Late Postoperative Period Research Articles

Temporal comparison of radiological and functional outcomes in calcaneal fracture surgery with and without iliac crest graft application: Mid- to long-term results

BackgroundThe standard approach for addressing intra-articular calcaneal fractures involves open reduction with plate and screw fixation, with ongoing discourse regarding the application of grafts to address bone gaps. The aim of this study is the temporal comparison of the radiological and functional outcomes in patients undergoing surgery for intra-articular calcaneal fractures, with a specific focus on the use of bone grafts.MethodsThirty patients, comprising 13 with iliac grafts and 17 without, were enrolled in the study. Preoperative and postoperative assessments included Gissane and Böhler angles, Visual Analog Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale, and Kellgreen-Lawrance subtalar arthrosis stages. The average follow-up period was 6.7 years, ranging from a minimum of 3.5 to a maximum of 10 years.ResultsThe Böhler angle exhibited a significant increase (p < 0.001), while the Gissane angle did not show significant changes in the early postoperative period across the entire study group (p = 0.1). Graft-treated patients demonstrated a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values (p = 0.04, p = 0.05). Similarly, patients without grafts exhibited a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values (p = 0.004, p = 0.002). No significant differences were observed between periods in Gissane measurements (p = 0.3), VAS scores, AOFAS scores, and the development of subtalar arthrosis in both grafted and non-grafted patients.ConclusionsEvaluation of patients with calcaneal fractures, both with and without grafts, was conducted using Böhler and Gissane angles, VAS scores, AOFAS scores, and the development of fracture union and subtalar arthrosis, assessing preoperative, early, and late postoperative periods. No significant differences were found between the two groups in terms of clinical and radiological outcomes during mid-to long-term follow-up.Level of evidenceA retrospective cohort study.

The effect of unilateral endoscopic arytenoid abduction lateropexy on swallowing in cases of bilateral vocal fold palsy.

Endoscopic arytenoid abduction lateropexy (EAAL) is a minimally invasive surgical technique for the immediate management of bilateral vocal fold palsy (BVFP). Specifically, it achieves a stable and adequate airway by lateralizing the arytenoid cartilage without resecting laryngeal structures. Thus, this study evaluated the effect of EAAL on swallowing in cases of BVFP. The participants consisted of 17 adult patients (15 female, 2 male) who underwent unilateral EAAL for BVFP. Swallowing function was evaluated by using the fiberoptic endoscopic evaluation of swallowing (FEES) on the 6th postoperative day and in the 6th postoperative month. The results were assessed by using the pharyngeal residue severity scale (PRSS) and the modified penetration-aspiration scale (mPAS). Additionally, the M.D. Anderson Dysphagia Inventory (MDADI) questionnaire was self-administered during the 6th postoperative month. Overall, 16 of the 17 patients demonstrated normal swallowing function during the early and late postoperative periods. Moreover, one patient experienced mild fluid aspiration early on, but initially managed it with dietary adjustments and eventually resolved it with a head flexion compensatory maneuver. There was no significant deterioration in swallowing-related quality of life according to the MDADI assessments. Based on this evaluation of unilateral EAAL, our results confirmed that this procedure is not only a reliable solution for BVFP from the perspective of respiratory function and phonation but also in terms of swallowing quality. 4.

Obesity Impacts Mortality After Cardiac Surgery

Background: Nutritional status can interfere with postoperative morbidity and mortality, but few studies have analyzed patients in the late postoperative period. Objective: To assess the relationship between nutritional status and mortality, complications and length of stay after cardiac surgery. Methods: A prospective longitudinal study, involving patients that had undergone elective cardiac surgery, who were followed up for 180 days. Results: A total of 100 participants, with a mean age of 63.3 years, were included, 61% of whom were men, and 89% of whom were sedentary. A mortality rate of 9% in 30 days and 13% in 180 days were found. Death was not related to physical activity, food, smoking, alcohol consumption and comorbidities. Patients who died had a higher Tuman score. After 6 months, it was observed that the risk of death was 2.17 times higher in those who were obese. Mortality was related to the type of surgery: myocardial revascularization (p &lt; 0.05), complications during surgery (p &lt; 0.001), postoperative complications (p &lt; 0.000) and obesity (p &lt; 0.05). Conclusions: Postoperative mortality is related to obesity, such as surgical complications and the type of surgery performed.

EVALUATION OF RETINAL MICROCIRCULATION CHARACTERISTICS FOLLOWING RHEGMATOGENOUS DETACHMENT

Introduction. Despite advancements in surgical techniques for treating retinal detachment, the risk of vision loss remains significant. Accurate assessment of changes in the macular microvascuature using optical coherence tomography-angiography (OCT-A) can improve predictions for recovery of vision in patients, making this a critical area of focus in modern ophthalmology. Purpose: to analyze changes in the retinal microvasculature following successful vitrectomy for rhegmatogenous retinal detachment (RRD), both with and without macular detachment, and to evaluate their impact on postoperative visual function. Materials and methods. A total of 89 patients were studied. Group I consisted of 47 patients with RRD without macular detachment, while Group II included 42 patients with RRD with macular detachment. Retinal microvasculature parameters were assessed in the late postoperative period (18 months) using OCT-A. All patients underwent closed subtotal vitrectomy, retinal endolaser coagulation, and vitreous tamponade with an octafluoropropane (C3F8) gas-air mixture. Results. In Group II, correlation analysis at 18 months revealed a significant relationship between the density of the deep capillary plexus and best-corrected visual acuity (BCVA) (r = 0.69, p = 0.023). Additionally, a correlation was observed between BCVA and the area of the foveal avascular zone (FAZ) (r = 0.24, p = 0.013). Conclusions. Restoration of the retinal microvasculature continues into the late postoperative period in patients with RRD involving macular detachment. OCT-A parameters, specifically deep capillary plexus density and FAZ area, are significant factors influencing visual function following surgery for RRD.

Study of Influence of Various Methods of Intraoperative Keratoprotection in Phacoemulsification of Senile Cataract on Morphological and Functional State of Ocular Surface Structures in Late Postoperative Period

Purpose: to study the effect of various methods of intraoperative keratoprotection in phacoemulsification (PE) of senile cataract (SC) on morphological and functional state of the ocular surface structures (OSS) in the late postoperative period.Patients and methods. 240 patients (240 eyes) who applied for surgical treatment of SC. Age: 65 ± 4 years. 109 men, 131 women. All patients were divided into three observation groups according to the method of intraoperative keratoprotection: 1st group — 60 patients, corneal irrigation with balanced solution; 2nd group — 60 patients, ophthalmic viscosurgical device was applied to the cornea; 3rd group: 3a subgroup — 60 patients, soft contact lens (SCL) was applied to the cornea; subgroup 3b — 60 patients, SCL impregnated with riboflavin solution was applied to the cornea. In addition to the standard ophthalmological examination, Schirmer I test, OCT-scanning were performed, and tear breakup time (TBUT) was determined.Results. The lowest indicator of Schirmer I test was detected in the 1st group a month after the operation. The indicators did not change 2 months after the operation. There were no significant intergroup differences in the final observation period. The TBUT index in all groups decreased. 3 months after the operation, TBUT in the eyes of 3b subgroup was significantly higher in comparison to other groups. The best state of corneal epithelium thickness (CET) occurred in 3a and 3b subgroups. During the epithelium analysis according to OCT-mapping of the cornea, it was noted that the maximum decrease of CET and the number of defects was detected in the 1st and 2nd groups, and the minimum — in 3a and 3b subgroups at all follow-up periods after surgery. There were no significant intergroup differences in preoperative tear osmolarity. 3 months after surgery, tear osmolarity in patients of 3a and 3b subgroups was significantly lower than in patients of the 1st and 2nd groups. OSDI scores in all groups before surgery were comparable. 3 months after the operation, the minimum OSDI values were 3a and 3b in subgroups. Iatrogenic dry eye syndrome (DES) in patients of 3b subgroup was significantly lower than in patients of other groups.Conclusion. In all the studied groups, the standard postoperative dynamics of OSS and TBUT and changes in CET were revealed, with the least variability in 3b subgroup. The use of SCL saturated with riboflavin showed the highest keratoprotective efficacy in PE SC, as it allowed a statistically significant reduction in the incidence of DES in patients after PE in SC (p &lt; 0.05) in comparison with other methods. The developed method for predicting iatrogenic DES in patients after PE in SC is highly informative, because the number of patients in the 1st group with DES was within the expected range of error.

Short- and Long-Term Swallowing Outcomes in Head and Neck Cancer Patients Receiving TORS and Adjuvant Therapy.

Dysphagia (difficulty swallowing) is a common morbidity resulting from the treatment of head-and-neck squamous-cell carcinoma (HNSCC) due to surgery and chemoradiation. Transoral robotic surgery (TORS) is a minimally invasive surgical technique for the management of HNSCC, which ideally avoids many of the known complications of open surgery. Research describing physiologic swallowing impairment after surgery using videofluoroscopy is lacking. We evaluated videofluoroscopic swallowing studies of 37 patients who received TORS for head and neck cancer using a validated scoring tool, the Modified Barium Swallow Impairment Profile (MBSImP), at three time points including baseline. Patients had worsened physiologic impairments in the immediate post-operative and late post-operative periods, particularly in components related to airway protection. Many patients also had baseline swallowing impairment. Further research is required to elucidate dysphagia at discrete time points before and after treatment as well as with different and evolving adjuvant therapy protocols.

Treatment of splenic artery aneurysms of patients with cirrhosis in the Waiting list

Objective. The aim of our work was to evaluate the immediate and remote results of ligation of splenic artery aneurysm in orthotopic liver transplantation in patients with decompensated liver cirrhosis.Material and methods. From June 2018 to May 2024, 232 liver transplants from a posthumous donor were performed at the Surgical Clinic of the Moscow Multidisciplinary Scientific and Clinical Center n.a. S.P. Botkin. In 4 patients (1.7%), the presence of aneurysmal dilatation of the splenic artery was revealed at the preoperative stage. During orthotopic liver transplantation, patients underwent ligation of the splenic artery proximal and distal to the aneurysms.Results. Mean time for the isolation and ligation of the splenic artery aneurysm was 18.4±3.3 minutes. In no case was there any damage or bleeding from either the branches or the aneurysm of the splenic artery; and there was no damage to the spleen. No adverse events related to the splenic artery aneurysm ligation were recorded in either early or late postoperative periods. In all cases, the control examination did not reveal any ischemic changes in the splenic parenchyma.Conclusion. Ligation of the splenic artery aneurysm during orthotopic liver transplantation is a safe, effective and necessary surgical intervention that can improve long-term results by reducing the risk of death from aneurysm rupture in the postoperative period.

Possibilities of transposition of the extensores carpi tendons in the treatment of the rheumatoid hand

With the advent of more effective conservative methods of treating rheumatoid arthritis (RA), patients with severe hand deformities are being treated less and less by orthopaedic surgeons. However, when significant changes occur in the hand joints, surgery is the only method to restore their function. The previously widespread arthrodesis procedures are gradually giving way to modern soft tissue joint-preserving surgeries that prevent the development of severe deformities and preserve hand function.Objective: to compare the functional outcomes of extensor carpi ulnaris and extensor carpi radialis longus transposition surgery (ECU+ECRL) and wrist joint arthrodesis in patients with RA.Material and methods. The study included 58 patients with a confirmed diagnosis of RA. Most patients (93%) were women with a disease duration of 4 to 6 years, the mean age was 46.3±14.6 years. All patients were seropositive for rheumatoid factors, most had radiological stages III and IV of RA according to Steinbrocker, radiological stage IV according to Larsen. Most of the patients had moderate disease activity. From 2021 to 2023, 21 patients underwent ECU + ECRL surgery and 37 patients underwent arthrodesis of the wrist joint. The groups were comparable in terms of key clinical characteristics. The average follow-up time after surgery was 6 months.Results and discussion. The mean DASH score in the transposition group (ECU + ECRL) was 38.3±10.12, while in the arthrodesis group it was 47.45±16.92 (p &lt;0.05). In the late postoperative period (after 6 months), all patients showed a positive dynamics according to the visual analogue scale, which was comparable in both groups: in the ECU + ECRL group – 2.66±1.49 cm, in the arthrodesis group – 3.0±1.6 cm. The range of motion of the wrist was significantly greater in the ECU + ECRL group than in the arthrodesis group (p &lt;0.05). At the follow-up examination in the postoperative period, a significant improvement in quality of life according to the EQ-5D was found in both the ECU+ECRL group (0.686) and the arthrodesis group (0.625), p&lt;0.05.Conclusion. X-shaped extensor tendon plastic surgery for wrist joint stabilization should be considered a promising technique that can reduce pain and improve patients' functional status and quality of life.

Определение тиреоидного профиля у младенцев при операциях с искусственным кровообращением и гипотермией

Thyroid hormones are of a particular interest as a support for patients who have undergone cardiac surgical interventions. According to the bibliographical findings, artificial blood circulation with CPB, hypothermia and the use of dopamine reduce the level of thyroid hormones. The purpose of this research was to determine the thyroid hormone levels in infants with “acyanotic” and “cyanotic” congenital heart defects at different stages of hospitalization, comparison of the results between groups. Materials and methods used: a single-center prospective cohort study of 54 cases of surgical treatment of children with congenital heart defects (CHDs) was conducted. Correction of congenital heart disease was carried out with CPB in accordance with the approved clinical protocols. To assess the thyroid profile, thyroid-stimulating hormone (TSH), thyroxine (free T4) and triiodothyronine (free T3) were examined. The algorithm for diagnosing hormone levels included three stages - it was measured prior to, one day after and 7 to 10 days after the surgical correction of congenital heart disease. The influence of clinical (hemodynamic) manifestations during surgical intervention on the level of thyroid hormones and TSH in the early and late postoperative period was assessed. Results: the majority of pediatric patients with “acyanotic” and “cyanotic” defects had a thyroid profile within normal limits upon admission to the hospital. In the early postoperative period, a decrease in the level of thyroid hormones and TSH was noted. By the end of hospitalization, a tendency towards independent normalization was revealed in the majority of patients. Children with free T3 level one day after the surgery below normal had longer CPB application (p=0.022), longer clamping of the aorta (p=0.019) and a higher inotropic index (p=0.005) in contrast with those who had free T3 within normal values. Conclusion: the results obtained would be of help in assessing the risk for the transient decrease in the level of thyroid hormones development among children in the first year of life who underwent CHD surgical correction with CPB as well as the need for hormone replacement therapy during the early postoperative period.

Pericardial Hematoma With Chest Pain and Tamponade in the Late Postoperative Period of Cardiac Surgery

Pericardial Hematoma With Chest Pain and Tamponade in the Late Postoperative Period of Cardiac Surgery

Long-term outcomes of carotid endarterectomy with eversion technique in patients with an open circle of Willis: A multicenter registry study.

Carotid endarterectomy (CEA) is a surgery aimed at removing atherosclerotic plaque from the carotid artery. There are classical and eversion CEA techniques. The eversion technique is the most popular because it does not require the use of implants. Eversion CEA is also associated with a lower risk of restenosis in the late postoperative period. During the surgery, the carotid artery is clamped and blood flow to the brain comes from the contralateral carotid artery and vertebral arteries. However, if the circle of Willis (COW) is not closed, compensatory mechanisms for protecting the brain are reduced, which can lead to the development of an intraoperative stroke. To analysis of in-hospital and long-term CEA outcomes in patients with different types of closed and non-closed COW. This is a multicenter Russian study. In the period from 2010 to 2020. 641 eversion CEA were performed. Depending on the type of structure of the COW, six groups of patients were formed: Type 1 - Closed posterior part (CRS) - in the presence of the posterior communicating (PCOMA) and P1 segment of the posterior cerebral (PCA) arteries; Type 2 - Intermediate type of structure of the posterior part (ISRP) - with hypoplasia of PCOMA or PCA; Type 3 - Open back part (OBP) - in the absence of PCOMA or PCA; Type 4 - Closed anterior part (CFS) - in the presence of the anterior communicating artery (ACOMA) and the A1 segment of the anterior cerebral artery (ACA); Type 5 - Intermediate type of anterior part structure (IFPS) - with ACOMA or ACA hypoplasia; Type 6 - Open Front Section (OFS) - in the absence of ACOMA or ACA. The long-term follow-up period was 107.3 ± 14.6 months. The end points of the study were death, ischemic stroke, transient ischemic attack (TIA), myocardial infarction (MI), ICA thrombosis, hemodynamically significant restenosis of the internal carotid artery, bleeding, and combined endpoint (death + ischemic stroke + TIA + MI).The type of distribution was determined using the Kolmogorov-Smirnov criterion. Group comparisons were performed using the Kruskal-Wallis and Pearson chi-square tests. Differences were assessed as significant at p < .05. According to clinical and demographic characteristics, the majority of patients were male and elderly. In 20% of cases, patients had a history of MI and/or stroke/TIA. Diabetes mellitus was diagnosed in 10%. There were no significant differences between groups in EuroSCOREII. In the long-term postoperative period, the largest number of deaths occurred in groups 5 and 6 (13 (45.1%) and 12 (30.1%)). The majority of strokes were diagnosed in groups 3 (OBP) and 5 (IFPS) (7 (13.5%) and 9 (17.6%)). The highest value of the combined end point (death + stroke/TIA + MI) was obtained in groups 3 (OBP), 5 (IFPS), and 6 (OFS) (23 (44.2%), 26 (50.1%), and 23 (58.9%)). The eversion technique of carotid endarterectomy for carotid artery stenosis is the most preferred. The greatest number of complications of eversion CEA in the hospital and long-term follow-up periods is observed in patients with OBP, IFPS, and OFS. In the presence of an unstable plaque, a temporary shunt can be used, which will exclude the pharmacological increase in blood pressure and the associated risk of embolization.

A prospective study of the method of intraoperative luminescent spectroscopy in the application of isolated profundoplasty in hybrid surgery of critical ischemia of the lower limb

Introduction. Currently, it is relevant to develop new diagnostic criteria for assessing the condition of the deep femoral artery (DFA), in order to determine the possibilities of its use in various hybrid reconstructions for critical lower limb ischemia.Aim: To determine the indications for isolated profundoplasty as the final stage of proximal hybrid reconstruction using the method of intraoperative luminescence spectroscopy.Material and Methods. The prospective open-label non-randomized pilot study included 64 people operated at City Clinical Hospital No. 29 with a clinical diagnosis of “Obliterating atherosclerosis of the arteries of the lower extremities. Stenosis of the external iliac artery. Steno-occlusive lesion of the common femoral/superficial femoral artery. Stenosis of the deep femoral artery of the thigh. Chronic arterial ischemia of the III st.”, in the volume of proximal hybrid reconstruction, including isolated profundoplasty. The first group (n = 28) consisted of patients who had stenosis or occlusion of the mouth of the deep femoral artery, the second group (n = 20) – had diffuse lesion of the deep femoral artery, the third group (n = 16) – had a distal type of lesion of this artery. The first stage of the hybrid operation was stenting of the external iliac artery. The choice of further intraoperative tactics occurred as a result of an assessment of the anatomy and severity of the lesion of the deep femoral artery, by measuring the ankle-shoulder and hip-popliteal indices. All patients underwent intravascular luminescent spectroscopy intraoperatively using our technique to determine the luminescent compensation coefficient (CI). The follow-up period was 3 months. The end point of the study was thrombosis of the reconstruction zone. The SPSS 17.0 software was used for statistical data processing when comparing study groups.Results. When comparing the obtained CI, a direct strong correlation was noted with a preoperatively determined hip-popliteal index (r = 0.76; at p &lt; 0.005). When assessing the interval of the hip-popliteal index from 0.3 to 0.4; 4 patients with thrombotic complications in the early postoperative period and 3 patients with no thrombotic complications were evaluated. When correlating CI in these categories of respondents, the statistically significant differences in indicators were established: CI (without complications) = 0.46 (0.43; 0.50); CI (complicated) = 0.59 (0.58; 0.60); with p &lt; 0.05. When studying preoperative deep femoropopliteal index in representatives of study groups 1 and 2 who had GPI in the range from 0.4 to 0.5, but differed in the outcomes of the late postoperative period, the statistical significance of differences in indicators was noted: Cl (without complications) = 0.44 (0.43; 0.46); Cl (complicated) = 0.61 (0.60; 0.62); at p &lt; 0.05.Conclusion. Intravascular luminescence spectroscopy is an important method of clarifying the intraoperative feasibility of performing isolated profundoplasty in addition to preoperative assessment of the degree of the hip-popliteal index.

Long-term experience of the modified David V re-implantation technique for valve-sparing aortic root replacement.

The modified David V technique is one of the valve-sparing aortic root replacement (V-SARR) techniques, which is an alternative to traditional composite valve graft root replacement techniques. We aimed to analyse our long-term experience with the modified David V re-implantation technique for the treatment of aortic root aneurysm and significant aortic valve insufficiency. From March 2009 to November 2021 the modified David V re-implantation technique, one of the V-SARR techniques, was performed on 48 patients in our centre. The results were analysed retrospectively. Two different-sized grafts were used in all patients. The grafts used in the proximal position were larger than the distal grafts. We performed both intra-operative and post-procedural transoesophageal echocardiography on each patient. All patients were followed by means of transthoracic echocardiography. The mean follow-up period was 5.7 ± 3.1 years. The mean age of this cohort was 56.3 ± 14.3 years (24-79) and the majority were men (75%). The mean aortic root diameter was 5.1 ± 0.6 cm. The mean diameter for the assending aorta was 5.4 ± 2.1 cm. The in-hospital mortality rate was 4.2% (n = 2). One patient needed aortic valve replacement in the early postoperative period. Two (4.2%) patients died in the early postoperative period and four (8.3%) died in the late postoperative period. Overall survival was 91 ± 4 and 86 ± 5% at one and five years, respectively. Aortic valve insufficiency was at moderate levels postoperatively. Freedom from moderate to severe residual aortic insufficiency was 89.6% at 10 years. None of the patients needed late re-operation of the aortic valve postoperatively. Freedom from valve re-operation was 100% at the end of the follow up. Our study shows that the David V technique is associated with excellent long-term durability, a remarkably low rate of valve-related complications, and it protects the re-implanted native aortic valve from a second operation. Additionally this technique could be safely implemented in patients with a bicuspid aortic valve and acute type A aortic dissection without leaflet deformity.

ПОСЛЕОПЕРАЦИОННЫЕ ВЕНТРАЛЬНЫЕ ГРЫЖИ: НЕРЕШЕННЫЕ ВОПРОСЫ ДИАГНОСТИКИ И ТАКТИКИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

Abstracts. Introduction. Postoperative ventral hernias are formed in 15-30% of cases after abdominal surgeries. Patients with postoperative ventral hernias rank 2nd after inguinal hernias, accounting for up to 22% of the total number of abdominal hernias. The advent of tension-free hernioplasty using synthetic implants helped solve some herniology issues: Number of relapses in the late postoperative period has significantly decreased. Aim of the study was to analyze the literature in accordance with modern problems regarding the surgical approaches to the treatment of postoperative ventral hernias. Materials and Methods. The literature review was made using the method of searching for publications in the PubMed databases. Results and Discussion. Computed tomography is the most informative in diagnosing the condition of the anterior abdominal wall tissues in patients with postoperative ventral hernias. The fundamental issue is the choice of abdominal wall layers for placing and strengthening the implant. An implant can be placed in the abdominal wall layers by different methods: Intraperitoneal, preperitoneal, retromuscular, and, in some cases, subaponeurotic and supra-aponeurotic. Conclusions. The use of combined methods of plastic surgery of the anterior abdominal wall for large postoperative ventral hernias using the sublay-inlay technique allows avoiding high traumatic effect of the operation and reducing the recurrence rate. In case of large postoperative ventral hernias, improving the optimal open surgery methods remains relevant.

REsolution of Symptoms afTer Oesophago-gastric cancer REsection delphi (RESTOREd)-standardizing the definition, investigation and management of gastrointestinal symptoms and conditions after surgery.

Oesophago-gastric cancer surgery negatively affects quality of life with a high postoperative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. This study aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients. Modified two-round Delphi consensus study of a multidisciplinary expert panel. Eighty-six of 127 (67.7%) and 77 of 93 (82.8%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first- and second-line investigation and first-line treatments were agreed. Consensus was not reached for third-line investigation of some conditions, or for second-, third- or fourth-line treatments for others. Twelve of 14 (85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (<1 year) and late (>1 year) postoperative periods. Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This may allow standardization and timely diagnosis and treatment of postoperative conditions, reducing variation in care and optimizing patients' quality of life.

EFFECT OF KYPHOPLASTY ON PAIN CONTROL AND VERTEBRAL RESTORATION.

Numerous studies have been conducted regarding vertebral restoration, development of kyphotic deformity, and pain control following balloon kyphoplasty. However, there is no consensus regarding the ideal time to perform kyphoplasty. Herein, we aimed to compare the results of treatment of different vertebral levels following early or late kyphoplasty. Between 2017 and 2022, 283 patients with single-level osteoporotic vertebral fractures were retrospectively reviewed. 100 patients who attended regular postoperative follow-ups, visual analog scale (VAS) values were recorded, and osteoporosis tests were performed were included in the study. Traumatic single-level fractures in patients with osteoporosis who were aged >60 years were included in the study. Patients with a history of malignancy, previous spinal surgery, or neurological deficits were not included in the study. A total of 50 patients underwent kyphoplasty within 3 days of sustaining the fracture (Group 1), and 50 patients underwent kyphoplasty more than 3 after sustaining the fracture (Group 2). Groups A, B, and C included fractures at the T7-T11 levels, T12-L1 levels (thoracolumbar junction), and L2-L5 levels, respectively. These groups were compared among themselves. Bilateral balloon kyphoplasty was performed under sedation in the prone position. Preoperative and postoperative VAS scores, anterior vertebral heights (AVH), and kyphotic angles (KA) were measured and recorded. The vertebral segments that underwent early and late kyphoplasty were also compared among themselves. In all the patients who underwent early or late kyphoplasty, there was a significant decrease in the kyphotic angle and a significant increase in vertebral heights during the early postoperative period (p < 0.001). There was no significant change in the vertebral heights and kyphotic angle between the early and late postoperative periods (p = 0.780). Early kyphoplasty demonstrated better pain control with a greater improvement in VAS score (p < 0.001) than late kyphoplasty. Kyphoplasty plays an important role in reducing pain and ensuring early mobilization in older patients. In our study, the improvements in both symptoms and radiologic features are concrete evidences in favor of performing early kyphoplasty.

THE RELATIONSHIP BETWEEN RETINAL PERFUSION AND FUNCTIONAL RECOVERING OF FOVEA IN DIFFERENT TYPES OF SURGICAL CLOSURE OF FULL-THICKNESS MACULAR HOLES

Rationale: The effect of retinal perfusion on functional recovery of the fovea, as well as the value of quantitative perfusion parameters as predictors of functional outcome in the surgical treatment of full-thickness macular holes (FTMH) remains poorly understood.Objective: To study the relationship between changes in retinal perfusion and functional parameters of the fovea in the postoperative period at 1 and 2 types of FTMH closure.Methods: A prospective study including 93 patients (93 eyes) with idiopathic FTMH stage 2-4 according to D. Gass after surgical treatment. In subgroups with type 1 and type 2 of FTMH closure, changes in the foveal avascular zone (FAZ) area and vessel density in the superficial and deep capillary plexuses (SCP and DCP) in the fovea, changes in BCVA, retinal sensitivity (RS) at the fixation point, and P1 amplitude in the fovea were studied. Studies were performed preoperatively, 1 and 6 months after surgery. A significant correlation was found between the changes in BCVA, RS at the fixation point, P1 amplitude in the fovea, and changes in vessel density in the SCP and DCP, which was more pronounced in the period from 1 to 6 months after surgery. The correlation of the changes in the parameters is higher in type 2 of FTMH closure than in type 1 of FTMH closure.Results:. Subgroups with type 1 and type 2 FTMH closure included 67 and 26 eyes, respectively. Type 2 FTMH closure showed lower vascular density in the DCP before (p=0.02) and 6 months after surgery (p=0.03), lower BCVA before surgery (p=0.03), 1 and 6 months after surgery (p &lt;0.001), lower RS at the fixation point before and after surgery (p&lt;0.002).Conclusion. In type 2 macular hole closure, postoperative changes in retinal perfusion have a more pronounced impact on functional recovery of the fovea, especially in the late postoperative period.

ASPECTS OF LIVER ECHINOCOCCOSIS SURGERY

According to the WHO, «…at any given time, more than 1 million people worldwide are aff ected by echinococcosis…». Due to the lack of tendency to decrease the number of patients and the existence of endemic regions where the incidence rate varies from 1.2 to 9.0 per 100,000 population, this parasitic disease continues to be a serious medical and social problem. At the present stage, the diagnosis of echinococcosis does not present signifi cant diffi culties, mainly due to the emergence of non-invasive imaging methods, the informative value of the complex application of which reaches 95-100 %.Aim of the study. Improving the treatment results of patients with liver echinococcosis.Research materials. The study included 328 patients with liver echinococcosis admitted to the surgery department of the multidisciplinary clinic of the Samarkand State Medical University in the period from 2005 to 2023. Depending on the choice of treatment, the patients were divided into two groups: the comparison group consisted of 154 (46.9 %) patients treated from 2005 to 2012 and the main group included 174 (53.0 %) patients operated on from 2013 to 2023.Research results. Compared with the comparison group, in the main group of patients, intraoperative complications decreased from 6.5 to 2.3 %, and complications in the early postoperative period from 18.2 to 5.2 %. In the late postoperative period, the recurrence of the disease decreased from 16.2 % to 3.6 %.Conclusions. The introduction of improved surgical instruments into practice – a modifi ed puncture needle, a «basket clamp» allowed to level the risk of seeding of surrounding tissues with embryonic elements. The introduction of a device for the purpose of identifying hidden biliary fi stulas in the residual cavity after echinococcectomy from the liver reduced the number of bile leaks. With the introduction of a modifi ed method for eliminating the residual cavity after echinococcectomy from the liver, the number of complications during surgery and in the early postoperative period was minimized.

Single stage direct -to- implant breast reconstruction following mastectomy (The use of Ultrapro® Mesh)

BackgroundImmediate breast reconstruction (IBR) with direct to implant (DTI) is the preferred method of reconstruction by many surgeons and patients, however, acellular dermal matrix (ADM) and other synthetic meshes are expensive especially in low- and middle-income countries.Aim of the workTo evaluate the technique, indications, aesthetic outcomes, and short and long-term complications of DTI breast reconstruction performed with Ultrapro®, a low-cost alternative mesh to ADM and other synthetic meshes.MethodsOur study is a prospective cohort study that was conducted on 133 patients who experienced IBR following nipple-sparing mastectomy (NSM) or skin sparing mastectomy (SSM) using silicone implants and Ultrapro® mesh between December 2020 and December 2023. Techniques used were either sub-pectoral or pre-pectoral, evaluating aesthetic outcome, complication rate and patient satisfaction using breast Q questionnaire.ResultsWe included 133 patients (141 breasts) with a median age of 39 years. Mean duration of follow up: 20.364 ± 5.39 months. The sub-pectoral and the pre pectoral techniques were used for 80 breasts and 61 breasts respectively. We used the Ultrapro® mesh in all our patients. Smooth round silicone implants were used. The overall Major complications rate was 16.3%. 8 implants (5.7%) were lost within 6 months post-operatively while 2 implants were removed in the late post-operative period (after 6 months) one due to rupture and the other due to local recurrence.Capsular contracture Baker 3 and 4 was observed in 36 breasts (25%), 31 of them had post mastectomy radiotherapy treatment. 11 (7.8%) were managed by capsulotomies and re-insertion of the same implant.Radiotherapy was a significant risk factors for major complications and capsular contracture with p value of (0.01) and (0.0001) respectively.ConclusionDTI in properly selected patients offers excellent outcomes and patient satisfaction. The complication rate is low and improves with the experience of the surgeon. The Ultrapro® mesh is a safe, low-cost alternative to ADM or other synthetic meshes especially in low socioeconomic countries. Radiotherapy is a significant risk factor for major complications and capsular contractures.

Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction

BackgroundDistal radius fractures are a common orthopedic injury, particularly prevalent among elderly and osteoporotic patients. Although surgical treatment effectively restores fracture alignment and stabilizes the bone, Complex Regional Pain Syndrome (CRPS) can occur as a postoperative complication, severely impacting patients’ rehabilitation and quality of life. Therefore, assessing the risk factors for postoperative CRPS is crucial for early clinical intervention, aiming to improve recovery outcomes and overall patient well-being.ObjectiveThis study aims to dynamically evaluate the risk factors for CRPS following distal radius fracture surgery through a retrospective analysis. The goal is to provide scientific evidence for early clinical identification and intervention.MethodsA retrospective analysis was conducted on 191 adult patients who underwent distal radius fracture surgery between January 2021 and December 2022, comprising 89 males and 102 females, with an average age of 59.7 ± 11.6(18–75) years. Baseline and follow-up data, including demographic information, clinical characteristics, and psychological assessments, were collected. Descriptive statistics, univariate, and multivariate logistic regression analyses were used to identify independent risk factors and assess their dynamic changes over time.ResultsAge, gender, occupation, fracture type, surgical method, osteoporosis, pain score (VAS), functional disability score (DASH), anxiety score (GAD-7), depression score (PHQ-9), physical therapy, and occupational therapy significantly affected the incidence of CRPS. Age and VAS scores were consistent risk factors. Female gender, internal fixation surgery, and high DASH scores posed higher risks in the early postoperative period but decreased over time. Occupation and fracture type were more significant in the mid to late postoperative period. Psychological factors were most significant in the midterm, while physical and occupational therapy were protective factors early on.ConclusionThe occurrence of CRPS is the result of many factors. Elderly patients, females, and manual laborers had higher risks, with complex fractures and internal fixation surgery patients showing increased risk later on. Osteoporotic patients had higher risks in the mid to late postoperative period. VAS, DASH, GAD-7, and PHQ-9 scores were significantly associated with CRPS. Early physical and occupational therapy can effectively prevent CRPS, but further research is needed to evaluate their long-term effects.