Late Complication Rate Research Articles

Comparative Safety and Effectiveness of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Obese Elder Patients: a Systematic Review and Meta-analysis.

This study aimed to compare the safety and effectiveness of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients aged 60years old or older. The available literature was searched for eligible studies up to November 2019. The meta-analysis was performed by the RevMan 5.3 software. This meta-analysis involved nineteen studies. The rates of early and late complications in RYGB were much higher than those in SG. More specifically, within 30days after surgeries, leak, urinary tract infection, obstruction, and death occurred more often in the RYGB group. The above differences may lead to higher rates of hospital readmission and return to the operating room. RYGB was superior to SG in terms of remission of hypertension and the 1-year follow-up weight loss outcome, while there were no differences in terms of remission of type 2 diabetes (T2D) and obstructive sleep apnea (OSA) as well as weight loss outcomes during 2- and 3-year follow-up. SG was the preferable option to RYGB for patients aged 60years old or older, as SG has been shown not inferior to RYGB in terms of effectiveness, while being safer than RYGB.

Laparoscopic Mini- Gastric Bypass in Management of Morbid Obesity A Prospective Study

Background: In recent years, a surgical technique known as single-anastomosis gastric bypass (SAGB) or minigastric bypass (MGB) has been developed. Its frequency of performance has increased considerably in the current decade. This procedure proposes a simplification of Roux-en-Y bypass by performing a single anastomosis, with a significant reduction of technical complexity, shorter operative time and a potential reduction in morbidity and mortality. Objective: This study aimed to evaluate if laparoscopic mini gastric bypass operation is safe and effective for treatment of different cases with morbid obesity and its associated comorbidities Material and methods: This was a prospective study of 100 patients with morbid obesity submitted to laparoscopic MGB from March 2018 to January 2019. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: The most important findings of this study were the safety and the high efficacy, which were translated into no mortality, very acceptable complications (early complication rate 4% and late complication rate 6 %). High excess weight loss (EWL) 72.26 ± 5.18 % and remission rate 92% of patients who had diabetes, as 100.0% of patients who had fatty liver, 96.0% of patients who had hyperlipidemia, 95.0% of patients who had sleep apnea and 94.0% of patients who had hypertension. Conclusion: MGB/ one-anastomosis gastric bypass (OAGB) is a simple, safe, effective, easy to learn and easy to reverse procedure. It has acceptable complications and mortality rates.

Laparoscopic Mini- Gastric Bypass in Management of Morbid Obesity A Prospective Study

Background: In recent years, a surgical technique known as single-anastomosis gastric bypass (SAGB) or minigastric bypass (MGB) has been developed. Its frequency of performance has increased considerably in the current decade. This procedure proposes a simplification of Roux-en-Y bypass by performing a single anastomosis, with a significant reduction of technical complexity, shorter operative time and a potential reduction in morbidity and mortality. Objective: This study aimed to evaluate if laparoscopic mini gastric bypass operation is safe and effective for treatment of different cases with morbid obesity and its associated comorbidities Material and methods: This was a prospective study of 100 patients with morbid obesity submitted to laparoscopic MGB from March 2018 to January 2019. This study was conducted in the Bariatric Surgery Unit, at Assuit university hospital and Osama Taha group clinic. Demographic and clinical data were prospectively collected from the preoperative evaluations. Results: The most important findings of this study were the safety and the high efficacy, which were translated into no mortality, very acceptable complications (early complication rate 4% and late complication rate 6 %). High excess weight loss (EWL) 72.26 ± 5.18 % and remission rate 92% of patients who had diabetes, as 100.0% of patients who had fatty liver, 96.0% of patients who had hyperlipidemia, 95.0% of patients who had sleep apnea and 94.0% of patients who had hypertension. Conclusion: MGB/ one-anastomosis gastric bypass (OAGB) is a simple, safe, effective, easy to learn and easy to reverse procedure. It has acceptable complications and mortality rates.

Sleeve gastric resection, rate of weight reduction, common early and late complications in GIT center of south of Iraq

Sleeve gastric resection, rate of weight reduction, common early and late complications in GIT center of south of Iraq

Safety and Efficacy of the Tracheobronchial Bonastent: A Single-Center Case Series

Background: Tracheobronchial stents are widely used devices in interventional pulmonology; however, the current literature on the effectiveness and complication rates of the different types of stents is limited. Objective: We report the largest case series of airway Bonastent placement and describe the efficacy and early (<30 days) and late (≥30 days) complication rates. Methods: We performed a retrospective review of our prospectively collected database of patients who underwent therapeutic bronchoscopy with stent placement. All adult patients who had a tracheal/bronchial Bona­stent placed between July 1, 2017, and July 30, 2019, for any indication at our institution were included. The efficacy as well as intraoperative and short- and long-term complications of Bonastent placement were evaluated. Results: Sixty Bonastents were placed in 50 patients. The etiology was malignant in 90% of the cases, while 2 patients had a tracheoesophageal fistula. All procedures were performed via rigid bronchoscopy. The most common location for stent placement was the bronchus intermedius, followed by the trachea, in 32 and 30% of the cases, respectively. Seventy percent of the patients (35/50) had improvement of respiratory symptoms within 30 days. Twenty-eight stents (48%) were removed at a mean of 74 days. Seventeen patients (34%) died within 30 days of stent placement. The overall complication rate was 54% (27/50 patients) at a mean follow-up of 111 days. The stent-related complication rate was 23.3% (14/60 cases) within <30 days and 53% (18/34 cases) at ≥30 days. Conclusions: The tracheobronchial Bonastent is effective for the treatment of patients with central airway obstruction and tracheoesophageal fistulae with an acceptable safety profile.

Secondary "Hybrid Reconstruction" Concept with Silicone Implants After Autologous Breast Reconstruction - Is It Safe and Reasonable?

BackgroundThe use of autologous tissue for breast reconstructive surgery following mastectomy has become routine and allows for excellent symmetry and aesthetic results. However, in some cases, the amount of tissue available from the utilized flaps is not enough to achieve the desired outcome. The use of autologous fat grafting, as well as other techniques, has been described to deal with such problems. However, though well-established, these techniques may also fail to achieve the desired results. The aim of this study was to highlight the opportunity to improve aesthetic results using a secondary prosthesis underneath the previously used free flap and to examine whether this is a safe and reasonable procedure.Material/MethodsIn our study we included patients with unsatisfied aesthetic results after free flap procedures (DIEP, S-GAP, TMG, and FCI) between 2011 and 2018. In each case described, a secondary prosthesis was placed underneath the original flap in order to improve symmetry, shape and projection. Patient age, indication for surgery, adjuvant therapy, complications and outcomes have been registered. A 12-point scale was established to analyze patient satisfaction and aesthetic outcome.ResultsOverall “operative success” was achieved in all 13 patients (14 flaps) evaluated. At 12 months after reconstruction, all aesthetic scores collected were between good and excellent. In contrast to other studies, we chose a secondary approach for the flap augmentation and we used the epipectoral pocket for the placement of the implant. In our series, low rates of early and late post-operative complications were observed, with a high overall rate of satisfaction.ConclusionsThe demonstrated “Hybrid Breast Reconstruction” approach, using an implant underneath a free flap autologous breast reconstruction, provided a safe and reliable option to optimize breast reconstruction outcomes.

Laparoscopic mini/one anastomosis gastric bypass: anatomic features, imaging, efficacy and postoperative complications.

Laparoscopic mini/one anastomosis gastric bypass (MGB/OAGB) is an increasingly used bariatric surgical procedure. This surgical technique is effective in terms of both weight loss and the resolution of comorbidities, but it is not without complications. To report our experience in MGB/OAGB, assessing comorbidities and complications, and to illustrate post-surgical anatomy and radiological appearance of complications, a single-centre retrospective study of 953 patients undergoing MGB/OAGB between January 2005 and September 2018 was done. The inclusion criteria: body mass index (BMI) of 40kg/m2 or higher or BMI between 35 and 40kg/m2 with significant comorbidities not responsive to medical therapies. In the postoperative period, all patients were evaluated with clinical and laboratory tests and radiological examinations (upper gastrointestinal series, computed tomography and magnetic resonance imaging). Median weight was 126.69kg and mean BMI was 49.4kg/m2. Regarding comorbidities, 37.2%, 52.8%, 46.7% and 43.2% of patients presented with preoperatively diagnosed type 2 diabetes mellitus (T2DM), hypertensive disease, dyslipidaemia and obstructive sleep apnoea syndrome (OSAS), respectively. Median excess weight loss at 6, 12, 24 and 60months after surgery was 33.45%, 53.81%, 68.75% and 68.80%, respectively. The remission of comorbidities was 91.4% for T2DM, 93.7% for hypertensive disease, 90.3% for dyslipidemia and 93.4% for OSAS. Early and late complication rates identified with radiological examinations were 1.5% and 1.6%, respectively. MGB/OAGB was effective for weight loss and comorbidities remission. Complications occurred at lower rate than with other surgical procedures were identified with imaging; CT was the main radiological technique.

Long-term Surgical Outcome and Risk Factors in Living Kidney Donors

ContextStudies on the surgical outcome in living kidney donors mainly report perioperative complications with short follow-up. ObjectiveThe objectives of this study are to evaluate the long-term surgical outcome in living kidney donors and to identify donors with an increased risk for a complicated postoperative course. Basic ProceduresA prospectively collected database of 496 living kidney donors at the Department of General, Visceral, and Transplantation Surgery of the Ruprecht Karls University Heidelberg was retrospectively analyzed in a retrospective, observational single-center study. ResultsThe median follow-up time was 37 months. The perioperative severe complication (Clavien-Dindo IIIb) rate was 2.8%, the early postoperative (PO) severe complication rate (1-3 months post operation) was 0.7%, and the late PO severe complication rate (> 3 months post operation) was 8.4%. In multivariate analyses, male sex was associated with higher overall perioperative complication rate (odds ratio [OR], 1.930; P = .005) as well as higher rate of late PO complications (OR, 2.243; P = .014). An increased body mass index was associated with a higher late and severe (Clavien-Dindo ≥ IIIb) PO complication rate (OR, 1.107; P = .009 and OR, 1.105; P = .008, respectively). Conclusions and RelevanceLong-term surgery-associated severe complications occur in 8.4% of kidney donors. Older age is associated with an increased operative time, greater intraoperative blood loss, and longer PO hospital stay. Male donors and donors with an increased body mass index have a higher risk for a complicated PO course after kidney donation. Within a shared decision-making process before living kidney donation, special awareness should be brought to these facts.

ASO Author Reflections: Major Late Complication Rates are Higher for Patients Who Underwent Iterative CRS\HIPEC When Compared to a Singular Procedure.

ASO Author Reflections: Major Late Complication Rates are Higher for Patients Who Underwent Iterative CRS\HIPEC When Compared to a Singular Procedure.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis.

PurposeThis study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer.MethodsA total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC.ResultsMedian disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality.ConclusionAlthough the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

The Bovine Pericardium Matrix in Immediate Implant-Based Breast Reconstruction.

Acellular dermal matrices have been introduced to optimize direct-to-implant breast reconstruction. We selected a bovine pericardium noncross-linked matrix. The study consists in the retrospective analysis of 123 patients (141 breasts) who underwent conservative mastectomy and immediate implant-based breast reconstruction with bovine pericardium matrix Veritas® from March 2012 to October 2017. The overall rates of early and late complications, after a median follow-up of 51.84months, were, respectively, 37.6% and 24.1%. The most noticeable early complications were flap ischemia [n = 39 (27.7%)], hematoma [n = 5 (3.6%)], marginal skin flap necrosis [n = 5 (3.6%)] and dehiscence of the surgical wound [n = 2 (1.4%)]. The most common late complications were rippling [n = 18 (12.7%)] and seroma [n = 4 (2.8%)]. The rate of clinically relevant capsular contracture was low: 12.1% (n = 17) presented grade II and only 2.1%% (n = 3) grade III. Implant substitution became necessary for five patients (3.6%). Early complications occurred more frequently in patients undergoing therapeutic mastectomy (p = 0.031). Patients undergoing preoperative radiotherapy more frequently developed late complications (p = 0.012). A clinically relevant capsular contracture (grade II-III) was found in higher average patients age (p = 0.0019). The left side developed less frequently late complications except for rippling (p = 0.002). Rippling occurred more frequently in patients who sustained a nipple skin-sparing mastectomy (p = 0.035). Our results further support the safety of Veritas® in immediate implant-based breast reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Unilateral versus bilateral endoscopic stenting in patients with unresectable malignant hilar obstruction: a systematic review and meta-analysis.

Background and study aims Endoscopic stent placement is used for palliative management of unresectable malignant hilar obstruction, which could be achieved by either unilateral or bilateral stent insertion. Materials and methods A literature search was performed to identify studies that reported outcomes of metallic biliary stent placement in patients with malignant hilar obstruction. Weighted pooled rates (WPR) along with 95 % confidence intervals (95 %CI) were calculated to determine and compare outcomes including technical and functional success, early and late adverse events, post procedure cholangitis, and stent occlusion between two groups. Results A total of 21 studies with 1292 patients were included. WPR of technical success was significantly higher in the unilateral group (97 %, 95 %CI: 93 –98 %) vs. bilateral group (89 %, 95 %CI: 84 –92 %) ( P = 0.0.003). WPR for functional success in the unilateral and bilateral groups were 96 % (95 %CI: 91 –98 %) and 94 % (95 %CI: 91 –97 %), respectively ( P = 0.48). The rate of early and late complications was comparable between the two groups. Conclusion In patients with unresectable malignant hilar obstruction, unilateral and bilateral metallic stenting techniques are comparable in terms of efficacy and safety.

Outcomes of ileal conduit urinary diversion in patients with multiple sclerosis.

The objective of this study was to report the long-term outcomes and complications of patients with multiple sclerosis (MS) who underwent noncontinent urinary diversion to treat lower urinary tract symptoms (LUTS). A retrospective study included all adult patients with MS who underwent an ileal conduit urinary diversion between 2000 and 2015. Early postoperative complications were reported as well as long-term complications, reoperation rates, and renal function. Overall, 91 patients were included. The surgery was indicated for refractory urinary incontinence (n = 73), renal failure (n = 8), major perineal skin ulcer due to urinary incontinence (n = 6), and recurrent urinary tract infections (n = 4). The median follow-up was 50 months (range, 3-158 months). A significant reduction (P < .05) of postoperative nonobstructive pyelonephritis rate was observed. There was no significant difference between preoperative and postoperative renal function (P = .32). Early postoperative complications were reported in 24 patients (26%): 4 Clavien I, 6 Clavien II, 9 Clavien III, 4 Clavien IV, and 1 Clavien V. Nine patients required reoperation for these complications (9.9%). Late complications were reported in 28 patients (30.8%): 8 ureteral anastomosis stenosis, 2 stoma stenosis, 2 incisional hernias, 6 kidney or ureteral lithiasis, and 10 pyelonephritis. Among them, 15 patients (16.5%) required reoperation for late complications. Noncontinent urinary diversion using ileal conduit appears to be an effective end-stage solution in MS patients. The perioperative morbidity rate of 26% and the late complication rate of 31% should be considered to better inform patients before the surgery.

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience.

Objective Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction. Methods This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel. Results Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% ( n = 8) and 5.9% ( n = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% ( n = 26), while 12.6% ( n = 15) of the patients had late postoperative CNS complications. Conclusion Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.

Metallic biliary stenting versus surgery for palliation of inoperable distal malignant obstructive jaundice

Background Pancreatic and biliary malignancies are rarely operable. The role of intervention is to palliate jaundice. Biliary drainage can be done by surgical bypass or biliary stenting either percutaneously or by endoscopic retrograde cholangiopancreatography. Plastic and expandable metal stents (EMS) are available.Aim To compare metallic biliary stenting versus surgery for palliation of inoperable malignant obstructive jaundice due to unresectable pancreatobiliary cancer.Patients and methods This retrospective, cohort study included 43 patients, presented by malignant obstructive jaundice due to unresectable pancreatobiliary cancer. They were divided into two groups: group I (20 patients) underwent palliative biliary-enteric surgical bypass; group II (23 patients) underwent endoscopic retrograde cholangiopancreatography and metal stent drainage.Results This study showed that both surgical bypass and EMS insertion have similar short-term satisfactory results in the control of jaundice. Surgical bypass had low incidence rate as regards late complications, although gastric outlet obstruction may occur for patients without gastric bypass. Despite EMS resulted in a shorter hospital stay, the higher late complications rate raised the cost, especially stent occlusion.Conclusion Endoscopic EMS and surgical bypass had similar results according to the efficacy of biliary drainage and mean survival period. EMS had a shorter hospital stay and fewer early complications. But, in the long run, surgical bypass results in less recurrent jaundice than the EMS but higher morbidity and mortality.

The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis.

Offering iterative cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for recurrence of peritoneal carcinomatosis (PC) poses a surgical dilemma. Safety of this repeatedoperation in the short and long term has not been largely investigated. Patients with PC who underwent 377 CRS/HIPEC procedures between 2007 and 2018 at our institution were included from a prospectively maintained database. Outcomes for patients who had singular CRS/HIPEC were compared with those forpatients who had repeated CRS/HIPEC. Overall, there were 325 singular and 52 iterative CRS/HIPEC procedures performed during this time period. Age, sex, and ASA class were comparable between cohorts (p = NS). Optimal cytoreduction, mean operative time, mean length of hospital stay, 90-day major morbidity, and 90-day mortality were also similar. At a median follow-up of 24months, there was no significant difference in recurrence rate (%, 60 vs 63, p = 0.76), disease-free survival (mean months, 19 vs 15, p = 0.30), and overall survival (mean months, 32 vs 27, p = 0.69). The iterative CRS/HIPEC group had significantly higher rates of major late complications than the singular CRS/HIPEC group (%, 18 vs 40, p < 0.01). Repeated CRS/HIPEC for PC has similar perioperative morbidity and mortality, as well as long-term oncological benefits, when compared with singular CRS/HIPEC. However, more than twice as many patients undergoing iterative CRS/HIPEC suffered from major late complications.

A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis

PurposeTo systematically and comprehensively evaluate the differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus sleeve gastrectomy (LSG) in obese patients.MethodsA systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018. The meta-analysis was performed by the RevMan 5.3 software.ResultsTwenty-three articles with 7443 patients were included. In short term (< 3 years), LRYGB was superior to LSG in terms of improving comorbidities (T2D, odds ratio (OR) 1.93, 1.06–3.52, P < 0.05, hypertension, OR 1.59, 1.08–2.34, P < 0.05, dyslipidemia, OR 1.61, 1.05–2.46, P < 0.05), but there were no differences in the midterm and long term. Quality of life (QoL) after bariatric surgery was included, but no differences were observed in the QoL after LRYGB or LSG (gastrointestinal quality of life index (GIQLI) and Moorehead–Ardelt quality of life questionnaire (M-A-Q), P > 0.05). LRYGB achieved a higher EWL% than LSG (after 3 years, WMD 5.48, 0.13–10.84. P < 0.05; after 5 years, WMD 4.55, 1.04–8.05, P < 0.05) in long term, but no significant differences were found during 0.25- to 2.0-year follow-up. The rate of early and late complications was much higher in LRYGB than in LSG (early complications, OR = 2.11, 95% CI = 1.53–2.91, P < 0.001; late complications, OR = 2.60, 95% CI = 1.93–3.49, P < 0.001).ConclusionsThis meta-analysis showed that LRYGB was more effective than LSG in comorbidities’ resolution or improvement in short term. For weight loss, LRYGB had better long-term effects than LSG. In addition, no differences were observed in the quality of life after LRYGB or LSG. LRYGB was associated with more complications than LSG.

The Results and Rationale of Tevar Procedure for Type B Intramural Hematoma of Aorta

Introduction: Aortic intramural hematoma (IMH) is one of the major acute aortic syndromes with potential lethal complications. The one involving aorta distal to innominate artery is referred to Type B IMH (BIMH) and is now mainly treated medically under careful surveillance and repetitive computing tomography (CT) follow-up[1]. For complicated IMH, it means relapsed chest pain, periaortic hemorrhage, presence of intimal disruption, or enlarging IMH, and is recommended to undergo invasive intervention [1][2]. We aim to analyze the effectiveness and outcome of thoracic endovascular aortic repair (TEVAR) as primary management of BIMH patients with variable indications in our hospital and attempt to establish rationale accordingly. Methods: From January 2015 to July 2018, 41 complicated BIMH patients treated with TEVAR were retrospectively reviewed. Initial CT images focusing on aorta diameter, IMH thickness, and intimal disruption along with surgeons' and peer reviewer's indication were presented. Procedure details, postoperative results including mortality, complication, and re-intervention events, the remodeling of aorta, and occurrence of new ulcer like projection (ULP) or intramural blood pool (IBP) during follow-up were recorded as outcome. Results: Among 41 patients, one had aorta maximal diameter >55mm, 87.8% had IMH thickness >1cm, 17.1% had intimal disruption depth >1cm, and only 7.3% met indication for classic penetrating aortic ulcer (PAU) standard (>2cm width and >1cm depth), whereas surgeons' recorded 58.5% of IMH with PAU as operative indication. IBP could be found in 51.2% patients [Table1]. There was one technique failure due to critical aorto-iliac occlusive disease. Mean 2.1 aortic stents were deployed, most were proximal Zone 3 and distal T9th landing; furthermore, 8 Chimneys, 2 coil emboli and 1 ex vivo fenestration to left subclavian artery were applied. Patients were discharged on post-op day 2-95 (mean 8.3). Nine patients were lost to follow-up. There was 0 early-mortality and 7 all cause late-mortality (17.1%). One was aorta-related. Early complications rate was 26.8%, including iliac occlusion, brain emboli, progressive paraplegia, pneumonia etc. Late complications rate was 31.7%, including proximal/distal stent-induced new entries, new ULPs and abdominal aortic aneurysm rupture etc. Re-intervention rate was 7.5%, mostly procedure-related (4/6). 84.4% had healing of target segment. 53.1% had complete thrombosis of native aorta. Up to 37.5% follow-up patients developed new ULPs or IBPs [Fig1]. Conclusion: The diagnosis of PAU is not standardized, for a large portion of patients with small and shallow ULPs/IBPs or tiny intimal disruption (TID) were treated as IMH with PAU. As for the procedure itself, TEVAR towards complicated BIMH is effective in eradicating initial intimal tears and preventing aortic related death but carries relatively high procedure-related complications. Besides, high incidence of new ULPs/IBPs in other aortic segments with uncertain causation makes the initial intention questionable.Table 1ULP/TID/IBP lesions in type B IMHFigure 1New ULPs/IBPs development after TEVARView Large Image Figure ViewerDownload Hi-res image Download (PPT) Disclosure: Nothing to disclose

National questionnaire on skills and techniques in pediatric tracheotomy surgery in Turkey

ObjectiveThe aim of the study was to determine the differences in surgical preferences of ENT Surgeons in Turkey with regard to pediatric tracheotomy. DesignQuestionnaire study. ParticipantsENT Surgeons. Materials and methodsThe national multiple-choice questionnaire study included a total of 16 questions about physicians technical preferences, different methods and complications in pediatric tracheotomy surgery. It was planned and implemented with the support of a professional survey company (www.surveymonkey.com). ResultsThe questionnaire was answered by 591 ENT Surgeons; the percentage of the physicians performing pediatric tracheotomies in the previous year was 59.6%. Forty point four percent (40.4%) of the physicians had not performed tracheotomies in the pediatric age group and 57.9% had not performed tracheotomies in patients under one year old. Seventy point six percent (70.6%) of the physicians who had performed tracheotomies had made vertical skin incisions, 69.5% of them had removed subcutaneous adipose tissue, 81.4% of them had retraction the thyroid isthmus area from their field of view; 83.9% of them had made a vertical incision to the trachea, 82.5% of them had applied a stay suture to the trachea and 4.7% of them had used additional techniques for stoma maturation. The intraoperative mortality, early complication, late complication, and total complication rates were 3.9%, 32.7%, 21.2% and 53.9 respectively. ConclusionsThis is the first large-scale questionnaire study with data on pediatric tracheotomy techniques and the practices of ENT Surgeons at a national level. Common approaches were observed among the.

Analysis of Outcomes of Younger (≤ 55 Years) Compared with Older (> 55 Years) Patients with Chronic Lymphocytic Leukaemia (CLL) in Seven Studies Conducted By the German CLL Study Group (GCLLSG)

Analysis of Outcomes of Younger (≤ 55 Years) Compared with Older (> 55 Years) Patients with Chronic Lymphocytic Leukaemia (CLL) in Seven Studies Conducted By the German CLL Study Group (GCLLSG)