Patients In Late Postoperative Period Research Articles

Comparative analysis of the effectiveness of the treatment of transsphincter anal fistulas by various methods

AIM: to assess the effectiveness late results of laser technologies in the treatment of anal fistulas compared with traditional methods (excision of the fistula followed by ligature, excision of the fistula followed by restoration of the sphincter).PATIENTS AND METHODS: a single-center retrospective study included 150 patients. Patients underwent 3 variants of surgical intervention. In the first group (50 patients), the fistula was treated with laser technology. In the 2nd group (50 patients), the fistula was excised followed by seton, in the 3rd group (50 patients), the fistula was excised followed by sphincteroplasty. Quality of life (according to the SF-36 school), as well as differences in the proportion of relapses on the 180th day after the surgery was carried out.RESULTS: it was revealed that higher indicators of the components of physical health (PH) (F = 11260.72 p < 0.001), as well as mental health (MN) (F = 10459.6 p < 0.001) were detected in the group of patients treated with laser technology. The calculation of significant differences in the observation groups showed that with the number of observations more than the specified one, it is possible to state a decrease in the number of relapses with the laser treatment method by 2.2 times compared with traditional methods.CONCLUSION: laser technology for anal fistulas is a progressive method that provides a significant reduce of recurrence rate, as well as improving the quality of life of patients in late postoperative period.

Визуальные исходы факоэмульсификации катаракты у пациентов с сахарным диабетом и различной клинической рефракцией

Purpose. To study the results of phacoemulsification (PE) in patients with diabetes mellitus (DM) depending on the anterior-posterior axis (APA) and eye refraction. Material and methods. The study involved 57 patients (57 eyes) with insulin-dependent compensated or subcompensated DM (type II). All the patients underwent PE with IOL implantation. According to the nature of refraction, the patients were divided into 3 groups: group 1 — 16 patients (16 eyes) with moderate and high myopia, group 2 — 18 people (18 eyes) with hypermetropia, group 3 — 23 patients (23 eyes) with emmetropia. Distribution of the patients according to the length of the anterior-posterior axis (APA): with moderate myopia and APA from 25.01 to 26.5 mm (7), high myopia and APA above 26.51 mm (9), with emmetropia and APA from 22.2 to 23.8 mm (23) and APA less than 22.2 mm — hypermetropics (18). Results. VA in the early and late postoperative period in patients with DM and myopic refraction after PE was higher than in patients with hypermetropia and emmetropia. Visual acuity of 0.5 and higher was observed at discharge in 75.0 % of patients with myopia (and changes in the retina in the form of diabetic retinopathy were much less frequent) than in patients with hypermetropia (50.0 %) and emmetropia (52.2 %), and in long-term follow-up in 73.3 %, 37.5 % and 36.8 %, respectively. Destabilization of diabetic retinopathy with the transition to the next stage was observed twice less often in patients with myopia (13.3 %) than in patients with hypermetropia and emmetropia (25 % and 26.3 %, respectively). Conclusion. Visual outcomes after cataract surgery in diabetic patients are strongly affected by refraction and the axial length of the eyeball. At discharge visual acuity of 0.5 and higher was observed in 75.0 % of myopic patients, 50.0 % of hypermetropics and 52.2 % of emmetropic patients; and over 3 years of follow-up — in 73.3 %, 37.5 % and 36.8 % respectively. At hospital discharge diabetic retinopathy in myopic patients was observed 4.3 times less frequently than in patients with emmetropia and hypermetropia, and its destabilization with the transition to the next stage after 3 years of postoperative follow-up was twice less often: in 13.3 % vs. 25 % and 26.3 %, respectively. Keywords: diabetes mellitus, cataract, phacoemulsification, anterior-posterior axis of the eye, refraction, myopia, visual acuity, diabetic retinopathy

Анализ геморрагических осложнений в хирургии пролиферативной диабетической ретинопатии

Purpose. Determination of factors associated with the incidence of hemophthalmos in the early and late postoperative period in patients with proliferative diabetic retinopathy (PDR). Material and мethods. Retrospective analysis of postoperative complications was performed in 124 patients (133 eyes) with PDR, who received treatment at the Research institute of Eye Diseases from 2018 to 2021. The study included patients with PDR with indications for surgical treatment (hemophthalmos, traction retinal detachment (TRD), traction diabetic macular edema). All patients underwent minimally invasive vitrectomy using additional chandelier-type illuminators with bimanual dissection and delamination of the proliferative tissue and careful removal of the vitreous base with sclerocompression. In all cases, the operation was completed without the use of any tamponade. Peripheral retinal photocoagulation (RP) was performed in 98 cases (73.7 %), phacoemulsification with intraocular lens implantation in 66 cases (49.6 %), angiogenesis inhibitors were used perioperatively in 47 cases (35.3 %). Results. Of 133 operated eyes, early postoperative intravitreal hemorrhage (EPH) was observed in 17 cases (12.8 %), of which 6 resorbed spontaneously and 11 required repeated surgical intervention. The development of EPH was significantly associated with the absence of intraoperative RP (p < 0.01), and the frequency of revision of the vitreal cavity to eliminate EPH correlated with the unstable course of arterial hypertension (AH) (p= 0.048) and with the absence of panretinal photocoagulation (PRP) before surgery (p= 0.012). It was found that EPH developed more often in patients operated on for TRD (p= 0.007) and in cases accompanied by severe intraoperative bleeding (p= 0.001) and unintentional intraoperative damage to the retinal vessels of the 2nd-3rd order (p< 0.01). Late postoperative intravitreal hemorrhage (LPH) was observed in 20 cases (19.8 %), of which 11 resorbed spontaneously and 9 required surgical treatment. The development of LPH is significantly associated with the absence of intraoperative RP (p< 0.01 for self-resorbed LPH and p= 0.041 for LPH requiring revision of the vitreal cavity). The frequency of revision of the vitreal cavity for the treatment of LPH is significantly associated with the unstable course of hypertension (p= 0.007) and the presence of EPH requiring surgical intervention (p= 0.003). The use of anti-angiogenic drugs before and during surgery did not show a significant correlation with the occurrence of EPH and LPH. Conclusions. Analysis of complications showed that EPH and LPH occurred in 12.8 % and 19.8 % of cases, respectively. Factors associated with the development of EPH were identified: the absence of PRP before surgery, the absence of intraoperative RP, TRD, intraoperative damage to the retinal vessels of the 2nd-3rd order. Factors associated with the development of LPH were identified: failure to perform RP intraoperatively, unstable course of hypertension, and the presence of EPH that required surgical intervention. Keywords: diabetic retinopathy, vitrectomy, bianual vitrectomy, postoperative hemorrhage, panretinal photocoagulation, peripheral retinal photocoagulation, arterial hypertension.

Retrospective analysis of functional and anatomical changes, the level of intraocular pressure in patients with glaucoma and highgrade myopia during surgical treatment of cataracts

Purpose of the study. To conduct a retrospective analysis of functional, morphometric changes, the level of intraocular pressure after phacoemulsification of cataracts in the early and late postoperative period in patients with glaucoma and highgrade myopia.
 Materials and methods. A retrospective analysis of lens morphometric parameters, baseline IOP in patients with PVKG and MIA, IOP in the early and late postoperative period (12 months) in 60 patients who underwent surgical treatment of cataracts by phacoemulsification. There were 2 groups: 1 group consisted of 20 patients with glaucoma, including men – 11, women – 9, the average age of patients in this group was 73,42 ± 6,8 years, the second group consisted of 20 patients with MIA, including men – 8, women – 12, the average age was 71,46 ± 8,25 years. The control group included 20 patients with cataracts (36 eyes), of whom there were 10 men, 10 women, the average age of patients was 70,82 ± 10,25 years.
 Patients in all groups were homogeneous and comparable in sex and age. Patients of the 1st observation group were in a state of compensation for the level of IOP on the background of the use of antiglaucoma drugs. All patients underwent standard ophthalmological examination, including visometry, perimetry, tonometers, biomicroscopy, ophthalmoscope, echobiometry, keratorefractometry.
 Results. A retrospective analysis of functional and anatomical changes in patients with glaucoma and highgrade myopia during surgical treatment of cataracts indicates the effect of FEC + IOL on the condition of ophthalmotonus and functional parameters of the eyes in both early and late postoperative period.
 Conclusion. Analysis of examination of patients with primary openangle glaucoma and high grade myopia revealed differences in functional, morphometric parameters and the level of intraocular pressure after phacoemulsification of cataracts. Maximum corrected visual acuity (MCG) after phacoemulsification of cataracts was significantly increased in all observation groups. The frequency of thick lenses in the control group was 25%, in the group with PVKG – 35%, and in patients with MIA the incidence was minimal, «respectively – 10%. In the remote period 1 year after FEC there is a decrease in IOP in the control group and in glaucoma patients by 0,8 and 1,1 mm Hg, respectively, while in the group of patients in the Ministry of Internal Affairs there is an increase in ophthalmotonus by 0,7 mm Hg (P  0,05). The frequency of reduction of IOP 1 year after FEC is 70% in patients of the control group, 55% in patients with glaucoma and 10% in patients with high myopia.

Effectiveness of Intraoperative Laser Acupuncture Combined with Antiemetic Drugs for Prevention of Postoperative Nausea and Vomiting.

Introduction: Postoperative nausea and vomiting (PONV) are frequent in patients undergoing laparoscopic cholecystectomy. The aim of this study is to evaluate the effectiveness of intraoperative laser acupuncture stimulation of Pericardium 6 (PC6) and Large Intestine 4 (LI4) acupoints combined with antiemetic drug prophylaxis on PONV. Methods: A total of 88 patients, scheduled for laparoscopic cholecystectomy, were assigned into 2 groups. Group I received bilateral laser acupuncture on PC6 and LI4 acupoints after induction of anesthesia and also received antiemetic drug (metoclopramide) prophylaxis. Patients in Group II received only antiemetic drug prophylaxis. Nausea and vomiting frequencies and need for rescue antiemetic drug (ondansetron) were recorded after extubation, at 30th minute at recovery room and at 6th hour at ward. Results: The incidence of nausea and rescue antiemetic drug need was higher at postoperative 6th hour in Group II. Vomiting was not different in groups at any time. Conclusion: Intraoperative laser acupuncture stimulation of PC6 and LI4 acupoints combined with antiemetic drug prophylaxis decreases nausea and rescue antiemetic drug need in late postoperative period in patients undergoing laparoscopic cholecystectomy.

Estimation of variants of the pancreatic gland pathology in patients, suffering complicated forms of chronic pancreatitis in late postoperative period

Objective. Estimation of variants of the pancreatic gland pathology and rate of the unfavorable results occurrence in late postoperative period in patients, suffering complicated forms of chronic pancreatitis, depending on the procedures of surgical treatment.
 Materials and methods. Results of surgical treatment of complicated forms of chronic pancreatitis in department of the gut surgery in 2007 - 2017 yrs were studied in 107 patients, who were divided into two groups: the Group I – 67 (62.7%) patients, in whom pancreato- and virsungodigestive operations were performed, and the Group II – 40 (37.4%) patients, in whom duodenum—preserving resection-drainage surgical interventions were done.
 Results. Unfavorable variants of pancreatic pathology were observed significantly more frequently in patients of the Group I – in 34/67 (50.7%) in comparison with patients of the Group II – in 6/40 (15.0%) (χ2=9.49, p=0.002).
 Conclusion. Analysis of rate of the unfavorable results occurrence in late postoperative period, depending on surgical tactics appled, have shown a trustworthy advantage of the resection-drainage operations.

A novel surgical technique: Crushed septal cartilage graft application in endonasal septoplasty

ObjectiveNowadays, different septoplasty procedures are applied for therapy of nasal septum deviation. However, various complications of the septoplasty procedures have been described. Several techniques have been developed to decrease the incidence of these complications by surgeons. We aimed to present the effectiveness of the crushed septal cartilage graft, which is a novel septoplasty technique. MethodsPatients: Patients The study was performed based on the parameters of 500 patients who underwent surgery with crushed cartilage graft technique in our clinic between the dates 2013 and 2016.Technique: This novel operation technique was performed under general anestesia. The NOSE (Nasal obstruction symptom evaluation) scale was applied to all patients in both the preoperative period and the 2nd month of the postoperative period, and then the both values were statistically compared. Additionally, all the patients were followed up for complications that may occur after the operation for a year. ResultsThe study included 140 (28%) female and 360 (72%) male patients, which totally makes 500 patients. The average age of the participants was 35±12.5. When compared to the preoperative NOSE scale values (P˂0.001), the postoperative NOSE scale values were found to be significant. We watched intranasal infection and incrustation in 7(1.4%) patients in early postoperative period and the epistaxis in 3(0.6%) patients in late postoperative period. We did not see any postoperative complications apart from these two minor and insignificant complications during the follow-up along a year. ConclusionThe crushed cartilage technique is a feasible, safe and effective alternative surgery technique to traditional septoplasty. What is more, complications of septoplasty can be prevented with the help of this novel surgical technique.

QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE.

ABSTRACT Background : The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients. Aim : To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods : Was applied the questionnaire “Bariatric Analysis and Reporting Outcome System” (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results : A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion : BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities.

Morphological and Functional Changes in the Brain in the Long-Term Period after On-Pump Cabg

Purpose: evaluation of brain substance’s morphological state and dynamics of cerebral tissue perfusion in patients undergoing on-pump CABG surgery compared preoperative and late postoperative period.Materials and methods. The study included 14 male patients who underwent on-pump CABG surgery. CT and PCT with intravenous bolus radiopaque drug in the cubital vein conducted to all patients in the preoperative period. Cranio-ventricular index, width III ventricle was measured. The presence and degree leukoaraiosis, the presence of cysts, areas of gliosis, CBF, CBV, TTP in symmetric cortical and subcortical regions was recorded. CT and PCT repeat after 5 years.Results.In preoperative period III ventricle width was 6.8 ± 1.4 mm; cranio-ventricular index = 4.9 ± 1.3. It were found cysts on the level of the basal ganglia in two cases (14%). Leukoaraiosis detected in four patients (28%). PCT in the preoperative period noted the absence of blood flow asymmetry, reducing blood flow to the frontal lobes, in the area of the junction of the parietal, temporal and occipital lobes. Significant expansion of the III ventricle 8.5 ± 2.5 mm, reducing cranio-ventricular index 3.6 ± 0.5, increasing the number of cysts and glial changes in 6 (43%) cases, leukoaraiosis in 8 (57%) cases, a significant increase in TTP in the index of the thalamus (11.5 ± 2.1 sec) was determined after the operation.Conclusions.Сhronic cerebral ischemia revealed progression of manifestations in the late postoperative period in patients undergoing on-pump CABG. The identified changes are not a direct result of on-pump CABG, because similar changes observed in patients with atherosclerotic lesions of the microvasculature and damage the blood-brain barrier and also in patients without cardiac surgery.

QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE.

ABSTRACTBackground: The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life. Aim: To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods: It was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results: A total of 47 patients between 21-60 years old were evaluated. The total mean of BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion: The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities in patients submitted to sleeve gastrectomy.

No change in B-type natriuretic peptide levels assessed in the late postoperative period in patients with severe mitral regurgitation after mitral valve surgery

The impact of mitral valve (MV) surgery on levels of B-type natriuretic peptide (BNP) postoperatively has not been clearly evaluated. The aim of this study was to assess whether BNP levels decrease three to six months after MV surgery in patients with severe mitral regurgitation (MR). We prospectively enrolled patients who were referred for MV surgery with severe MR. BNP levels were measured prior to and after surgery. The mean age was 61.3 ± 13.6 years; 75% were male (n = 52). There was no difference between the mean preoperative and postoperative BNP (242.9 ± 280.3 pg/ml, 290.8 ± 549.8 pg/ml, P = 0.45) obtained at a mean of 138.7 ± 33.5 days with the bias-corrected bootstrapped 95% confidence intervals, 117.6-321.8 pg/ml and 185.4-483.8 pg/ml, respectively. Postoperative BNP tended to increase as the amount of MR increased (no MR: 212.7 ± 197.5 pg/ml, 1+MR: 592.9 ± 1174.9 pg/ml, 2+MR: 133.6 ± 121.6 pg/ml, 3+MR: 547.7 ± 332.0 pg/ml; P < 0.0001). A mild inverse correlation was noted with postoperative BNP and postoperative ejection fraction (r = -0.2596). A decrease in the ejection fraction was noted after surgery (51.7 ± 11.1%, 56.3 ± 9.6%; P = 0.03). Our findings contradict an intuitive thought that BNP levels should decrease after MV surgery for MR.

The Effect of Thoracic Epidural Analgesia on the Occurrence of Late Postoperative Hypoxemia in Patients Undergoing Elective Coronary Bypass Surgery

To evaluate the effect of perioperative thoracic epidural analgesia followed by postoperative epidural analgesia compared with conventional IV anesthesia on the occurrence of late postoperative hypoxemia in patients undergoing elective coronary bypass graft (CABG) surgery. Randomized controlled trial. Cardiac surgery unit at a university hospital. A total of 50 patients undergoing elective CABG surgery. Patients were randomly assigned to receive either conventional IV anesthesia (CON) or general anesthesia combined with thoracic epidural anesthesia followed by postoperative epidural analgesia (TEA) with bupivacaine. Postoperatively, the patients were monitored in the surgical ward with a pulse oximeter for a total of two postoperative nights (the second and third postoperative nights). The overall incidence of episodic hypoxemia was 56% (28 of 50 patients) on the second postoperative night and 89% (41 of 46 patients) on the third postoperative night. More than 30 episodes of hypoxemia developed on the second night in 22% of patients (11 of 50 patients), and on the third night in 30% of patients (14 of 46 patients). Despite oxygen therapy, 7% of patients (3 of 46 patients) experienced constant hypoxemia on the third night. In general, hypoxemia seemed to be slightly worse on the third postoperative night compared with the second postoperative night. Significantly more patients in the TEA group (25 of 25 patients) experienced episodic hypoxemia on the third postoperative night compared with the CON group (16 of 21 patients; p < 0.05). Otherwise, there were no significant differences between the two regimens. Both episodic and constant hypoxemia were common in the late postoperative period in patients on the ward after CABG surgery with no clinically significant intergroup differences. Thus, perioperative epidural anesthesia/analgesia combined with postoperative epidural anesthesia/analgesia was not protective against hypoxemia, and therapy with opioids did not seem to be of importance for the occurrence of late postoperative hypoxemia on nights 2 and 3 after CABG surgery.

Late ultrasonographic findings in cases operated for hydatid cyst of the liver

Purpose: The aim of this study was to evaluate and present the images due to surgical intervention and to recurrences in patients who had been operated for hydatid cyst of the liver at least 12 months prior to the imaging process. Material and methods: A total of 77 patients (46 females, 31 males) with a mean age of 38 years (10–60 years) who had undergone surgical intervention for hydatid cyst of the liver were included in this study. The type and the number of operations were determined by reviewing previous medical records of the patients. Recurrence findings and postoperative images were examined by ultrasonography in all patients. Results: Of the 77 patients, 68 had undergone surgical operation for hydatid cyst of the liver for once, six cases for twice, one patient for three and another patient for four times. Ultrasonographic examination was considered normal in 9 (11.6%) patients. The most frequent finding in the remaining patients was hypoechoic ( n = 6) and anechoic ( n = 14) images with a hyperechoic periphery within the operation area. While a coarse heterogenous area was visualized in 12 cases (15.5%), a sole hypoechoic image was present in 10 patients. Recurrence was detected in 9 (11.6%) patients of whom 7 were asymptomatic. While daughter cysts were detected in two recurrent cases; the remaining were unilocular cysts. An omentum image extending to the operation area was detected in 11 patients. Calcification was present in 14 patients, whereas four cases had less common findings of anechoic tubular structures adjacent to the operation area. Conclusion: While the liver may seem normal by ultrasonography in the late postoperative period in patients, who had been operated for hydatid cyst of the liver, various images may also be present. These images may be misinterpreted as recurrence or other pathologies. Thus, the radiologist should be familiar with the postoperative ultrasonographic findings of hydatid cyst and should not misinterpret the image of anechoic fluid as recurrence. When in doubt, ultrasonographic follow-up is essential. An early postoperative ultrasonographic examination may be the key point in precluding a misdiagnosis.

Myelography in the late postoperative period in patients subjected to anterior cervical decompression and fusion.

During a 13 year period, 286 patients with cervical disc herniation and/or spondylotic spurs, were subjected to anterior decompression and vertebral interbody fusion with autologous bone. Twenty patients were re-admitted in the late postoperative period due to recurrent radicular symptoms and/or signs of myelopathy. In these patients myelography was performed again. In 14 patients spinal cord compression and/or nerve root involvement at a new level was visualized. At the operated level, however, the myelograms demonstrated a smooth anterior wall in the spinal canal. The series confirms the safety, effectiveness and reliability of the Cloward procedure in achieving long term spinal cord and nerve root decompression, and a solid vertebral interbody fusion.