Intraoperative Andpostoperative Complications Research Articles

Cardiac lipoma causing obstructive sleep apnea: A case report

Introduction. Cardiac lipomas are rare benign cardiac tumors. The symptoms they cause and the diagnosis depend on their size and location. Case Report. We report the case of a 69-year-old male, whose main symptom was progressive dyspnea on exertion and in the supine position. The diagnosis of a large subepicardial lipoma in the wall of the right atrium, causing superior vena cava compression and consecutive obstructive sleep apnea syndrom, was made using different imaging techniques. The patient underwent open heart surgery, and the tumor was extracted with no intraoperative and postoperative complications. During a 1-year follow up, he remained asymptomatic, with no clinical signs of obstructive sleep apnea after the surgery. Conclusion. When it comes to the diagnosis and treatment of obstructive sleep apnea, cardiac tumors should be considered.

Omission of the Bladder Flap Suggests Short Term and Long Term Benefits

Background: Cesarean section is now the most common major surgical procedure performed on women worldwide. With the increasing numbers of cesarean sections, there is the need to utilize evidence based techniques to optimize outcomes and minimize complications. We hypothesize that omission of the bladder flap in both primary and repeat cesarean sections will be associated with shorter operating time without a significant increase in intraoperative and postoperative complications. Methods: 550 patients were enrolled in the study. They were randomly allocated in the 2 groups to evaluate the effects of cancelling the bladder dissection. Results: Significant reduction of the total operating time (p = 0.01), skin to delivery time (p = 0.02) and micro-hematuria (p = 0.01) in group with bladder omission. Long term result: Including more bladder adhesion and fibrosis in the cases with bladder dissection. Conclusions: Omission of the bladder dissection achieved short-term advantages as regards reduction of operating time, incision-delivery duration and decreased blood loss as well as long-term effects include different in the bladder adhesion.

Intra-Operative Complic atio n of Lumbar Kyphoplasty Instrumentatio n in Non-Osteoporotic Patients with Compression Fractures

Background: Vertebral augmentation is a surgical procedure used to stabilize fractured vertebrae and reduce pain in patients with compression fractures. When intra-operative and post-operative complications do occur, they can have dire consequences. Some of the common risks associated with kyphoplasty are worsening of the fracture, infections, spinal cord compression, etc. Typically, we do not consider the risk of instrumentation failure. Objectives: In 2 cases, we describe patients who has undergone kyphoplasties with live fluoroscopic guidance. Both procedures used a unipedicular approach and the CareFusion system (Becton Dickinson, Franklin Lakes, NJ). The CareFusion AVAFlex curved augmentation needle was used, and intra-operatively the handle broke off at the neck making it difficult to remove the cannula and curved needle. To remove the system, an Arthrex Reamer (Arthrex Inc., Naples, NY).was used with Chuck Key (Arthrex Inc., Naples, NY). Study Design: Case report. Setting: Outpatient Interventional Pain Clinic. Methods: The vertebral body was accessed with an AVAFlex curved needle, a CareFusion AVAMax vertebral balloon, and Cement injection with polymethylmethacrylate, were used. The removal of the AVAFlex cannula was attempted with a gripping and pulling motion of the blue handle on the cannula, which resulted in the handle breaking at the most distal portion of the cannula. The cannula was then removed using the Arthrex Reamer with Chuck Key. The entire cannula was successfully removed from the vertebral body after cement had been delivered. Results: The density of bone tissue in a traumatic compression fracture of a nonosteoporotic individual will be higher and less porous when placing the needle and cannulas. Also, it is important to have an understanding of the different instruments that are available in the operative setting. Limitations: Small sample size. Conclusion: Instrumentation experience, understanding how to handle instrument failures, bone health of the patient, and the history of mechanism for compression fracture should all be considered when performing kyphoplasty. Key words: Kyphoplasty, vertebroplasty, compression fracture, instrumentation failure

Endospine Surgery Complications in Lumbar Herniated Disc

Spine surgery is entering a new era of evolution, with minimally invasive spine surgery to decompress the neural structures without affecting the stability of the spine. However, complications may occur. The surgeon must have these in mind in order to prevent them. We report on the main intraoperative andpostoperative complications of endospine surgery of lumbar disc herniation. It was a retrospective study spread over 22 years (January 1993-December 2015) concerning 10,433 patients who underwent treatment for lumbar disc herniation at the Endospine Surgery Center Bordeaux France. Among them 1189 patients had 1 intraoperative or postoperative complication. This study comprised 10,433 patients, among whom 1189 had various complications, which represented 11.39%. The average age of this sample was 46 years, and the eldest were 91 years. A male predominance was noted in 6502 of cases with a sex ratio of 6502/3931= 1.65. The complications were recurrences (6.77%) followed by dural tears (1.91%), facet resection (1.14%), two-level approach instead of one (1.09%), radicular lesion (0.17%) that remained with motor or pain symptoms, wrong level and infections such as spondylodiscitis and wound infection, respectively (0.08%) each, deep vein thrombosis (0.04%), and gauze (0.03%). Twenty-two years of follow-up on endospine treatment for lumbar disc herniation showed a low complication rate. An early and efficient management will nevertheless allow a good outcome in the majority of patients operated.

Outcome of cataract surgery in diabetic patients

Introduction. The association between diabetes and cataract formation has been shown in many clinical studies. Development of cataract occurs more frequently and at an earlier age in diabetic patients. Due to the increasing prevalence of diabetes worldwide, the incidence of diabetic cataracts steadily rises. While the overall outcomes of cataract surgery are excellent, patients with diabetes may have poorer vision outcomes than those without diabetes. The objective of this study was to evaluate the visual outcomes (visual acuity and visual function), intraoperative and postoperative complications of cataract surgery, and to assess the final surgical outcomes. Material and Methods. The prospective study included 128 patients (133 eyes) with cataract and diagnosis of diabetes mellitus type 2 at least 5 years prior to cataract surgery, operated at the Eye Clinic, Clinical Center of Vojvodina, Novi Sad. A full medical history included patients? age, the time since the diagnosis of diabetes, current management of diabetes, blood pressure and assessment of glycemic control using glycosylated hemoglobin. All patients underwent complete ophthalmological examination before cataract surgery, and were re-examined 7 days, one and six months after the surgery. Results. The mean age of patients at the time of surgery was 63.5 years (SD ? 6.5, range 57 - 70 years) with mean duration of diabetes 8.5 years. The glycosylated haemoglobin level in the group treated with insulin was 6.8 vs. 8.2 in patients on oral medications (p < 0.05). Diabetes mellitus was accompanied by other systemic diseases in 81 patients (63.28%), whereas 45 of 133 operated eyes (33.83%) had other ocular diseases. Intraoperative complications occurred in 20 of 133 operated eyes (15%): posterior capsular rupture with vitreous loss, intraoperative miosis, iris hemorrhage and suprachoroidal hemorrhage. Conclusion. Cataract surgery with intraocular lens implantation is an effective and safe surgical procedure in diabetic patients, and sight threatening complications are rare. Our study confirmed that visual acuity after surgery in diabetic patients depends on the severity of diabetic retinopathy at the time of surgery.

Comparative evaluation of outcomes of phacoemulsification in vitrectomized eyes: silicone oil versus air/gas group

The purpose of this study is to comparatively evaluate the morphology of cataract, intraoperative and postoperative complications (IPC), and surgical outcomes of phacoemulsification in post 23G vitrectomized eyes in silicone oil versus air/gas group. This prospective interventional clinical study took place in the Dr. RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. Eighty-nine eyes of 89 consecutive vitrectomized patients with cataract were included. All underwent phacoemulsification and evaluated for cataract morphology, surgical difficulties, IPC, visual acuity, and specular count. Mean age of patients was 50.24±15.19years. There were 65 males and 24 females and 48 eyes in silicone oil group and 41 in air/gas group. Combination type was the commonest morphology seen in both silicone oil (52.08%) and air/gas group (70.33%) followed by posterior subcapsular cataract (PSC) in 31.25% silicone group and 12.2% air/gas group. Posterior capsular plaque (PCP) was seen in 41.67% of silicone oil versus 7.32% air/gas group; p<0.005. Pupillary abnormalities were significantly more in oil (31.25%) than in air/gas group (9.76%); p=0.014. Mean duration between vitrectomy and phacoemulsification in oil group versus air/gas group was 8.39±4.7months and 10.9±5.22months, respectively; p<0.005. Mean postoperative logMAR visual acuity was better in air/gas (0.43±0.25) than in oil (0.66±0.29) group, p<0.005. There was no significant difference in mean endothelial cell loss postoperatively in either groups (p=0.25). Morphology of cataract differs in the two groups with PSC being more common in oil group. The mean time of cataract onset was significantly less in patients with oil group, and poor visual outcome in oil group may be attributable to the increased PCP noted.

Complications in Cochlear Implantation at the Clinical Center of Vojvodina.

The first modern cochlear implantation in Serbia was performed on November 26, 2002 at the Center for Cochlear Implantation of the Clinic for Ear, Nose and Throat Diseases, Clinical Center of Vojvodina. The aim of the paper is the analysis of intraoperative and postoperative complications. Major complications include those resulting in the necessity for revision surgery, explantation, reimplantation, severe disease or even lethal outcomes. Minor complications resolve spontaneously or can be managed by conservative therapy and do not require any prolonged hospitalization of the patient. In the 2002-2013 period, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Both intraoperative and postoperative complications were analyzed in the investigated patient population. The analysis encompassed 99 patients, the youngest and the oldest ones being one year old and 61 years old, respectively. The complications were noticed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5%) were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure (4.04%) and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification (1.01%) and transient ataxia (2.02%) occurred rarely. Stimulation of the facial nerve (1.01%), intraoperative perilymph liquid gusher (1.01%), device failure and late infections (1.01%) were recorded extremely rarely. Complications such as electrode extrusion, skin necrosis over the implant or meningitis, which is considered the most severe postoperative complication, have not been recorded at our Center since the very beginning. Absence of postoperative meningitis in patients treated at the Center can be attributed to timely pneumococcal vaccination of children.

Total laparoscopic radical trachelectomy in the treatment of early squamous cell cervical cancer: A retrospective study with 8-year follow-up

ObjectiveThe objective of this study was to evaluate the surgical, oncologic, and obstetrical outcomes of total laparoscopic radical trachelectomy (LRT) in patients with early-stage squamous cell cervical cancer who want to preserve their fertility. MethodsTwenty-five patients with early-stage cervical cancer were treated by total LRT from January 2005 to December 2012. Data regarding operational time, blood loss, intraoperative-and post-operative complications, recurrence, and subsequent pregnancies were recorded. Other published reports on LRT were also reviewed. ResultsThe median age of the patients was 29years (range 22–34years). The median surgical time was 232min (range, 180–340min). The median blood loss was 120ml (range, 50–200ml), and the median length of hospitalization was 3.3days (range, 2–4days). The median time to return to daily activities was 2days (range, 1–3days). No intra-operative complications occurred; three patients had post-operative complications. The median follow-up time was 66months (range, 1–82months), and no recurrences were observed. Twelve patients attempted to conceive during the follow-up, and nine succeeded. ConclusionsIn this retrospective analysis, total LRT was an effective and safe procedure for patients with early-stage cervical carcinoma who wished to preserve fertility. A larger prospective study with long-term pregnancy and survival analyses is warranted.

Maternal and Neonatal Outcomes in Elective versus Emergency Cesarean Section in Zagazig University Hospitals

The evolution of cesarean section during this century is a relatively safe procedure. It isgenerally accepted that a planned operation often does better in terms of morbidity than oneperformed as an emergency. The aim of the present study were to find out indications forelective and emergency CS and to compare elective and emergency CS regarding intraoperativeand postoperative complications in both mother and her newborn. A prospectivedesign was selected in carrying out this study and a representative sample of 400 parturientwomen (200 with elective CS and 200 with emergency CS) were recruited for this study inthe Maternity hospital at Zagazig University. The tools used for data collection were; aninterview questionnaire sheet, a clinical assessment form, the partograph, a summary of laborsheet and a neonatal assessment sheet. The results of the present study revealed that therewere no statistical significant differences in intra-operative and postoperative complicationsbetween two groups. Additionally, women who had elective cesarean section had a highermean apgar score at the first and fifth minutes (7.7 ± 1.2 and 9.2 ± 1.3) than those who hademergency cesarean section (6.9 ± 1.0 and 8.3 ± 1.5). It can be concluded that, the womenwho had emergency CS were younger than 25 years, had less mean number of gravida andpara and had lack of antenatal care attendance than those who had elective CS. The studyrecommended that: higher incidence of emergency cesarean section is associated with intraoperativeand postoperative complications, so cesarean should be done at earliest possibletime to reduce drastic outcome.

A Surgical Technique of Medial Patellar Luxation in Dogs

Medial patellar luxation is a displacement of the patella from the trochlear sulcus, a common cause of lameness in small-breed dogs, but also occurs in large-breed dogs . Without an adequate treatment, medial displacement of the quadriceps muscle group, lateral torsion of the distal femur, a lateral bowing of the distal one third of the femur, femoral epiphyseal dysplasia, rotational instability of the stifle joint, or tibial deformity can occur. The grades of luxation (4 grades) and the best therapeutic management can be established after the signalment, history, diagnostic imaging and physical examination findings. A 9-month-old female was presented for an intermittent weight-bearing lameness at left hindleg. The leg holded in a flexed position at steps, patella luxated medially most of the time and medial displacement of the quadriceps muscle group were the physical examination which included the disease in grade 3 of medial patellar luxation . Under general inhalatory anaesthesia, the method performed was trochlear resection. After a lateral parapatellar arthrotomy, the technique consisted in removing of the articular cartilage and bone from femoral trochlea with a rongeur. Medial and lateral trochlear ridges were made parallel to each other and the base of the groove perpendicular to each trochlear ridge, so the new groove could accommodate 50% of the height of patella. After trochlear resection, two layers of interrupted mayo matress sutures (polyester 1-0) were done for a lateral capsular imbrication. No major intraoperative and postoperative complications were noted. The local swelling of stifle decreased progressively in the first days postoperative due to anti-inflamatory drugs (carprofen). A long-term sample protocol of physical rehabilitation consisting in exercises (massage, passive range of motion, swimming, criotherapy) was recommended. The normal function of the leg was observed after 12 weeks postoperative. Our case confirm that the trochlear resection is a simple surgical procedure which can reestablish the normal alignment of the patellar complex mechanism, but it should only be performed when a recession procedure or a lateral imbrication are impossible, because removing the articular cartilage of the trochlea allows articulation of the patella on the rough cancellous surface, which results in wearing of patellar articular cartilage in time.

Treatment of Vault Prolapse: Laparoscopic versus Open Sarcocolpopexy

Pelvic organ prolapse is one of the common problems for parous women.A literature review of published articles was done to determine the bestmethod of treatment for pelvic prolapse mainly laparoscopic and openlaparotomy methods. Electronic search made via medline, google andspringer link using the keywords laparoscopic/open sarcocolpopexyand vault/organ prolapse and relevant articles were reviewed. More than2000 patients included in this review and the results showedthat laparoscopic sacrocolpopexy has shorter hospital stay 1-1.8days in the as compared to the laparotomy group which is 4-5.8 days(p < 0.005). Regarding estimated blood loss laparoscopy has less bleedingcompared to laparotomy (172 +/� 166 mL vs 234 +/� 149 mL; P = .04).But the operation time is longer with this method, mean operation timeis 223(+/�24) minutes for the laparoscopic group and 195 (+/�45)minutes for the abdominal sarcocolpopexy group. Other complicationslike mesh erosion up to 5% is the same for both procedures. The chanceof recurrence10-20% after sarcocolpopexy is a possibility for bothmethods with short and long-term period of follow-up 3 months to 13years. In conclusion laparoscopic approach has favorable outcome ifproperly done by skilled surgeon especially with decreased hospitaltime and operation time.Aims and objectives: The aim of the study was to compare theeffectiveness and safety of laparoscopic and conventional openabdominal sarcocolpopexy in the treatment of pelvic organ prolapse.Parameters evaluated for both methods include patient selection,operative technique, and operative time, intraoperative andpostoperative complications. Evaluation was also done for postoperativemorbidity, hospital stay, cost effectiveness and short-termand long-term quality of life.Materials and methods: A literature search was performed usingMedline and search engines�, Google, Springer link and Highwire press.The following search terms were used laparoscopic sacrocolpopexy,pelvic organ prolapse, vault prolapse, suspension treatment.1640citations were found in total and selected papers were screened forfurther references. Criteria for selection of literature were the numberof cases (excluded if less than 20), method of analysis (statistical ornonstatistical), operative procedure (only universally acceptedprocedures were selected) and the institution where the study wasdone (specialized institution for laparoscopy surgery).

Complications in laparoscopic surgery

The development of technology and improvement of laparoscopic equipment enhanced expansion laparoscopic surgeries. Various operations performed using classical operative approach are nowadays done laparoscopic technique. The expansion of the repertoire, the performance of most complicated surgical procedures and increase in the number of laparoscopic interventions result in the increased number of intraoperative and postoperative complications. They occur due to the basic disease that is the cause of surgery and surgical procedure, but also due to other factors. We cannot influence the very disease - it is the reason for surgical treatment. However, we can make some changes in approach concerning the laparoscopic technique, which can considerably influence possible development of complications. This involves a different approach to the operative field, but also to very surgery. In laparoscopic surgery such approach causes specific intraoperative and postoperative complications. These complications are mainly caused by technical factors, such as the quality of the equipment, instruments and human factors, such as inexperience, insufficient education and excessive self-assurance. To decrease the frequency of intraoperative and postoperative complications in laparoscopic operations we require perfect equipment and instruments, education in a referent institution, but also everyday training with laparascopic equipment and experimental animals.

Cataract surgery in previously vitrectomized eyes

To evaluate the results of extracapsular cataract extraction (ECCE) and phacoemulsification (PHACO) performed in previously vitrectomized eyes. In this retrospective study, 56 vitrectomized eyes that had ECCE and 60 vitrectomized eyes that had PHACO were included in the study group while 65 eyes that had PHACO in the control group. The evaluated parameters were the incidence of intra-operative and postoperative complications (IPC) and visual outcomes. Chi-squared, independent samples and paired samples tests were used for comparing the results. Deep anterior chamber (AC) was significantly more common in the PHACO group of vitrectomized eyes (PGVE) and observed in eyes that had undergone extensive vitreous removal (p < 0.05). Except for this there were no significant differences in the rate of IPC between the ECCE group and the PGVE (p > 0.05). Some of the intra-operative conditions such as posterior synechiae, primary posterior capsular opacification (PCO) and postoperative complications such as retinal detachment (RD), PCO were significantly more common in vitrectomized eyes than the controls (p < 0.05). There was no significant difference in the visual acuity gain between the ECCE group and the PGVE (p > 0.05). Deep AC is more common in eyes with extensive vitreous removal during PHACO than ECCE. Decreasing the bottle height is advised in this case. Except for this, the results of ECCE and PHACO are similar in previously vitrectomized eyes. Posterior synechiaes, primary and postoperative PCO and RD are more common in vitrectomized eyes than the controls.