Late Postsurgical Complications Research Articles

Multimodality Imaging of Postmastectomy Breast Reconstruction Techniques, Complications, and Tumor Recurrence.

For women undergoing mastectomy, breast reconstruction can be performed by using implants or autologous tissue flaps. Mastectomy options include skin- and nipple-sparing techniques. Implant-based reconstruction can be performed with saline or silicone implants. Various autologous pedicled or free tissue flap reconstruction methods based on different tissue donor sites are available. The aesthetic outcomes of implant- and flap-based reconstructions can be improved with oncoplastic surgery, including autologous fat graft placement and nipple-areolar complex reconstruction. The authors provide an update on recent advances in implant reconstruction techniques and contemporary expanded options for autologous tissue flap reconstruction as it relates to imaging modalities. As breast cancer screening is not routinely performed in this clinical setting, tumor recurrence after mastectomy and reconstruction is often detected by palpation at physical examination. Most local recurrences occur within the skin and subcutaneous tissue. Diagnostic breast imaging continues to have a critical role in confirmation of disease recurrence. Knowledge of the spectrum of benign and abnormal imaging appearances in the reconstructed breast is important for postoperative evaluation of patients, including recognition of early and late postsurgical complications and breast cancer recurrence. The authors provide an overview of multimodality imaging of the postmastectomy reconstructed breast, as well as an update on screening guidelines and recommendations for this unique patient population. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Costs of pediatric hydrocephalus treatment for the Brazilian public health system in the Northeast of Brazil.

To estimate the costs of the surgical treatment of pediatric hydrocephalus, specifically ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV), for the Brazilian public health system (SUS). Retrospective cohort study of health records of patients < 14years of age with a diagnosis of hydrocephalus who underwent VPS or ETV between September 2009 and June 2016, regularly followed up for 24months. Seventy-six medical records were included. The groups of children who underwent VPS and ETV consisted of 60 and 16 patients, respectively. Complications during 2years of follow-up were identified in 56% of the children undergoing VPS and in 18% of those undergoing ETV (p = 0.0103). The initial cost of VPS was lower than that of ETV up to approximately 1year of post-surgical follow-up. After that, VPS generated higher expenses for the SUS due to higher rates of late post-surgical complications and repeated readmissions. Higher public expenditures were observed in the group of children undergoing VPS due to higher rates of infectious and mechanical complications requiring repeated hospitalizations and prosthesis replacements. Public policies must be tailored to offer the best treatment to children with hydrocephalus and to make judicious use of public resources without compromising the quality of treatment.

The impact of patient-reported outcomes on loss to follow-up care after bariatric surgery

High rates of attrition to post-bariatric surgical care continue to be common, despite recommendations for lifelong follow-up. There is little available work focusing on the etiology of attrition to post-bariatric surgical follow-up. Patient-reported outcomes (PROs) are metrics of patients' perceptions of their own health and have been used for their predictive value in other specialties. The relationships between PROs and loss to follow-up have not been explored. PRO data from patients who met the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) definition of loss to follow-up at 1-year postoperatively were reviewed and compared to patients who were compliant with 1-year follow-up. Patient-reported outcomes measurement information system (PROMIS) measures are routinely collected pre- and postoperatively at our institution using a series of validated computer-adaptive tests that assess depression, satisfaction with social roles, pain interference, and physical function. A series of univariate logistic regressions tested whether baseline PROs or change in PROs from baseline to 6-month postoperatively predicted loss to follow-up at 1 year. Neither baseline PROs nor change in depression, satisfaction with social roles, pain interference, or physical function were significant predictors of loss to follow-up. Similarly, patient state of residence, Charlson Comorbidity Index, BMI, and percent excess weight loss were not significant predictors of follow-up attrition. The PROs in this study were not significant predictors of loss to follow-up at 1-year postoperatively. The rate of bariatric procedures continues to increase nationally, so does the potential for late post-surgical complications. Given the potential impact of loss to follow-up on adverse late post-surgical outcomes, there is a need to facilitate long-term post-surgical follow-up and more investigation is needed to identify and intervene on underlying causes of bariatric patient follow-up attrition.

Surgical Therapy of Esophagus Reflux Disease

Abstract Introduction: Fundoplication is the most frequently used action in the surgical treatment of gastroesophageal reflux disease (GERD). There are several types of fundoplication. The objective of our study was to identify complications after surgical treatment of GERD. Material and Methods: We determined several parameters of the monitored and we recorded complications related to surgery: occurrence of surgical, early and late post-surgical complications. Results: 52 patients (24 men and 28 women) with an average age of 53.3 years were included. The most frequently chosen type of fundoplication was Nissen-Rossetti. The most frequently occurring subjective post-surgery difficulties were temporal dysphagia (11.5%), sensation of nausea and vomiting after eating (3.8 %), pain in the surgical wound, and dyspnoea occurring in all patients after thoracotomy. Early post-surgery complication developed in 6 patients (11.5 %) Conclusion: Occurrence of complications in the group monitored by us was up to 11.5 % and perioperative mortality was 0 %. Hiatal hernia is frequently found in patients with GERD and it is considered to be one of the major causes for the development of this disease.

Pedicle screw placement accuracy impact and comparison between grading systems.

Background:Pedicle screw instrumentation is widely used for spinal stabilization. However, the accuracy for free-hand screw placement ranges from 69% to 94%. This study assesses the value of the existing classification systems, and investigates their impact on the ability to assess the accuracy of free-hand screw placement.Methods:Data were collected retrospectively from the medical records of 34 patients who received 224 pedicle screws placed utilizing a free-hand technique. Screw placement was evaluated employing the 2-mm increment and Zdichavsky et al. classification systems. Kappa coefficient and Landis and Koch interpretations were employed for statistical analysis.Results:The 2-mm increment classification system resulted in a total of 18 (8.03%) misplaced screws. Lateral screw misplacement was observed in 13 (5.8%) instances, with medial pedicle wall penetration being noted in 5 (2.23%). Of the 18 misplaced screws, 4 (22.22%) were classified as minor (≤2 mm), 12 (66.67%) as moderate (2–4 mm), and 2 (11.11%) as severe (>4 mm) (K = 0.882). The Zdichavsky et al. grading system categorized 208 (92.84%) pedicle screws as Ia, 10 (4.46%) as Ib, 1 (0.45%) as IIa, 2 (0.90%) as IIb, 2 (0.90%) as IIIa, and 1 (0.45%) as IIIb grade; this resulted in a total of 16 (7.14%) misplaced screws (K = 0.980). One patient exhibited a new postoperative radiculopathy attributed to poor screw placement. There were no additional early or late postsurgical complications attributed to screw misplacement.Conclusion:The free-hand pedicle screw placement technique is both safe and effective. Postoperative computed tomography studies; however, are useful to confirm the accuracy of screw placement. Although, the available grading systems proved reliable, easy to use, and clearly reflected the individual surgeon's skills, they do not clearly document whether screws are safely placed.

Surgical Complications of Simple and Complex Gastroschisis in Newborn

Objective:To determine early or late post surgical complications secondary to simple and complex gastroschisis.Methods:The association between early (acid-base disorders, electrolyte disturbances and presence of hypoalbuminemia), and late postnatal complications (respiratory, gastrointestinal, infectious) was investigated in newborn.Results:42 children, 54.8% male, 73.8% premature, average gestational age of 35.6±2.5 gestational weeks of age (GWA), weight 2147±537gr, they have a NICU stay of 192±14 days, PNT of 19.2±20 days, mortality of 26.2%. The frequent immediate postoperative complications were base-acid imbalance; the metabolic acidosis was associated to simple gastroschisis (p=0.049). The complex gastroschisis was associated to necrotizing enterocolitis (p=0.025), surgical closure type (p=0.003), reinterventions (p=0.025).Conclusion:Acid-Base alterations (76.1%), hypoalbuminemia (59.5%) as early complications and Late sepsis (40.4%), cholestasis (26.1%) as late complications are the most common in patients with Gasthoschisis.

Notice of withdrawal

Clinical Implant Dentistry and Related ResearchEarly View MiscellaneousFree Access Notice of withdrawal First published: 09 December 2013 https://doi.org/10.1111/cid.12198AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Notice of withdrawal: “Prognosis of Deantigenated Equine Bone Used for Bone Augmentation: A Multicenter Retrospective Study on Early and Late Postsurgical Complications in 81 Consecutive Patients” The above article from Clinical Implant Dentistry and Related Research, published online on 24 July 2013 in Wiley Online Library (www.onlinelibrary.wiley.com), ), has been withdrawn pending further investigation. Reference Felice, P., Piana, L., Jacotti, M., Di Lallo, S., Todisco, M., Foschini, M. P., Checchi, L. and Carinci, F. (2013), Prognosis of Deantigenated Equine Bone Used for Bone Augmentation: A Multicenter Retrospective Study on Early and Late Postsurgical Complications in 81 Consecutive Patients. Clinical Implant Dentistry and Related Research. doi: 10.1111/cid.12115 Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Withdrawn: Prognosis of Deantigenated Equine Bone Used for Bone Augmentation: A Multicenter Retrospective Study on Early and Late Postsurgical Complications in 81 Consecutive Patients

To evaluate the clinical outcome of deantigenated equine bone (DEB) grafts in a series of patients treated with DEB at six months postaugmentation. One hundred DEB grafts were inserted in 81 patients between January 2004 and December 2006. Thirty-two DEBs were blocks and 68 were granules (52 sinus lift and 16 guided bone regeneration [GBR] procedures performed). A total of 147 implants were inserted. A Pearson chi-square test was used to detect any statistically significant correlation between the studied variables and early and/or late failures. There were 6 early and 26 late graft failures and another 16 failures after prosthesis placement. The overall failure rate was 25% in the GBR procedures, 31.9% in sinus lift, and 54.3% with blocks, for a total complication rate of 39.5%. A statistically significant relation was detected with respect to graft type and early complications (p = .005), with a worse outcome for DEB blocks compared to granules. After provisional prosthesis restoration, 23 implants were lost, and another 41 failed after definitive prosthesis delivery, for an overall failure rate of 43.5%. The follow-up period was 3 years after surgery. DEB grafting material had a very high rate of complications. Blocks had more than 50% failures, mainly in the immediate postoperative period. Other procedures such as GBR and sinus lift also showed more than 25% infections and resorption, and late failures (i.e., after-implant placement) were also common. Our results show that DEB is less than ideal for crestal bone reconstruction.

The modern way to prevent complications in laparoscopic antireflux surgery

Aim. To improve the results of surgery on patients with hiatus hernia. Methods. Case histories of patients who underwent surgeries at the department of gastric and esophageal surgery from 1996 to 2011 were analyzed. 626 laparoscopic fundoplications in patients aged form 15 to 78 years were performed, among them - 57 using transillumination with fiber optic sensor tube. All patients were present with signs typical for hiatus hernia and gastroesophageal reflux disease (heartburn, belching, early satiety, epigastric discomfort etc.). Pre-surgical examination included X-ray and esophagogastroduodenoscopy. Most patients underwent Nissen fundoplication. The surgery duration varied from 30 to 180 minutes (mean time 65 minutes). Results. Surgical complications such as hollow organs perforation were registered in 4,3% of cases (27 cases out of 626 surgeries). No such complications were registered in group where surgery was performed using transillumination with fiber optic sensor tube. In 12 cases laparotomy for perforation closure was required, in other 15 cases perforation was closed using laparoscopy. No serious events were registered in early post-surgical period, with all patients discharged from the hospital at days 5-7. Such complications as dysphagia and gas-bloat syndrome were predominant in early post-surgical period after laparoscopic fundoplication. The incidence of the early post-surgical complications in patients who underwent surgery without transillumination with fiber optic sensor tube was: dysphagia - 28,8% (164 out of 569 patients), gas-bloat syndrome - 23,7% (135 patients). In cases when transillumination with fiber optic sensor tube was used, dysphagia was diagnosed in 1 case (1,8%), gas-bloat syndrome - in 9 (15,8%) cases. The incidence of late post-surgical complications including dysphagia, relapses and situations when fundoplication becomes undone over time: without transillumination with fiber optic sensor tube - 10,2% (58 out of 569 patients), using transillumination with fiber optic sensor tube - 3,5% (2 out of 57 patients). Conclusion. Preliminary results show that using transillumination with fiber optic sensor tube in laparoscopic fundoplication in patients with hiatus hernia reduces the incidence of post-surgical complications.

Phase II study of preoperative radiation with concurrent capecitabine, oxaliplatin, and bevacizumab followed by surgery and postoperative 5-FU, leucovorin, oxaliplatin (FOLFOX), and bevacizumab in patients with locally advanced rectal cancer: A trial of the Eastern Cooperative Oncology Group (E3204).

3605 Background: Oxaliplatin and bevacizumab potentiate the antitumor activity of fluoroyprimidines and radiotherapy in preclinical and clinical studies of colorectal cancer. This phase II trial evaluated the efficacy of the preoperative combination of capecitabine, oxaliplatin, and bevacizumab with radiotherapy in rectal cancer. Methods: Eligibility: resectable T3/T4 adenocarcinoma of the rectum ≤ 12 cm. from anal verge. Preoperative treatment was capecitabine (825 mg/m² bid M-F), oxaliplatin (50 mg/m² weekly), bevacizumab (5 mg/kg D1,15,29), and pelvic external beam radiotherapy (50.4 Gy/28 fractions). Surgery was performed within 6-8 weeks. Within 12 weeks of surgery, patients received 12 cycles of FOLFOX + bevacizumab (5 mg/kg) Q2 weeks. Pathologic complete response (path CR) was the primary endpoint. Secondary endpoints included resection rate and toxicity. Results: Fifty-seven patients (pts) enrolled from 7/06 to 5/10 and 54 were eligible. Clinical staging: T3/4 (50/4), NX0/1/2 (2/16/31/5). Most common grade 3/4 non-hematologic toxicities during treatment were rectal pain (9), fatigue (8), and diarrhea (7). Two patients died of aspiration. Nine pts had early postsurgical complications (9 wound infections, 6 dehiscence, 1 abscess) and 23 had late surgical complications (23 non-healing wounds, 12 dehiscence, 5 bowel obstruction/ileus, 2 abscess). Pathologic staging: T0/1/2/3 (11/3/15/19), N0/1/2 (32/10/7). Nine pts had path CRs (17%, 90% CI:[9%-27%]. Surgery was LAR (38) and APR (11). Twenty-two pts did not receive postoperative chemotherapy (39%), 16 due to adverse events. Five local recurrences have been reported. RFS and OS data are immature. Conclusions: The addition of oxaliplatin and bevacizumab to capecitabine and radiotherapy for locally advanced rectal cancer resulted in downstaging for the majority of pts but did not improve the pathologic complete response rate compared to historical controls. The combination resulted in significant early and late postsurgical complications.

The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population

Our purpose was to assess the cost, quality of life impact, and the cost-utility of bariatric surgery in a managed care population. We studied 221 patients who underwent bariatric surgery between 2001 and 2005. We analyzed medical claims data for all patients and survey data for 122 survey respondents (55% response rate). Patients were generally middle-aged, female, and white. Sixty-four percent underwent open and 33% underwent laparoscopic Roux-en-Y procedures. One year after surgery, mean body mass index fell from 51 to 31 kg/m(2) in women and from 59 to 35 kg/m(2) in men with substantial improvements in comorbidities. Postsurgical mortality and morbidity were low. Total per member per month costs increased in the 6 months before bariatric surgery, were lower in the 12 months after bariatric surgery, but increased somewhat over the next 12 months. When presurgical quality of life was assessed prospectively, average health utility scores improved by 0.14 one year after surgery. In analyses that took a lifetime time horizon, projected future costs based on age and obesity and discounted costs and health utilities at 3% per year, the cost-utility ratio for bariatric surgery versus no surgery was approximately $1,400 per quality-adjusted life-year gained. In sensitivity analyses, bariatric surgery was more cost-effective in women, non-whites, more obese patients, and when performed laparoscopically. Although not cost-saving, bariatric surgery represents a very good value for money. Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity.

CT Findings in Urinary Diversion after Radical Cystectomy: Postsurgical Anatomy and Complications

Numerous surgical procedures have been developed for urinary diversion in patients who have undergone a radical cystectomy for bladder cancer or, less frequently, a benign condition. Because urinary diversion procedures are complex, early and late postsurgical complications frequently occur. Possible complications include alterations in bowel motility, anastomotic leaks, fluid collections (abscess, urinoma, lymphocele, and hematoma), fistulas, peristomal herniation, ureteral strictures, calculi, and tumor recurrence. Computed tomography (CT) is an accurate method for evaluating such events. Multiplanar reformatting and three-dimensional volume rendering of multidetector CT image data are particularly useful for achieving an accurate and prompt diagnosis of complications and obtaining information that is essential for adequate surgical management. In addition, knowledge of urinary diversion procedures, normal postsurgical appearances, and optimal CT technique for postsurgical evaluations is essential for detecting complications and avoiding misdiagnosis.

Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patients

To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.

Is the placement of shunts in patients with idiopathic normal-pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure.

Data from many studies have demonstrated that shunt insertion in patients with idiopathic normal-pressure hydrocephalus (NPH) is associated with high morbidity and a lack of significant improvement; however, the use of strict diagnostic and treatment protocols can improve the results of surgery in these patients. The primary aim in this prospective study was to analyze the results of shunt placement in 43 patients with idiopathic NPH. A secondary aim was to determine the relationship between several clinical and neuroimaging factors, and patient outcome after surgery. Thirty men and 13 women with a mean age of 71.1 +/- 6.9 years participated in this study. All patients underwent clinical, neuropsychological, and radiological assessment before and 6 months after surgery. In all patients continuous monitoring of intracranial pressure was performed using a fiberoptic extradural sensor. In 31 patients cerebrospinal fluid dynamics were also determined. Eighty-six percent of patients showed clinical improvement after shunt insertion, 11.6% showed no change, and 2.3% exhibited some worsening. Gait improved in 81.4% of the patients, sphincter control in 69.8%, and cognitive dysfunction in 39.5%. There was no treatment-related death. Early or late postsurgical complications occurred in six patients (14%), although all of these complications were minor or were satisfactorily resolved. The complete clinical triad, cortical sulci size, and periventricular lucencies were related to outcome, whereas patient age, symptom duration, ventricular dilation, and the degree of presurgical dementia were unrelated to outcome. Given the correct diagnosis, shunt insertion can produce marked improvement in patients with idiopathic NPH syndrome, causing few deaths and few clinically relevant complications.

Complications, continence and quality of life after an intensive preoperative radio-chemotherapy regimen for locally advanced rectal cancer: analysis of a phase I–II study

Complications, continence and quality of life after an intensive preoperative radio-chemotherapy regimen for locally advanced rectal cancer: analysis of a phase I–II study

Frontal sinus fractures: principles of treatment and long term results after sinus obliteration with the use of lyophilized cartilage

The most commonly used techniques for frontal sinus obliteration involve the implantation of an autogenous tissue graft: either fat, muscle or bone. Lyophilized allogenic cartilage due to its unique properties, such as the tendency to ossification and resistance to volume reduction, can be used as the material of choice for sinus obliteration. A clinical and radiological study of 66 patients operated on for frontal sinus fractures, between January 1 1988 through December 31 1995 was undertaken. Variables recorded included the aetiological factors, the clinical and radiological fracture features with the corresponding treatment modality, the association of frontal sinus fractures with intracranial involvement, the early and late postsurgical complications and the correlation between pre- and postoperative radiological findings. Obliteration of the frontal sinus with lyophilized cartilage chips was performed in 51 (77.3%) patients. The postsurgical evaluation showed no major complications. Revision of the frontal sinus was only required in one patient. The radiological findings verified the progressive calcification of the obliterated sinus. Allogenic lyophilized cartilage implantation offers distinct advantages in cases of severe frontal sinus trauma: 1. There is nearly unlimited availability of the material. 2. There is no need for a second operation field with the associated potential donor site morbidity. 3. The operation time is reduced due to the avoidance of a second operation on the donor site.

New Perspectives in the Diagnosis of Echinococcus Disease

Echinococcosis, an endemic disease on the Asian continent, is caused by the tapeworm Tenia Echinococcus, which produces cysts in the liver and other organs. I reviewed 157 patients with hydatid disease of the liver. The hydatid cysts were single in 125 patients and predominantly in the right lobe, but multiple in 31 patients, localized in both lobes or in the lung, spleen, pancreas, heart, or peritoneum. In 14 patients, early complications were manifested by rupture of the cyst into the biliary tract, the lung, or the peritoneum. Infection of the cysts was rare. Late postsurgical complications, noted in 10, were the development of an abscess or cirrhosis. I evaluated the importance of computed tomography (CT) in the diagnosis of hydatidosis of the liver and other visceral organs: It made a correct and accurate diagnosis in 96% of 157 patients. But, in ruptured or infected cysts, CT scans could not distinguish between a hydatid cyst and an abscess. Surgery is still the treatment of choice in hydatid disease. It is absolutely indicated in complicated cases, and is easy and curative in uncomplicated ones. I have used Mebendazole in 18 patients for 2 years without significant benefit, except in two patients with disseminated hydatidosis. Mebendazole stabilized the disease.