Late Postoperative Period Research Articles

Lateral hinge fracture does not compromise postoperative alignment of valgus open wedge high tibial osteotomy

Objectives Verify whether the previously planned correction with osteotomy was achieved and, in cases with hinge fracture, whether the accuracy of the correction was affected. In addition, identify the fracture characteristics responsible for inaccurate repair, including the type of fracture and the location of the hinge Methods Retrospective evaluation of patients who underwent tibial osteotomy with medial opening wedge and fixation with locking plate. The sample size was based on other similar studies available in the literature. After applying the exclusion and inclusion criteria, data from 47 participants were used. The research participants underwent the same surgical procedure, divided into two groups: patients without lateral cortical fracture and patients with fractures. Patients with fractures were compared to patients without fractures in terms of the statistical difference in the axis of correction of lower limb alignment. Results In the preoperative period, the following measurements were evaluated: Tibiofemoral Angle, Tibial Slope, mPtA (Medial Proximal Tibial Angle), Joint Obliquity (JLCA). In the immediate postoperative period: Tibiofemoral angle, tibial slope, mPtA, joint obliquity. In the late postoperative period: Tibiofemoral Angle, Tibial Slope, mPtA, Joint Obliquity, MAD (Mechanical Axis Deviation) and correction achieved between groups. There was no statistical difference between the groups in the preoperative, immediate postoperative and late postoperative periods. Conclusion No statistical differences were found between the group with and without lateral cortical fracture. We conclude that lateral cortical fracture does not cause loss of alignment correction as long as a rigid fixation method is used.

Botulinum Toxin and Electrophysiological Intervention Improve Post-Surgical Breast Entdoprosthetics: A Clinical Trial Study.

The majority of plastic surgeon specialists note a distinct tendency to increase the number of breasts endoprosthetic surgeries with silicone implants in the Republic of Uzbekistan - the number of such surgeries now reaches 3-4 thousand annually. Breast replacement for aesthetic purposes is widespread throughout the world and has been rapidly spreading in Uzbekistan in recent years. Due to surgical endoprosthetics of mammary gland tissue with silicone implants, both in the early and late postoperative periods, quite often the patient's body experiences typical postoperative pain, which, if subclinical, requires constant dynamic monitoring and preventive rehabilitation procedures. Rehabilitation measures are a prerequisite for a successfully performed aesthetic surgery to enlarge the mammary glands. To address the effectiveness of intramuscular botulinum toxin A and the INDIBA electromagnetic field electrophysiology we used, a prospective randomized trial was designed to evaluate the effectiveness of patient-reported postoperative pain and pain reduction in these settings. The results of the conducted research allow us to conclude that the course of electrophysiological influence by INDIBA preparation, conducted in the first week, daily, i.e. 7 procedures after aesthetic breast endoprosthetics, significantly increases the efficiency of anesthetic effect of botulinum toxin type A drug administration 14 days before the intervention. These studies results allow us to conclude that a course of electrophysiological treatment with INDIBA, conducted in the first week after aesthetic breast endoprosthetics, significantly increases the effectiveness of the analgesic effect of botulinum toxin. Thus, the given results are convincing in terms of the fact that the proposed complex of rehabilitation measures after aesthetic endoprosthetics of mammary glands in the form of parenteral intramuscular administration of botulinum toxin preparation and a course of electrophysiological influence by electromagnetic field has a statistically significant pathogenetically-based pronounced and prolonged analgesic effect in the postoperative period.

Long-term results of fronto-orbital advancement and remodeling using distraction osteogenesis in craniosynostosis patients

In the initial report describing the fronto-orbital distraction technique, bone segments were advanced preserving their attachments with the dura. This approach does not allow for the remodeling of the frontal segment. However, in the technique described herein, the fronto-orbital segment is separated from dura, remodeled, and advanced as a bone graft using distractors. Twenty-seven craniosynostosis patients that underwent fronto-orbital advancement and remodeling using distraction osteogenesis were retrospectively reviewed. The mean age at the time of surgery was 19.03 ± 9.19 months; the mean follow-up was 86.04 ± 34.98 months. The mean distraction amount was over 19 mm. No significant difference was found between frontal and occipital bone density measurements at the cortex and medulla. The mean total defect area was 4.79 ± 4.43 cm2 and the mean number of bone defects was 4.8 ± 2.2. The cephalic index decreased from 98.56 ± 6.39 to 87.63 ± 4.54, and 59.3% of the patients reached the normal range in the late postoperative period. Fronto-orbital advancement and remodeling using distraction osteogenesis appears to be safe and effective. Distraction of the frontal bone as a graft does not lead to bone resorption, and new bone formation and improvements in head shape can be achieved.

Choice of hernioplasty method based on the degree of intra-abdominal hypertension

Aim. To study the variability of intra-abdominal pressure and the choice of hernioplasty method for large and giant abdominal hernias.Material and Methods. This study analyzed the outcomes of various hernial orifice repair methods in 134 patients with large and giant hernias of the anterior and lateral abdominal walls. The majority of cases involved incisional hernias (n=52), while 47 patients presented with recurrent hernias, and 35 cases involved primary hernias. In 84.3% of cases, the hernias were localized in the anterior abdominal wall, and concomitant comorbidities were identified in 82 patients. Preoperative evaluations included clinical examination, imaging studies, and assessment of intra-abdominal pressure. Research results. In 31 (29.2%) observations, hernia repair was performed using the inlay method due to high intra-abdominal pressure. Anterior and posterior component separation with prosthetic reinforcement using the sub lay technique was carried out in 21 patients (7.5%). Additionally, the placement of a mesh prosthesis using the on lay method was performed in 54 patients (20.7%). The overall mortality rate was 2.2% (n=3), while 11 patients experienced recurrence in the late postoperative period, resulting in a recurrence rate of 8.2%.Conclusion. The increasing frequency of abdominal and retroperitoneal surgeries has led to a rise in the incidence of abdominal hernias. Traditional hernia repair techniques continue to evolve, and new, minimally invasive approaches are being developed to enhance patient outcomes. Despite ongoing advancements in surgical techniques for large and giant abdominal hernias, several challenges remain unresolved, necessitating further research and innovation in this field.

Reverse RV remodeling after isolated tricuspid valve surgery

Abstract Background Impact of tricuspid regurgitation (TR) on right ventricular (RV) and atrial (RA) size and function is one of the main determinants of prognosis. However, there is scarce data about the recovery of right chambers after isolated tricuspid valve surgery (ITVS). Purpose Our aim is to evaluate postsurgical changes in right chamber morphofunctional parameters by echocardiography after ITVS. Methods We selected all the patients that underwent ITVS in our tertiary centre between 2009 and 2022 excluding those with congenital anomalies. Echocardiographic right ventricular classical parameters (RV diameters, RA area, TAPSE and fractional area change (CAF)) as well as myocardial deformation (free wall (FW)- and 4 chambers (4C)- global longitudinal strain (GLS)) were compared in baseline studies, early and late postsurgical periods. Results Among the 45 patients included (65 ± 2 years-old, 51% female, TRI-SCORE 2 [1-4]) surgical indication was functional TR in 51%, 29% underwent tricuspid valve repair and 71% replacement. The treatment was considered ineffective (postoperative TR ≥ moderate) in 9%. In the early postsurgical phase (1.9 [1.2 – 3] months) a significant reduction in basal (-17%, p<0.01), mid (-15%, p<0.01) and longitudinal (- 7%, p<0,01) RV diameters as well as RA area (-26%, p<0.01) was noted. These changes persist in the late postoperative period for basal (-16%, p<0.01) and mid (-20%, p<0.01) RV diameters and RA area (-19%, p=0.03). RV function parameters suffer significant reduction in the early phases: TAPSE (-39%, p<0.01), FAC (-24%, p<0.01), FW-GLS (-17.1%, p<0.01) and 4C-GLS (-16.3%, p<0.01). In later stages the major worsening in classical parameters persist: TAPSE (-28%, p=0.01) y FAC (-20%. P=0.01). However, strain variables recover to the baseline values. Postoperative RV reverse remodeling is reflected in Table and Figure. Conclusions Postoperative changes in echocardiographic right chambers features after ITVS suggest that myocardial deformation parameters should be the method of choice for follow-up of this surgical procedure. Table. Comparison of baseline and postsurgical echocardiographic parameters. Figure. Echocardiographic parameters evolution.TableFigure

Results of endoprosthesis of the elbow joint in patients with tumors of forming it bones

Background. The use of both individual and modular oncological endoprostheses of the elbow joint is possible with primary and secondary (metastatic) tumor lesions of the bones forming it. The purpose of the study was to assess the effectiveness of restoring the function of the elbow joint and the upper limb and improving the quality of life of the patient after endoprosthesis of the elbow joint due to tumors of the bones forming it. ­Material and methods. The results of the treatment of 14 patients who underwent endoprosthesis of the elbow joint due to tumors of the bones forming it were evaluated. Endoprosthesis was performed in 9 (64.3 %) subjects with primary bone tumors and in 5 (35.7 %) patients with metastatic tumors. Reconstruction of the elbow joint was performed with individual oncological endoprostheses in 10 (71.4 %) subjects and modular oncological endoprostheses in 4 (28.6 %) ones. Reconstruction was primary in 12 (85.7 %) patients and secondary in 2 (14.3 %) ones. Results. Du­ring follow-up, 4 (28.6 %) patients died from the progression of the main disease with an ave­rage follow-up period of 24.8 ± 11.9 months, the other 10 (71.4 %) were alive, with an average follow-up period of 80.8 ± 10.3 months. In the early postoperative period, the following complications were observed: neuropathy of the ulnar nerve in 1 (7.1 %) patient. In the late postoperative period, 1 (7.1 %) patient had an infectious complication after 14 months. 1 (7.1 %) subject developed aseptic loose­ning of the humeral leg of the endoprosthesis 12 months after endoprosthesis. In 1 (7.1 %) subjects with a metastatic tumor, local recurrence of the tumor was observed 9 months after surgery. Mean MEPS and MSTS functional scores were 80 and 72 %, respectively. The patients’ quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 40 points in the preoperative period to 84 points after elbow joint replacement. Conclusions. Endoprosthesis of the elbow joint in the schemes of complex and combined treatment of primary and metastatic tumors of the bones forming it helps to improve the quality of life of this contingent of patients.

Prediction of the risks of developing clinically significant frontal imbalance in surgical treatment of severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve

Objective. To create a multifactorial model for predicting the risks of developing clinically significant frontal imbalance in surgical treatment of severe idiopathic scoliosis based on the identification of predictors influencing the main clinical parameters of trunk asymmetry.Material and Methods. The results of surgical treatment of 288 patients with severe forms of idiopathic scoliosis with a primary thoracic scoliotic curve of types 1, 2, 3 according to Lenke (mean 97.6° ± 15.5° according to Cobb) who underwent surgery in 1999–2019 using posterior segmental instrumentation with hook, hybrid and transpedicular fixation, were analyzed. There were 243 female (84.4 %) and 45 male patients (15.6 %). The average age of patients at the time of surgery was 15.3 [10–39] years. The average postoperative follow-up period was 3.5 [2.0–19.5] years. The analysis included clinical and radiological data obtained in the preoperative, postoperative and late postoperative periods. Predictors of the occurrence of frontal imbalance (the distance from the plumb line to the navel and intergluteal fold more than 15 mm, the tilt of the shoulder girdles more than 5° and the tilt of the scapula more than 15°) were identified by building single- and multivariate logistic regression models.Results. In the total cohort, 41 (14.2 %) patients with clinically significant frontal imbalance were identified, including 10 (3,0 %) – with an increase in the distance from the plumb line to the umbilicus of more than 15 mm, 12 (4.2 %) – with an increase in the distance from the plumb line to the intergluteal fold of more than 15 mm, 8 (2.8 %) – with a shoulder girdle tilt of more than 5°, and 11 (3.8 %) – with a scapular tilt of more than 15°. A significant predictor of the risk of developing frontal imbalance was determined as postoperative thoracic scoliotic curve of more than 63°. Multiplicative predictors of the risk of frontal imbalance were identified: postoperative increase in the distance from the plumb line to the umbilicus by more than 15 mm and a tilt of the shoulder girdles by more than 5° with a sensitivity of 88.9 % and 100.0 %, and a specificity of 89.5 % and 100.0 %, respectively (p < 0.001).Conclusion. Identification of multiplicative predictors of the risk of frontal imbalance allows predicting the risk of increasing the distance from the plumb line to the navel by more than 15 mm and the risk of shoulder girdle tilt by more than 5°. To eliminate the risk of frontal imbalance, it is necessary to strive for maximum correction of the thoracic scoliotic curve. When planning surgical treatment using transpedicular fixation for the correction of severe thoracic scoliosis, it is necessary to take into account the patient’s gender and the presence of concomitant neurosurgical, cardiological and pulmonological pathology to prevent shoulder girdle imbalance.

Differentiated Approach to Surgical ­Treatment of Gunshot Diaphyseal Shin Fractures

Background. The roots of problems in the treatment of gunshot fractures to extremities lay in the high-energetic character of these traumas, the frequency of infectious complications, high rate of slow consolidations, and occurrence of pseudoarthroses and bone tissue lesions. Objective. The objective of the study was to improve the treatment results of patients with gunshot fractures of the shin bones based on the development of a differentiated approach to the treatment of such injuries. Material and Methods. The study is based on the results of examination and treatment of 128 patients with dominant combat shin traumas. The patients were divided into two groups. The first group (control group) included 68 patients who underwent treatment with an external fixation device (EFD). The second group (study group) included 60 patients who underwent the extrafocal osteosynthesis replaced by an internal, mostly intramedullary one. To assess the functional outcomes of treatment, we applied the LEFS (Lower Extremity Functional Scale) in the dynamics of the therapy, namely in 3, 6, 12, and 18 months after the injury. Results. Mean values in both groups during the first two to three weeks showed no statistically significant difference, and their average score according to the LEFS scale was 15.75 points. The most significant differences were observed in the period from 6 to 12 months after the injury, 39.4±2.4 (EFD) and 57.3±2.1 (intramedullary nailing). After 18 months, excellent results showed 20.7% of patients from the study group and 15.8% of the control group (61 – 80 LEFS scores). Good results had 43.2% and 33.1%, respectively (41 – 60 LEFS scores). 28.1% and 39.3%, respectively, showed satisfactory results (21 – 40 LEFS scores). Poor results showed 8.0% of patients of the study group and 11.8% of the control group (p<0.05). Conclusions. The analysis of treatment outcomes of patients with gunshot diaphyseal shin fractures demonstrates that conversion, when used according to indications and following criteria to the replacement of the method of fixation, reduces the incidence of complications in both the early and late postoperative periods, fastens consolidation of gunshot diaphyseal shin fractures by 4.5±2.3 weeks, reduces the frequency of fracture consolidation disorders by 10.6%, and improves the functional results of the patients by 15.0%.

"Sterile hypopyon following pars plana vitrectomy and silicone oil injection".

To report five cases of post-operative sterile endophthalmitis in patients who underwent pars plana vitrectomy with silicone oil injection for retinal detachment. Review of the medical records of five patients who underwent pars plana vitrectomy with silicone oil injection at Southend University Hospital and the Royal Eye Infirmary, Derriford Hospital for rhegmatogenous or tractional retinal detachment. All five patients presented with signs of anterior chamber inflammation exhibiting flare, fibrin and hypopyon in the early or late post-operative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was commenced, with rapid resolution of the anterior chamber inflammatory reaction and no further intervention required. The use of silicone oil as a tamponade agent for retinal detachment can rarely induce sterile anterior chamber inflammation with signs resembling infectious endophthalmitis. Onset of symptoms, absence of pain and good response to topical steroids can help differentiate between the two entities.

The seven-day cumulative post-esophagectomy inflammatory response predicts cancer recurrence

BackgroundThe relationship between postoperative cumulative systemic inflammation and cancer survival needs to be investigated. We developed an approach to the prognostication of postoperative esophageal cancer by establishing low and high cut-off values for the C-reactive protein (CRP) area under the curve (AUC) at 7 and 14 days after esophagectomy.MethodsOne hundred and twenty-five consecutive patients with biopsy-proven invasive esophageal squamous cell carcinoma (SCC) who underwent esophagectomies were evaluated. Postoperative CRP levels were analyzed for the first 14 days after surgery. The AUC on days 7 and 14 were calculated and compared with clinicopathological features and survival. The cut-off values for CRP at 7 days (CRP 7 d) and 14 days (CRP 14 d) were 599 mg/L and 1153 mg/L, respectively.ResultsThe patients in the low CRP 7 d group had significantly better recurrence-free survival (RFS) and overall survival (OS), not that in the low CRP 14d group. The OS rates in the high CRP groups at PODs 1, 3, 10, and 14 were significantly lower than those in the low CRP groups. Postoperative complications were more common in the high CRP groups on PODs 3, 10, and 14. Univariate analyses revealed that pTNM stage, depth of tumor invasion, tumor location, lymph node involvement, and CRP 7 d were significant prognostic factors for both OS and RFS. The Cox proportional hazards model identified pTNM, tumor location, and CRP 7d as independent prognostic factors for the RFS and OS.ConclusionsEarly prediction of patients with postoperative complications, and adequate management will suppress the elevation of CRP 7 d and further suppress the CRP value in the late postoperative period, which may improve the prognosis of esophageal cancer patients after esophagectomy.

Функциональное восстановление фовеа после хирургического лечения сквозных макулярных разрывов: роль отдельных изменений морфологии и перфузии сетчатки в послеоперационном периоде

Purpose. To evaluate the relationship between changes in functional and structural indicators, indicators of retinal perfusion in the fovea after surgery of full-thickness macular holes (FTMH). Material and methods. A prospective study was conducted on 62 patients (62 eyes) with FTMH stages 1–4 who underwent surgical treatment. We studied BCVA, retinal sensitivity (RS) at fixation point (FP), the fixation zone area, the amplitude and implicit time of P1 at FP, the thickness of the macular complex of ganglion cells (mcGC), the ellipsoid zone (EZ) defect area, the foveal avascular zone (FAZ) area and vessel density in the superficial and deep capillary plexuses (SCP and DCP). The correlation of indicator changes in the period from the preoperative examination to 6 months after treatment and in the period from 1 to 6 months after treatment was studied. Results. Changes in BCVA in the period from the preoperative examination to 6 months after surgery significantly correlated with changes in mcGC thickness (R=0.39, p=0.004), EZ defect area (R= –029, p=0.001) and SCP and DCP vessel density (R=0.35 and R=0.29, p=0.002); RS changes at FP correlated with the changes in EZ defect area (R= –0.31, p=0.001), and P1 amplitude with the change in the EZ defect area (R= –0.34, p=0.001) and vessel density in DCP (R= –0.29, p=0.001). In the period from 1 to 6 months after closure of the FTMH, a more significant correlation of changes in BCVA, RS and P1 amplitude of mentioned above indicators was observed. Conclusion. Processes of functional restoration of the fovea after surgery of FTMH for at least 6 months is influenced by changes in such indicators as the mcGC thickness, the EZ defect area, and vessel density of SCP and DCP. In the late postoperative period, the importance of postoperative changes in retinal perfusion increases. Key words: Full-thickness macular hole (FTMH), microperimetry, multifocal electroretinography, multimodal imaging, optical coherence tomography, optical coherence tomography-angiography

CLINICAL CASE OF A NEW METHOD FOR SURGICAL TREATMENT OF HILL-SACHS REVERSAL FRACTURE IN OLD-ENGINED POSTERIOR SHOULDER DISLOCATION.

The article presents a clinical case in which the use of a new method of surgical treatment of a HILL-SACHS type reversal fracture in chronic posterior shoulder dislocation is considered. In this clinical case, we proposed an operational-biomechanical theory, the main goal of which is surgical treatment of a HILL-SACHS reversal fracture with stabilization of the shoulder joint by moving the tendon of the long head of the biceps to the impression zone and fixing it with anchors. The outcome of this clinical case is the absence of clinical symptoms of instability of the shoulder joint and restoration of function of the shoulder joint in the late postoperative period.

Dropped head syndrome secondary to head and neck cancer: Impact on functıonal and body image scale

ObjectiveThe primary aim of our prospective study was to assess the impact of Dropped Head Syndrome (DHS), a rare condition in Head and Neck Cancer (HNC) clinics, on patients' functional status and body image. Our secondary aim is to investigate the relationship between head and neck lymphoedema (HNL) and DHS, which will be examined for the first time in the literature. MethodsWe conducted a study involving 47 patients, aged between 18 and 75, who had been diagnosed with HNC, and exhibited clinical symptoms of DHS for at least 12 months. The staging of HNL was assessed using the MD Anderson Cancer Center HNL (MDACC HNL) staging system. We also administered The Total Functional Scale (TFS) which was a subscale of EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30) and the Body Image Scale (BIS). ResultsIn the study, it was observed that the BIS was significantly lower in patient groups aged 50 and over (p = 0.0495), those with a laryngectomy (p = 0.0002), those who had undergone bilateral neck dissection (p = 0.0291), and particularly in patients with stage 2–3 lymphedema (p < 0.0001). Similarly, it was noted that passive cervical extension limitation had a statistically significant impact on both the BIS (p < 0.0001) and the TFS (p < 0.0001). It was also found that BIS (p < 0.0001) and TFS (p < 0.0001) improved in the late postoperative period (12 months ≤) and this improvement was statistically significant. ConclusionsIn this study, we found statistical relationships between age, laryngectomy, surgery procedures, lymphedema stages, passive cervical extension limitations, total functional score, and BIS. Early diagnosis of DHS allows for supportive care and physiotherapy methods, which can lead to improvement. HNL and DHS should be prevented to improve quality of life and body image and increase survival. Therefore, further research with a much larger patient population is needed.

Consideration Of the Peculiarities of Non-Drug Rehabilitation Treatment After an Ectopic Pregnancy

The features of the application of physical rehabilitation after undergoing an ectopic pregnancy and conducted surgical treatment of severe gynecological pathology requiring emergency care are considered. The program of physical rehabilitation in the early and late postoperative periods, aimed at restoration of reproductive function in patients conducted after surgery tubal ectopic pregnancy options.

The effect of different power radiofrequency ablations in treatment and postoperative pain in patients with atrial fibrillation: a retrospective study

BackgroundThere has been no consensus on what power of radiofrequency energy can be used to produce the best surgical results in patients with atrial fibrillation. In addition, patients undergoing local anesthesia and fentanyl analgesia may experience pain when radiofrequency ablation is performed. This study investigated the effect of different power radiofrequency ablations in treatment and postoperative pain in patients with atrial fibrillation.MethodsA retrospective study was performed with 60 patients who underwent radiofrequency ablation for atrial fibrillation between January and June 2023. Patients were divided into 2 groups according to the power of the radiofrequency ablation catheter used, with 30 patients in the conventional power group (35 W) and 30 patients in the high-power group (50 W). The cardiac electrophysiological indexes and postoperative pain of the 2 groups were compared.ResultsMost of the procedural key parameters between the 2 groups had no significant differences. However, the total application time during radiofrequency ablation and pulmonary vein isolation time in the high-power group were significantly shorter than those in the conventional power group (p < 0.001). Patients in the high-power group reported significantly less pain than those in the conventional power group in the immediate postoperative period and the late postoperative period (p < 0.001).ConclusionsHigh-power radiofrequency ablation showed a shorter treatment time, and could reduce postoperative pain compared to conventional power ablation.

Oral donor site evaluation in the early and late postoperative periods for augmentation and replacement urethroplasty

Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials &amp; methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

The Surgical Outcome of Infective Endocarditis in South Africa over 10 Years: A Retrospective Review.

Objectives: There is a paucity of data on the outcome of left-sided cardiac valve surgery for infective endocarditis in South Africa. It is hypothesized that outcomes may be poorer compared to international standards due to differences in disease burden, timing of surgery, organism prevalence, and co-morbidities. Method: This is a retrospective study of 160 patients with left heart valve endocarditis who underwent cardiac surgery from January 2010 to December 2019. Demographic, operative, and admission-related parameters were assessed to determine their association with all-cause mortality during the early post-operative (<30 days) and late post-operative (>30 days) periods. Results: Early post-operative mortality (<30 days) was 8.8% and late post-operative mortality (>30 days) was 13.1%. Late survival showed 77.5% of the patients were alive with a mean follow-up period of 41 months. Increased age (p = 0.04), critical illness (p < 0.001), and higher urgency of intervention (p < 0.001) were associated with higher early post-operative mortality. Peri-operative organ failure, including cardiac (p = 0.025), renal (p = 0.016), and respiratory failure (p < 0.001), contributed significantly to both early and late mortality. Pre-operative antibiotics for fewer days (p = 0.024), ongoing sepsis (p = 0.022), and para-valvular extension (p = 0.046) were associated with higher early mortality. Conclusions: Infective endocarditis is a common indication for cardiac valve surgery in South Africa. Goal-directed medical management and clinical optimization prior to surgery were crucial to achieving better outcomes. Salvage procedures and critical illness with organ failure prior to surgery were associated with poorer outcomes. Despite unique challenges, cardiac surgery for infective endocarditis at Tygerberg Hospital compares favorably to international standards.

590. RESOLUTION OF SYMPTOMS AFTER OESOPHAGO-GASTRIC CANCER RESECTION (RESTORED)–STANDARDISING GASTROINTESTINAL SYMPTOMS AND CONDITIONS AFTER SURGERY: A MULTI-DISCIPLINARY EXPERT DELPHI STUDY

Abstract Background Oesophago-gastric cancer surgery negatively affects quality of life with a high post-operative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. We 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. Design Modified 2-round Delphi consensus study of a multidisciplinary expert panel. Results 86/127(67.7%) and 77/100(77.0%) 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, nor for second, third or fourth-line treatments for others. 12 of 14(85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (&amp;lt; 1 year) and late (&amp;gt; 1 year) post-operative periods. Conclusion Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This will allow standardisation and timely diagnosis and treatment of post-operative conditions, reducing variation in care. It will facilitate comparative, prospective research to establish the incidence and response to treatment of these conditions, helping develop robust evidence to optimise patients’ quality of life.

Laser Hemorrhoidoplasty and Lateral sphincterotomy Procedures vs Conservative Treatment for Hemorrhoids and Fissure in Ano: A Trial Comparing Laser and Conservative treatments

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure and laser aided lateral sphincterotomy vs conservative treatment of symptomatic hemorrhoids and fissure in ano. Material and Method: A comparison trial between hemorrhoid laser procedure, lateral sphincterotomy and conservative treatment for hemorrhoids and fissure in ano was made. This study was conducted at Vels Medical College and Hospital, Manjankaranai, Tamil Nadu. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 30 patients treated with the laser hemorrhoidoplasty, 30 patients–with laser aided lateral sphincterotomy and 40 patients treated with conservative methods. Operative time, postoperative pain, post-op healing time were evaluated. Results: A total number of 100 patients ( 65 men and 35 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty, laser sphincterotomy and conservative treatments were observed in operative time and early postoperative pain. The procedure time for LHP was 15.49 min laser aided lateral sphincterotomy was 10.19 min. Conclusion: The laser hemorrhoidoplasty and laser guided sphincterotomy procedures were more effective than conservative methods. Postoperative pain and healing time were drastically less in the early and late post op period.

OUTCOMES OF SHOULDER JOINT ENDOPROSTHETICS AFTER REMOVAL OF TUMORS IN THE HUMERUS

Introduction. The use of endoprostheses of the shoulder joint is possible with primary and secondary (metastatic) tumor lesions of the proximal part of the humerus. The possibility of using both individual oncological endoprostheses and modular oncological endoprostheses for tumors of the proximal part of the humerus is reported. Aim. To assess the effectiveness of restoring the function of the shoulder joint and upper limb and improving the patient's quality of life after shoulder joint arthroplasty for tumors of the proximal part of the humerus. Materials and methods. The results of the treatment of 27 patients who underwent shoulder arthroplasty in the conditions of the clinical departments of the "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" for tumors of the proximal part of the humerus from 2014 to 2024 were evaluated. Endoprosthesis was performed in 22 (81.5%) patients with primary tumors of the proximal part of the humerus and in 5 (18.5%) with metastatic tumors. Endoprosthesis of the shoulder joint was performed with individual oncological endoprostheses in 24 (88.9%) patients and modular oncological endoprostheses in 3 (11.1%) patients. Arthroplasty was primary in 25 (92.6%) patients and secondary in 2 (7.4%) patients. Results. During follow-up, 3 (11.1%) patients died with an average follow-up period of 10.3±1.9 months, the other 24 (88.9%) were alive, with an average follow-up period of 88.1±8.7 months. The overall frequency of complications in our study was 6 (22.2%) cases, 3 (11.1%) patients had an infectious complication in the late postoperative period after 12, 24 and 36 months, 1 (3.7%) patient had aseptic loosening of the leg of the endoprosthesis after 36 months, in 2 (7.4%) patients after 5 and 6 months, dislocation of the head of the endoprosthesis from the joint cavity was noted. Local tumor recurrence was observed in 2 (7.4%) patients. The overall mean MSTS total limb functional outcome after shoulder arthroplasty for all 27 patients was 74.2%, and of the 24 patients who survived, the mean limb functional outcome after shoulder arthroplasty was 78.4%. The patients' quality of life (according to the EORTQ-QLQ-С30 questionnaire) increased from 32 points in the preoperative period to 78 points after shoulder joint replacement. Conclusions. Endoprosthetics is a modern method for reconstructing bone segments in the surgical treatment of tumors of long bones in the limbs. This method allows for the replacement of bone defects of any size (volume) and length. Shoulder joint endoprosthetics within the framework of combination and multimodal treatment of primary and metastatic tumors of the proximal part of the humerus provides restoration of both shoulder joint functions and the upper limb as a whole, thereby improving the quality of life for this group of patients.