examination showed no signs of strangulation or perforation, we decided to perform elective surgery after a definitive diagnosis. After colonoscopy, we diagnosed sigmoid colon cancer with extra-serosal invasion; however, we could not insert a colorectal tube. Although we proposed sigmoid resection and temporary ileostomy, we chose the open Hartmann procedure because the patient wanted a single surgery. For the hernia, we simultaneously used the Iliopubic Tract Repair method, which does not require a mesh. Eight months after the surgery, no recurrence of cancer or hernia was observed.ConclusionsWe report a case of advanced sigmoid colon cancer with a long-standing inguinal hernia that later became incomplete bowel obstruction. Although previous studies have used various approaches among the available surgical methods for cancer within the hernial sac, such as inguinal incision, laparotomy, and laparoscopic surgery, most hernias are repaired during the initial surgery using a non-mesh method. For patients with inguinal hernias that have become difficult to treat, the complications of malignancy should be taken into consideration and the treatment option should be chosen according to the pathophysiology.

A Bicentric, International, Retrospective Study to Assess Steelex Sternum Set for Sternal Closure in Cardiac Surgery – STERCCAS a Cohort Study

Sternal fixation with steel wires or cerclages, is the gold standard for closing a midline sternotomy, the standard incision in cardiac surgery. Rare wound complications can occur following a sternotomy wire closure. The objective of this study is to establish that the clinical efficacy of the Steelex Sternum Set is equivalent to the results documented in existing literature. The cohorts of the previously conducted OPTICABG and PREMIVALVE studies served as a foundation for the design of this retrospective, bicentric, international, single-arm study. The purpose of the study was to evaluate the clinical performance of the Steelex Sternum Set for sternal closure after coronary artery bypass grafting or cardiac valve replacement/reconstruction surgery. The primary endpoint was the incidence of a composite consisting of sternum instability, sternum dehiscence, superficial and deep sternal wound infection up to six months after surgery. A quantitative summary of the available clinical literature has been conducted for comparison purposes. There were 229 patients in total (89 PREMIVALVE and 140 OPTICABG). The combined rate of surgical site infection and sternal dehiscence/instability was 3.49%, compared to 1.5 - 20% described in the literature. Severe complications such as mortality, stroke, myocardial infarction, and mediastinitis occurred in about 0.8 - 2% of cases. The Steelex Sternum Set is a safe and appropriate method for sternal closure in a diverse patient population undergoing cardiac valve replacement and/or reconstruction, as well as coronary artery bypass graft surgery, in routine clinical settings.