Intraoperative Blood Research Articles

Comparison of two surgical methods for the treatment of intertrochanteric fractures of the femur in elderly patients with knee osteoarthritis

To explore the difference in the effectiveness between proximal femoral nail anti-rotation(PFNA) and proximal femoral locking compression plate(PFLCP) of intertrochanteric fracture in the elderly patients combined with knee osteoarthritis. The clinical data of 65 intertrochanteric femoral fractures combined with knee osteoarthritis between June 2015 and February 2021 were retrospectively analyze. They were divided into two groups according to the different surgical methods. PFNA group was composed of 36 patients, 12 males and 24 females, aged from 61to 88 years old with an average of (77.0±6.4)years old. There were 17 cases of left injury and 19 cases of right injury. According to modified Evans classification, there were 3 cases of typeⅡ, 19 cases of type Ⅲ, 10 cases of type Ⅳ, and 4 cases of type Ⅴ. PFLCP group was composed of 29 patients, 11 males and 18 females, aged from 60 to 92 years old with an average of (78.8±6.5) years old. There were 14 cases of left injury and 15 cases of right injury.According to modified Evans classification, there were 2 cases of typeⅡ, 18 cases of type Ⅲ, 7 cases of type Ⅳ, and 2 cases of type Ⅴ. Comparison of operation time, intraoperation blood loss, postoperative bed time, incidence of postoperative complications, Harris score at 6 months and 1 year postoperation. All 65 patients were followed up ranging from 12 to 24 months with an average of (16.9±3.6) months. In the PFNA and PFLCP groups, the operation time was respectively (57.6±6.8) min and (77.4±6.5) min, the intraoperative blood loss was (128.3±50.3) ml and (156.3±23.9) ml, postoperative bed time was (4.0±2.5) days and (8.1±2.0) days, Harris score at 6 months postoperative was (45.3±8.6) points and (36.3±7.0) points. There were significant differences between two groups(P<0.05). Incidence of postoperative complications was 19.4%(7/36)and 34.5%(10/29), Harris score at 1 year postoperative was (60.8±6.7) points and (59.0±8.1) points.There was no significant difference between the two groups(P>0.05). Compared with PFLCP, PFNA treatment of elderly patients with knee osteoarthritis between the femoral intertrochanteric fractures shorter surgical time, less intraoperative blood loss, bed rest after surgery, short-term hip function recovery better, when the affected knee joint can tolerate traction, can be used as a priority.

Application of Multi-Rod Constructs for the Revision of Thoracolumbar Fractures.

The revision procedure for failure of internal fixation after thoracolumbar fracture is controversial. Combined anterior and posterior surgery is associated with higher risk more intraoperative bleeding and tissue damage. The success rate of simple anterior surgery needs further confirmation, and posterior surgery lacks stability of internal fixation. This study evaluates the feasibility and surgical effect of multi-rod constructs in the revision of thoracolumbar fractures. Eleven patients with thoracolumbar fractures who underwent previous construct failure and were treated with revision and internal fixation with the multi-rod technique from March 2017 to September 2018 were analyzed. The original internal fixation was removed and replaced in the medial insertion of satellite rods and bone graft. The average follow-up time was 15.97 months. The intraoperation blood loss, the time of the operation, activation and discharge and the rate of rod fracture were calculated. The sagittal Cobb angle before revision, after revision and at the last follow-up were compared. The clinical effect was evaluated by visual analogue scale (VAS) and Oswestry Disability Index questionnaire (ODI). The average operation time was 107 min, the intraoperative blood loss was 131.81 mL, the active time was 1.59 days, and the discharge time was 10.89 days. No rod fractured again during the follow-up period. The paired t-test was used to compare the Cobb angle, VAS score, and ODI before and after surgery. There was significant difference in the sagittal Cobb angle between the pre-revision and the posterior sagittal position (p = 0.000), and no significant difference was found between post-revision and last follow-up (p = 0.551). VAS and ODI were greatly improved at the last follow-up. The literature on revision of thoracolumbar fractures is insufficient and comprises varying opinions. This paper proposes a new treatment option. The application of the multi-rod constructs in the revision of thoracolumbar fractures is safe, simple, and effective and might provide guidance for future clinical work.

Pre-operative Anemia as a Risk Factor of Morbidity and Mortality in Valvular Surgeries

Pre-operative anemia can be a hindrance to speedy recovery and will increase blood transfusion intraoperative and post operatively. Objective: To find a correlation between preoperative anemia and the subsequent morbidity and mortality rates in patients undergoing valvular surgeries. Methods: A retrospective observational study, involving 493 valvular surgeries’ patients. All patients had the same anesthetic and surgical techniques. According to the WHO, anemia is a hemoglobin level &lt; 13 g/dl for men and &lt;12 g/dl for women. Clinical variables were compared using chi-square and independent t-test. Results: The patients received cardiac surgery for valvular heart disorders and had an average age of 42.2±14.1 years, with 60.9% being male. Most patients exhibited NYHA III (48.9%) and CCS III (36.5%) functional class symptoms. Highest comorbidity was hypertension (35.1%), followed by diabetes (14.4%) and dyslipidemia (6.5%). 43.2% were anemic and older than non-anemic individuals (P=0.02). Anemic people had a significantly greater incidence of HTN (P 0.02) and DM (P &lt; 0.001). Both groups exhibited identical perfusion and cross-clamp periods (P=0.4 vs. P=0.3). Though not statistically significant (P=0.08), non-anemic patients needed more intraoperative blood or blood product transfusions. Patients with anemia have worse outcomes, including increased rates of in-hospital mortality (P=0.03), extended artificial breathing (P=0.04), and postoperative blood/product transfusion (P&lt;0.001). 44.8% of anemic individuals needed RCC, 41.9% FFP, and 41.4% platelets. Conclusions: anemia is associated with the poorest post-operative results. There is conflicting information about the impact of preoperative anemia, particularly iron deficiency anemia, on valvular surgery.

Comparison between electrocautry and ligasure in terms of preoperative blood loss in modified radical mastectomy in carcinoma breast.

Objective: To compare mean intra operative blood loss using ligasure and electrocautery in modified radical mastectomy in patients of breast malignancy. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital, Faisalabad. Period: June 2020 to December 2020. Material &amp; Methods: After fulling inclusion criteria, 60 Patients from surgical OPD of Allied Hospital Faisalabad were enrolled for the study. Informed consent was taken. Two groups of patients were made on random basis. Group A patients underwent modified radical mastectomy using ligasure while in Group B electrocautery was used to secure bleeding. In both groups, surgery was performed by senior consultant surgeon. Intra operative blood loss was measured. Results: In this research, mean intra operative blood loss was 17.63+1.22 ml in Group-A while 21.76+1.41 ml in Group-B, p value was 0.001. Conclusion: Mean intra operative blood loss using LigaSure is significantly lower when compared with electrocautery in modified radical mastectomy in patients of breast cancer.

INEVITABLE MYOMECTOMY OF EXTRUDING INTRAMURAL FIBROID DURING CAESAREAN SECTION- A CASE REPORT

Myomectomy during caesarean sections have been avoided routinely in the past in the fear of massive hemorrhagewhich may lead to obstetric hysterectomy. However in the recent times with adequate facilities and expertise, caesarean myomectomies are being performed with good outcomes. Case Presentation: A35-year-oldprimi gravida was diagnosed to have intramural fibroid - anterior 4.6*4.3cm and posterior 1.8cm*2.8cm at 8 weeks of gestation.By 13 weeks, during her NT scan there was increase in the size of anterior wall fibroid 7.0*6.6cm, the rest of NT scan and first trimester screening was normal. She developed early onset intrauterine growth restriction in her anomaly scan. She was conservatively managed as the doppler flow was normal. Her scan at 36 weeks showed estimated fetal weight at 2nd centile with normal doppler flow in breech presentation and an anterior intramural fibroid of size 9.5*8.2cm.Hence an elective caesarean section was planned at 37 weeks.Baby was delivered by breech extraction. Manual removal of placenta was done. As the uterus started contracting, the intramural fibroid started extruding, became submucosal and bulging into uterine edges. Hence planned for myomectomy. Injection vasopressin was injected into the surface of myoma,enucleation of the myoma done and myoma bed closed in 2 layers followed by the closure of uterine edges. Intra operative blood loss was around 800ml. No primary or secondary PPH noted. Patient was discharged on 5th post operative day without any complaints. Conclusions: Routine myomectomy at the time of cesarean section is not a standard procedure worldwide. However, it may be considered in carefully selected patients in centers with good facilities to tackle complications by the experienced obstetricians.

The effects of forced air warming system on the hemodynamic status, pain intensity, tremors, nausea and vomiting in candidates of emergency laparotomy patients: a double-blind randomized clinical trial

Objective: During emergency laparotomy surgeries, a wide incision is usually created in the abdomen causing the exposure of visceral organs to cold temperatures in the operation room. Other factors such as excessive stress, intra-operation blood transfusion, and prolonged anesthesia increase the risk of hypothermia in these patients. In this study, we studied the effects of forced air warming systems on the hemodynamic status, pain intensity, tremors, nausea and vomiting in emergency laparotomy patients.&#x0D; Methods: In the present double-blinded clinical trial, 80 candidates for emergency laparotomy were randomized into two groups: intervention (patients receiving forced air warming during anesthesia) and control (patients without an active warming system). Patients’ hemodynamic status (during anesthesia and at post anesthesia care unit (PACU), pain intensity, opioids received, tremors, nausea, vomiting, and antiemetics administration were compared between the two groups.&#x0D; Results: The amounts of opioids (P=0.041) and relaxants (P=0.039) received by the patients were significantly lower in the intervention group than in the control group. The hemodynamic status was more stable in the patients of the intervention group than those in the control group at all times measured. Pain intensity (per minute) at the PACU was significantly higher in the control group than in the intervention group (P=0.041). Among the patients admitted to the PACU, participants with no tremors (P=0.005) or nausea (P=0.005) were significantly higher in the intervention group than in the control group. Also, in the recovery unit, patients in the intervention group received significantly lower amounts of opioids (i.e., mg of pethidine, P=0.036) and antiemetics (P=0.011) compared to the control group.&#x0D; Conclusion: The use of a forced air warming system in the operation room stabilizes the hemodynamic status and reduces the pain intensity, tremors, nausea and vomiting in emergency laparotomy patients. As a non-pharmacological strategy, this method was observed to have satisfactory safety.

FTP2.3 A Systematic Review and Meta-Analysis Comparing Outcomes of the Common Perineal Procedures for Rectal Prolapse -Delorme Vs Altemeir

Abstract Introduction There is no consensus yet as to the best surgical option for treatment of rectal prolapse. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme’s and Altemeier’s procedure. Methods A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included total operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. The analysed secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis. Results 10 studies including a total of 605 patients were selected; 286 patients had Altemeier procedure, 39 patients had Altemeier and Plasty (perineoplasty or levatoroplasty) whilst 280 patients had Delorme procedure. Recurrence was found to be significantly lower in the Altemeier group compared to the Delorme group (OR: 0.66; 95% CI [0.44 – 0.99], P= 0.05). Anastomotic leak was found to be significantly less in the Altemeier group than in the Delorme group (RD: 0.05; 95% CI [0.00 – 0.09], P= 0.03). Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95 – 5.51], p=0.004). No significant difference was found with respect to operative time, Intra operative blood loss and mortality rates. Conclusion Our study indicates that between the two common perineal procedures, Altemeier’s operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.

Zero-P and ROI-C implants versus traditional titanium plate with cage to treat cervical spondylotic myelopathy: clinical and radiological results with 5 years of follow-up

BackgroundAnterior cervical discectomy and fusion (ACDF) is the gold standard for treating cervical spondylotic myelopathy (CSM). While implanting plates in ACDF may increase the risk of complications. Zero-P and ROI-C implants have been gradually applied for CSM.Methods150 patients with CSM were retrospectively analyzed from January 2013 to July 2016. Group A consisted of 56 patients who received traditional titanium plates with cage. 94 patients underwent ACDF using zero-profile implants and were divided into 50 patients with the Zero-P device (Group B) and 44 with the ROI-C device (Group C). Related indicators were measured and compared. The clinical outcomes were evaluated by JOA, VAS, and NDI scores.ResultsCompared with group A, group B and C had a less blood loss and shorter operation time. The JOA and VAS scores improved significantly from pre-operative to 3 months postoperative and last follow-up in three groups. The cervical physiological curvature and segmental lordosis at final follow-up were higher than that of pre-operation (p < 0.05). Dysphagia rate, adjacent level degeneration rate, and Osteophyma rate was the highest in group A (p < 0.05). The bone graft fusion was achieved at the final follow-up in three groups. There were no statistical significance in fusion rate and subsidence rate among the three groups.ConclusionsACDF with Zero-P or ROI-C implants can also obtain satisfactory clinical outcomes compared to traditional titanium plate with cage after 5 years follow-up. The zero-profile implant devices carry a simple operation, short operation time, less intraoperation blood loss, and incidence of dysphagia.

To Compare the Outcomes of Bipolar Electro Cautery Tonsillectomy Vs Cold Steel Dissection Pediatric Tonsillectomy in Terms of Mean-Operative Time and Intra-Operative Blood Loss

Background: One of the most popular surgical operations performed using a variety of techniques is a tonsillectomy. The two that are used the most frequently are the traditional cold dissection technique (CDT) and electrocautery, the latter of which is carried out using the monopolar and bipolar electrocautery procedures (BET).All techniques used during tonsillectomy are intended to lessen perioperative bleeding, the intensity of felt pain, and postoperative morbidities. Aim: To compare the outcomes of the bipolar electro cautery tonsillectomy versus cold steel dissection pediatric tonsillectomy in terms of mean-operative time and intra-operative blood loss. Setting: ENT department of Sir Ganga Ram Hospital, F.J. Medical University Lahore from 11-03-2022 to 10-09-2022 Study design: Randomized Controlled Trial Study type: Quantitative study type Methods: The sample size of 110 (55 in group A 55 in group B) was estimated by using 95% confidence level, 90% power of test with an anticipated mean loss of blood during surgery of tonsillectomy i.e. 7.38±2.81m1 with bipolar electro cautery dissection and 11.73±2.86 ml with cold steel dissection. Results: One hundred and ten patients were included as per calculated sample size with the mean age of 8.96±2.42 years. The lowest age limit of children was 5 years while the maximum age limit of children was 13 years. In group A, the mean age of children was 8.80±2.46 years. In group B, the mean age of children was 9.13±2.38 years. The difference was observed as insignificant i.e. p--value = 0.481. Of 110 patients, 67(60.91%) patients were male whereas in group B 29(52.7%) were males. Similarly in group A 17(30.9%) were females and 26(47.3%) were females. The difference was observed as insignificant i.e. p--value = 0.079.In group A, the mean operative time was 19.76±4.47 minutes. Conclusion: This study concluded that bipolar electro cautery tonsillectomy showed significantly better outcome as compared to cold steel dissection pediatric tonsillectomy. Keywords: Cold dissection tonsillectomy, Electrocautery tonsillectomy, Mean operative time, Intra operative blood loss.

Single-unit vs Multiple-unit Transfusion During Curative Cancer Surgery: A Prospective Observational Study

Introduction: Blood transfusions can be lifesaving interventions but have also been linked with increased rates of postoperative complications. It has been shown that even one unit of blood transfused during surgery is associated with increased postoperative complications. There are few studies on the cancer patient population. More information on the adverse effects of transfusing more than one unit of blood, particularly during cancer surgery, would provide a better understanding of the complications associated with increased blood transfusions in cancer patients.Methods: Following USF IRB approval, the medical records of all patients who received a blood transfusion during curative cancer surgery at Moffitt Cancer Center from December 1, 2021 to December 31, 2021 were reviewed to collect data from prospectively enrolled patients. Perioperative data were collected, which included postoperative complications, intensive care unit admission, length of hospital stay, and readmission rates within 30 days.Results: There was a total of 32 patients who received a blood transfusion during curative cancer surgery at Moffitt Cancer Center from December 1, 2021 to December 31, 2021 which made the overall transfusion rate of 5.31%. Of those who received perioperative blood transfusions, 56.3% received more than one unit of blood. There were no significant differences between the groups who received 1 or >1 unit in terms of preoperative demographics, intraoperative data, hospital length of stay, or postoperative complications at 30 days, except intraoperative blood loss.Conclusion: There were no significant differences in outcomes between patients who received only 1 unit of blood vs patients who received >1 unit when cancer patients underwent curative surgery. We found that many patients who received a blood transfusion during curative cancer surgery were preoperatively anemic.

Evaluating intraoperative norepinephrine versus fresh frozen plasma in patients undergoing cytoreductive surgery and HIPEC to reduce renal insult

ABSTRACT Objective This study aims to compare the efficacy of intraoperative norepinephrine infusion versus plasma in reducing renal insult during cytoreductive surgeries. Methods Sixty patients (ASA I–III) of both genders were included in the study. Plasma group: received early fresh frozen plasma and RBCs in ratio exceeded 1:1, and norepinephrine group: received continuous low-dose norepinephrine (0.05–0.1 mic/kg/min). Results Both groups were comparable for their clinical characteristics and distribution of demographic data. Plasma group had significant elevation of their intraoperative heart rate with significant reduction in their mean arterial blood pressure values compared to norepinephrine group (30.3 ± 4.1 versus 17.9 ± 4.5 bpm and −21.6 ± 2.2 versus −16.1 ± 2.3 mmHg, respectively, p < 0.001) with preserved urine output (748.3 ± 92.4 for norepinephrine group versus 693.3 ± 117.2 ml for plasma group, p = 0.048) and better renal outcome (0.2 ± 0.1 mg/dl increase in serum creatinine level for norepinephrine group versus 0.3 ± 0.1 mg/dl for plasma group, p < 0.001). Additionally, patients in the norepinephrine group required less intraoperative blood and fresh frozen plasma transfusion (3.1 ± 1.8 units) compared to the plasma group (4.3 ± 1.3 units), p < 0.001. Conclusion Norepinephrine infusion can play a promising role in maintaining hemodynamic stability with adequate tissue perfusion and better renal outcome in patients undergoing CRS/HIPEC procedures.

Preliminary results of biportal endoscopic lumbar interbody fusion, decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability

Objectives: To evaluate the preliminary clinical outcomes of biportal endoscopic lumbar interbody fusion (BE-LIF), decompression and pedicle screw insertion assisted with endoscopic technique for lumbar spinal stenosis combined with spondylolisthesis or instability. Methods: The data of 9 patients with single-level lumbar spinal stenosis who underwent BE-LIF, decompression and pedicle screw insertion assisted with biportal endoscopy in Xinjiang Production and Construction Corps Hospital from March 1st 2022 to April 30th 2022 were analyzed retrospectively. The visual analogue scales (VAS) for pain in back and legs, and the Oswestry disability index (ODI) of all the patients were collected before operation, on the third day after operation and at the last follow-up. Moreover, the operation time, intra-operation blood loss, radiation shots for pedicle screw insertion, post-operation drainage and ambulation time were recorded. The screw position was checked with CT after the operation. Results: All the patients were female with a mean age of (70.3±8.4) years (ranged 56-84 years); the patients were followed-up for 12-16 weeks. All 9 patients had good clinical results. The VAS scores for back pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(2.9±0.6), (1.8±0.4) vs (6.4±1.1) points, both P<0.05]. The VAS scores for leg pain on the third day after operation and at the last follow-up were both significantly lower than that preoperatively[(1.9±0.3), (1.4±0.5) vs (7.3±1.6) points, P<0.05]. The ODI scores at last follow-up was significantly lower than that before the operation ((24.0%±6.5% vs 55.7%±12.8%, P<0.05). The intra-operative blood loss was (177±103) ml, the drainage amounts post-operation was (122±56) ml, the operation time was (207.8±32.7)min, the ambulation time was (2.3±0.5) days. The total radiation shots for pedicle screw insertion were 20-42 times, the average radiation shots per screw was (6.9±1.5) times. No severe complications or adverse events occurred. No nerve root injury or dural tear occurred in the operation, and no revision surgery needed. Conclusions: The pedicle screw insertion assisted with biportal endoscopic technique can decrease the radiation exposure with good feasibility and safety during the BE-LIF. The BE-LIF combined with the pedicle screw insertion assisted with biportal endoscopy is an effective and safe surgery for lumbar spinal stenosis with good early results.

Need for blood transfusion during cesarean section in rivers state university teaching hospital

Background: Cesarean Section (CS) has been associated with major intra operative Blood loss. Obstetric hemorrhage has been identified as a major cause of direct maternal mortality, maternal near miss and Maternal morbidity. Blood transfusion is often associated with CS. With the advent of various medical and surgical techniques to prevent excessive blood loss during CS, the need for blood trans fusion in every CS procedure need to be reviewed. High risk pregnancy cases may require blood transfusion. However, 90% of low risk pregnancy cases may not require blood transfusion, especially when the application of blood loss preventive measures are put in place.Aim: The aim of this study is to ensure thorough review of patients peri-operatively, and to find out if intra-operative measures can reduce the need for blood transfusion during CS.Method: This was a retrospective cross sectional study of 1000 patients who had Cesarean section between January 2020 to December 2021. Five hundred (500) of them were cases associated with high risk factors for massive hemorrhage at CS, and thus with increased need for blood transfusion.The other 500 were low risk cases for intra operative hemorrhage during CS. It was expected that blood transfusion will be minimal within this group. The result was that these blood loss preventive measures helped to reduce intra-operative blood loss, thus reduced the need for blood transfusion. In addition, the modal units of blood transfused was 2units, unlike previous studies where modal Transfusion was 3 units [1, 3, 4]. Two hundred and three (203) 40.6% were transfused in the high risk group. Only 11(2.2%) were transfused in the low risk group.Conclusion: The need for blood transfusion during cesarean section was reduced with adequate peri-operative preparations. Optimizing maternal hemoglobin concentration during the antenatal period may reduce the incidence of cesarean section related blood transfusion.

Preliminary study on efficacy and safety of submucosal plasma ablation of inferior turbinate in children with allergic rhinitis complicated with obstructive sleep apnea syndrome

Objective:This study aimed to investigate the long-term clinical efficacy and safety of inferior turbinate submucosal plasma ablation combined with or without tonsillar and adenoid surgery in children with allergic rhinitis（AR） combined with obstructive sleep apnea syndrome（OSAS） who were ineffective after conservative systemic treatment. Methods:A total of 43 children with AR complicated with OSAS who met the inclusion criteria among 68 children hospitalized from January 2019 to February 2022 were retrospectively analyzed. The data were collected, including the clinical characteristics, surgical methods perioperative management and prevention and treatment of complications. Moreover, one year follow-up was performed to compare the VAS scores of children before and after surgery, and to evaluate their mid-term and long-term outcomes. Results:The average operation time was 36 minutes, meanwhile, the intraoperative blood was limited. The symptoms of nasal congestion, runny nose, sleep snoring, and mouth breathing were significantly improved after operation, and the results were satisfactory after one-year follow-up without complications such as bleeding, hematoma, intraoperative adhesion, and nasal dryness. Conclusion:Submucosal plasma ablation of inferior turbinate with or without tonsillectomy adenoidectomy in children with AR can effectively improve the clinical symptoms of AR combined with OSAS children who are ineffective after conservative treatment. It can improve the symptoms of sleep-disordered breathing such as sleep snoring and mouth breathing, with good mid-and long-term curative effects and fewer complications, which is an effective and safe treatment for children with AR combined with OSAS.

Individualized 3D printed navigation template-assisted atlantoaxial pedicle screws vs. free-hand screws for the treatment of upper cervical fractures.

ObjectiveThis study aims to compare the efficacy and safety of freehand atlantoaxial pedicle screws against custom 3D printed navigation template screws in the treatment of upper cervical fractures.MethodsIn our institution from 2010 to 2020, a retrospective cohort analysis of 23 patients with upper cervical fractures was done. These patients were separated into two groups: group A (N = 12), which received customized 3D printed navigation template-assisted screws with virtual reality techniques, and group B (N = 11), which received freehand screws assisted by intraoperative fluoroscopy. Every patient was monitored for more than 1 year. The two groups were contrasted in terms of screw implant accuracy, cervical spine Japanese Orthopaedic Association (JOA) score, American Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, surgical time, fluoroscopy times, and intraoperative blood loss.ResultsA total of 88 atlantoaxial pedicle screws in all, 46 in group A and 42 in group B, were implanted. In group A, the screw insertion accuracy rate was 95.7%, compared to 80.0% in group B (P < 0.05). When compared to group B, group A had shorter surgery times, less blood loss, fewer fluoroscopies, a higher short-term JOA score, and overt pain reduction (P < 0.05). However, there was no discernible difference between the two groups' VAS scores, long-term JOA scores, or ASIA scores (sensory and motor), at the most recent follow-up.ConclusionIndividualized 3D printed guide leads to significant improvement in the screw safety, efficacy, and accuracy, which may be a promising strategy for the treatment of upper cervical fractures.

The success of robot-assisted cystectomy in the treatment of muscle-invasive bladder cancer

Background. Bladder cancer is a serious problem of modern oncourology due to the annual increase in the number of diagnosed malignant neoplasms of the urinary system. High-risk muscle-invasive and non-muscle-invasive forms are subject to surgical treatment, while open radical cystectomy serves as the “gold standard”. Laparoscopic and robot-assisted radical cystectomy are serious competitors to this method. To date, the robotic method of removing the bladder is the least studied, despite the fact that it seems to be the most technologically advanced and modern.Aim. To analyze the own results of the use of robot-assisted interventions in high-risk musculoskeletal and non-musculoskeletal invasive bladder cancer, as well as to study the literature on the use of robot-assisted radical cystectomy in the treatment of malignant neoplasms of the bladder.Materials and methods. A prospective study was conducted on the basis of the clinic of the Bashkir State Medical University with the participation of 70 patients who were diagnosed with bladder cancer (T1–T4). The subjects underwent a robot-assisted radical cystectomy with various variants of urine derivation.Results. At the end of the study, the outcomes after robot-assisted radical cystectomy were analyzed and evaluated. The primary endpoints were 30- and 90-day complications of the Clavien–Dindo system. According to secondary indicators, robot-assisted radical cystectomy demonstrated a low duration of surgery, intraoperative blood loss.Conclusion. Robot-assisted radical cystectomy is a serious competitor to open and laparoscopic interventions for early and long-term perioperative indicators. This technique has shown its profitability in the treatment of bladder cancer, demonstrating a sufficient level of effectiveness and safety.

TH2.2 Optimum Timing of Emergency Cholecystectomy for Acute Cholecystitis - A Single Sited Retrospective Cohort Study

Abstract Aim To evaluate timing of emergency cholecystectomy performed at one of the hospital in West Midlands. Methods This is a retrospective single centre study conducted from September 2019 to August 2020. The patients were divided into two groups with those operated within 1 week as emergency group (EG) and those operated after a week but within 6 weeks as delayed group(DG). The outcome is to evaluate post-operative complications, conversion to open, re-admissions, hospital stay, intra-operative blood loss, surgery duration and level of surgeons. Results Among 176 patients, only 88 patients underwent LC. Only 40.9% (36) underwent LC within 1 week of index admission and 12.5% (11) underwent LC after 1 week but within 6 weeks of admission. The remaining 46.5% (41) underwent delayed LC after 6 weeks. 10.6% (5) developed post op complications. Among which only one developed complication in EG and 8.5% (4) developed in DG. Total number of readmissions after LC in both group was 5.5% (5) and 10.2% (9) respectively. Median Length of hospital stay in days (4.03 versus 8.72 days respectively), Duration of surgery was 81(23–153) mins versus 69 (28–122) mins respectively), Intra operative blood loss (64 ml versus 166 ml respectively). Level of surgeon by consultant and Registrar in both groups were 21:6 and 15:5 respectively. None of the patients were converted to open surgery in both group. Conclusion Early LC within 1 week can be performed safely in most patients with AC to minimise the intra-operative blood loss, total hospital stay, post-op complication and readmissions rate.

Safety and efficacy of preoperative tranexamic acid in reducing intraoperative and postoperative blood loss in high-risk women undergoing cesarean delivery: a randomized controlled trial

BackgroundObjective to assess the value of preoperative tranexamic acid (TXA) in reduction of intraoperative and postoperative blood loss in high-risk cesarean delivery (CD).MethodsA double blind randomized controlled trial included 160 high risk women who underwent elective lower segment CD. They were equally randomized to receive either 1 g of TXA or placebo 15 min before surgery. The primary outcome was Intraoperative blood loss.ResultsThe estimated blood loss was significantly higher in the placebo group when compared to TXA group (896.81 ± 519.6 vs. 583.23 ± 379.62 ml, P < 0.001).Both postoperative hemoglobin and hematocrit were lower (9.2 ± 1.6 and 27.4 ± 4.1 vs. 10.1 ± 1.2 and 30.1 ± 3.4, P values < 0.001and 0.012 respectively) and their change percentages (15.41 vs. 7.11%, P < 0.001) were higher in the placebo group when compared to TXA one.The need for further ecbolics was higher in placebo group when compared to TXA group (46.25 vs. 13.75%, P < 0.001).ConclusionPreoperative TXA is safe and effective in reducing blood loss during and after high-risk CD.Trial registrationClincalTrial.gov ID: NCT03820206.

Appropriate Method of Administering Vasopressors for Maternal Hypotension Associated with Combined Spinal Epidural Anesthesia in Elective Cesarean Section: Impact on Postnatal Respiratory Support for Newborns.

Background and Objectives: Vasopressors are used for treating maternal hypotension. However, the appropriate administration method and effects on newborns have not been reported. We evaluated maternal blood pressure fluctuation and neonatal findings in patients who received continuous vasopressor administration during elective cesarean sections and those who received bolus vasopressor administration upon onset of hypotension. Materials and Methods: We retrospectively analyzed the data of 220 patients scheduled for elective cesarean delivery under spinal anesthesia at Mie University Hospital between April 2017 and March 2021. The patients were classified according to the method of vasopressor administration. Maternal information, intraoperative maternal blood pressure fluctuation, and neonatal findings were examined. A multiple regression analysis was performed for the administration of postpartum neonatal respiratory support using maternal background information and other variables related to blood pressure changes as independent variables. Results: The Continuous group and the Bolus group were composed of 98 and 122 patients, respectively. No difference was observed in maternal background information between the groups. Significant changes were noted in several blood pressure parameters between both groups. As for neonatal parameters, newborns of Bolus group patients had lower pO2, 1 min and 5 min Apgar scores, and required more respiratory support than those of Continuous group patients. In the multiple regression analysis, the groups and maternal post-anesthesia diastolic blood pressure variability were considered explanatory variables. Conclusions: Maternal hypotension and the need for neonatal respiratory support associated with anesthesia administration in elective cesarean section may be improved by continuous vasopressor administration upon induction of combined spinal–epidural anesthesia.

Hepatobiliary-pancreatic surgery for patients with a prepancreatic postduodenal portal vein: a case report and literature review

BackgroundPrepancreatic portal vein (PPV) is a congenital anatomical variant of the portal vein (PV). PPVs are extremely rare and generally classified into two categories, prepancreatic preduodenal portal vein and prepancreatic postduodenal portal vein (PPPV). Prepancreatic preduodenal portal veins are rare, with approximately 100 reported cases globally; PPPVs are even more atypical, with less than 20 documented cases globally. Despite the extremely low occurrence, PPPV knowledge and recognition are important, especially for hepatobiliary-pancreatic (HBP) surgeries, such as pancreaticoduodenectomy (PD) for patients of a PPPV. Here, we report a case of PPPV and a literature review.Case presentationA 73-year-old-male with ampullary carcinoma underwent PD at our hospital. Preoperative enhanced CT revealed an abnormal L-shaped PV, identified as a PPPV. Both the PPPV and the postpancreatic “normal” superior mesenteric vein (SMV) divaricated from the SMV at the caudal side of the pancreas. A splenic vein and inferior mesenchymal vein flowed into the postpancreatic “normal” PV, which encircled the common bile duct and potentially flowed into the liver, forming a cavernous transformation at the hilar plate. During surgery, we attempted to isolate the PV from the pancreas and common bile duct. However, it was difficult to isolate from the pancreas. The PPPV was so fragile that bleeding from the PPPV became uncontrollable. To remove the tumor, we resected the PPPV and reconstructed a “normal” PV as an autogenous graft. To maintain intraoperative hepatic blood flow and avoid small bowel congestion, an antithrombogenic bypass catheter was placed between the SMV and umbilical vein during reconstruction. After surgery, several complications occurred, such as PV thrombosis and hyperammonemia. The patient was discharged on postoperative day 45.ConclusionsPPPV is a rare vascular variant but is easily diagnosed preoperatively due to its distinct shape on CT imaging. However, isolating the PPPV from the pancreas and bile duct is incredibly difficult and potentially associated with increased operative risks and postoperative complications. PV resection rather than isolation is a potential solution to reduce the risk of hemorrhage, even in the absence of invasion.