Late Results Of Surgical Treatment Research Articles

Prediction of late results of surgical treatment of traumatic retina detachment in eye injury of multiple origin

Purpose. To evaluate the possibility of predicting the anatomical and functional results of surgical treatment of traumatic retinal detachment (RD) in trauma of various geneses, taking into account the clinical picture and the severity of the proliferative syndrome based on large clinical data.Materials and methods. A comprehensive analysis of the clinical picture (using 22 features) and long-term results of surgical treatment of 427 patients with traction traumatic RD (TRD) after open and closed eye injury was carried out. The patients were divided into 7 groups depending on the mechanism of injury. The observation period was 5 years.Results. The most severe proliferative syndrome was observed in TRD after an open injury: OEI A (contusions with scleral rupture), OEI D (double puncture wound) and OEI E (explosive trauma with scleral rupture), when both the process of mooring and PVR are present, as well as with CEI A (contusion) in the event that after the first operation PVR continued to progress. We found a direct dependence of PVR activity in TRD on the area of the detached retina and the presence of a traumatic cataract, and the inverse dependence on the presence of intraocular foreign body (IFB), its size and the ability of IFB to cause metallosis. A direct dependence of long-term functional results of treatment on the PVR stage, the area of detached retina and the diagnosed retinal rupture during the first vitreoretinal surgical intervention was established.Conclusion. In order to make the surgical treatment of TRD more effective, it is worth using antiproliferative drugs intravitreally during vitreoretinal surgery, especially in OEI A, OEI D and OGI E, when the proliferative syndrome is caused both by PVR and mooring, as well as in CEI A in the case of a pronounced PVR stage.

Surgical treatment of mitral stenosis, complicated by massive thrombosis of the left atrium: stationary stage

Objective. Elaboration of the correction methodology of mitral stenosis, complicated by massive thrombosis of left atrium, for improvement of immediate and late results of surgical treatment of this pathology.
 Materials and methods. Into the group analyzed 344 patients with mitral stenosis, complicated by massive thrombosis of left atrium, operated in Amosov National Institute of Cardiovascular Surgery in a period from 1 January 1984 yr to 1 January 2019 yr, were incorporated. In all the patients surgical correction of mitral stenosis and thrombectomy from left atrium was performed. In 161 (46.8%) patients a radical removal of thrombotic mass together with their base–lining was performed, while in 183 (53.2%) – without it. In 256 (74.4%) patients the left atrium auricle was ligated or resected, while in 88 (25.6%) – left intact.
 Results. The hospital lethality index have had directly proportionally raised with enhancement of degree of the left ventricle auricle: I – 0%, II – 3.9%, III – 5.1% (p<0.05). In a general group during all period of the investigation a directly proportional dependence of index of hospital lethality due to lethal thromboembolic complications on degree of massive thrombosis of the left atrium auricle was observed: I – 0.0%, II – 3.5%, III – 5.2% (p<0.05). Best indices of hospital lethality were achieved in radical removal of thrombi together with their base–lining with ligature or resection of the left atrium auricle as a possible origin of thrombi creation.
 Conclusion. While doing surgical correction in patients with massive thrombosis of left atrium it is important to remove the thrombotic base–lining and to ligate or resect the left atrium auricle, what significantly lowers the risk of hospital lethality, thromboembolic complications on stationary stage of treatment.

Colitis ulcerosa laparoszkópos sebészi kezelése, rövid és hosszú távú eredmények aszegedi Sebészeti Klinikán.

Introduction. An estimated 20–30% of patients with ulcerative colitis need surgery. The generally accepted procedure for the surgical treatment is total proctocolectomy with ileal pouch-anal anastomosis. Nowadays laparoscopic technique is used more frequently. Minimally invasive surgical technique is used during the surgical treatment of colorectal diseases in the Department of Surgery in Szeged since 2005. Aim. We aimed to compare the last 16 years’ results of patients treated with conventional and laparoscopic methods. Methods. Between 01. 01. 2005. and 31. 03. 2021. 99 patients (53 female, 46 male) received surgery. The laparoscopic technique was used in 74 (74.7%) and the conventional method in 25 (25.3%) cases. General status of patients, early and late results of surgical treatment, and mainly complications were analyzed. Results. There was no difference between the groups in-hospital stay, the number of days spent in the intensive care unit and the need for transfusion. During the follow-up period the time to the recovery of the bowel function, and the occurrence of late complications were significantly lower in the laparoscopically operated group of patients. Conclusions. Laparoscopic surgical treatment can be used safely for both emergency and elective cases in UC patients. The short-term perioperative results and the morbidity showed no differences between the laparoscopic and open techniques. The long-term effect of laparoscopic surgery insured alower rate of complications.

Late results of surgical treatment of critical ischemia of the lower extremities after one-staged direct revascularization

Objective. To optimize the tactics of surgical treatment in patients, suffering chronic ischemia of the lower extremities with the help of elaboration and introduction of a one-staged direct and indirect revascularization into clinical practice.
 Materials and methods. Analysis of the treatment results in 162 patients, suffering obliterating atherosclerosis of the lower extremities vessels, who were treated in stationary in Department of Vascular Surgery of Zakarpattya Regional Clinical Hospital named after Andriy Novak in 2015 - 2020 yrs. The patients were distributed in accordance to the lower extremities ischemia degree: ІІB – 7 (4.3%), ІІІA – 61 (37.7%), ІІІB – 58 (35.8%), ІV – 36 (22.2%). All the patients have had atherosclerotic affection of femoro-ankle-foot segment of the main arteries with preservation of central blood flow in aorto-iliac segment.
 Results. Occlusion of femoral artery was noted in all patients. Occlusion of anterior tibial artery was revealed most frequently – in 72% of the patients, than in fibular - in 42% of patients (p=0.00), and equally frequently with occlusion of posterior tibial artery – in 68% (p=0.61). The foot arteries were involved into the process in 51 (31.5%) patients. Affection of 2-3 arteries of the shin were registered more frequently, than occlusion of one artery – in 109 (67.3%) and 48 (26.5%) patients, accordingly. Occlusive-stenotic affection of popliteal artery have had 127 (78.4%) patients.
 Mostly frequent affection of the shin arteries was observed in basin of anterior tibial artery – in 67 (41.4%) patients, as well as in combined affection of anterior and posterior tibial arteries - in 45 (27.8%) patients. Іsolated affection of posterior artery was revealed in 36 (22.2%) patients. Combined affection of posterior tibial and fibular was observed in 14 (8.6%) patients.
 Conclusion. Efficacy of indirect revascularization after the arterial inflow restoration is more prognosticated, than efficacy of its isolated conduction in environment of chronic critical ischemia of the lower extremities. Combined application of direct and indirect revascularization guarantees more secure positive result in remote postoperative period and enhancement of the extremities preservation index.

Late results of surgical treatment of the aortal arch hypoplasia in newborns and babies

Objective. To conduct the analysis of late results of the aortal arch reconstruction in newborns and babies, basing on determination of the risk factors for lethality and reoperations.
 Materials and methods. In 2010 - 2019 yrs in the Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery the aortal arch reconstruction was performed in 445 patients, ageing up to 1 year old, suffering coarctation and hypoplasia of one or several aortal segments. Into the investigation were included the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 161 (36.2%) girls and 284 (63.8%) boys with the age median 0.7 mo [0.3; 2.7], while the body mass median – 3.7 kg [3.25; 4.59], and the body surface square median – 0.23 m2 [0.20;0.27]. Echocardiography was the main diagnostic method for the failure as well as for estimation of immediate and late results.
 Results. Overall lethality have constituted 3.3%, the hospital one – 2.7%, lethality in late period of observation – 0.7%. The observation period have lasted from 1 mo till 9.4 yrs, (2.8 ±2.5) yrs at average. Reoperations on aortal arch were performed in 47 (10.5%) patients: in 12 – surgical aortal arch rereconstruction, in 27 – balloon angioplasty, and in 8 patients both methods were used. The risk factors for lethality after the aortal arch reconstruction in the patients, ageing up to 1 yr old were revealed: the patients’ age on the operation moment lesser than 0.9 mo, the body mass lesser than 2.6 kg, durable operation, presence of concurrent inborn heart failures, residual hypoplasia of the aortal segments A and B. Low mass and the surface square of the body, presence of the aortal arch segments hypoplasia preoperatively, residual pressure gradient on the aortal arch more than 20 mm Hg, hypoplasia of any aortal arch segments after reconstruction have constituted the risk factors for reoperations.
 Conclusion. Surgical treatment of the aortal arch hypoplasia in newborns and babies is effective and giving good immediate and late results. Anatomic correction of secondary obstruction on the aortal arch level is secure, with low indices of lethality and reoperations, and performed either surgically or endoscopically. Taking into account the risk factors revealed for lethality and reoperations on aortal arch, have permitted to improve the results of treatment of the aortal arch hypoplasia in patients ageing up to 1 yr old.

Surgical treatment of peripheral hepatic cholangiocarcinoma with a visceral vein invasion

Objective. To estimate the immediate and late results of surgical treatment in patients, suffering peripheral cholangiocarcinoma with invasion of visceral vein.
 Маterials and methods. Retrospective analysis was accomplished for surgical treatment of 84 patients, suffering peripheral cholangiocarcinoma, in whom radical operations were performed in Department of Transplantation and Hepatic Surgery of Shalimov National Istitute of Surgery and Transplantology in a period from Jan. 2004 tо Dec. 2018 yrs. The investigated group consisted of 28 patients, to whom hepatic resection with simultant resection and plasty of visceral veins for tumoral vascular invasion was performed. Into comparison group 56 patients were included, in whom hepatic resection was not accompanied with vascular resection.
 Results. Trustworthy differences were absent between groups in accordance to following indices: the patients’ age (p=0.16-0.7), gender (p=0.3), physical status (p=0.36), pre- and postoperative stationary stay (p=0.4). In the investigated group there were performed 14.3% hemihepatectomies, 32.1% extended hemihepatectomies and 53.6% threesectioectomies, and in a comparative one - 57.2% (р ≤ 0.001), 14.3% (р = 0.054) and 21.4% (р = 0.002), accordingly. Simultant intervention on biliary ducts was done in 37.5% patients from investigated group and in 25% patients from comparative group (р = 0.305), the adjacent organs resection - in 14.3 and 12.5% (р = 0.819) patients, accordingly. Clinically significant postoperative complications were observed in 25 and 30.4% (р = 0.262) patients, accordingly. In the investigated group postoperative mortality was absent, while in a comparative one it constituted 3.5%. In the investigated group a 3-years and a 5-years total survival was noted in 47 and 35% patients, accordingly, while in a comparison group - in 49% (р = 0.317) and 38% (р = 0.003) patients, accordingly. In investigated group a 3-years and a 5-years survival without a recurrence was noted in 39 and 28% patients, accordingly, and in a comparative group - in 44% (р = 0.04) and 31% (р=0.002) patients, accordingly.
 Conclusion. Іnvasion of peripheral cholangiocarcinoma into visceral veins does not constitute a contraindication for operative treatment, if it is conducted in a highly specialized multidisciplinary centre.

Use of laparoscopic technique in the treatment of ulcerative colitis

An estimated 20-30% of patients with ulcerative colitis need surgery. The generally accepted procedure for the surgical treatment is total proctocolectomy with ileal pouch-anal anastomosis. Nowadays laparoscopic technique is used more frequently. Our aim was to compare the last 13 years results of patients treated with conventional and laparoscopic methods. Between 01. 01. 2005 and 31. 05. 2018, 89 patients (n = 48 female, n = 41 male) received surgery. The mean age of the patients was 45.06 ± 14.4 and 39.8 ± 13.4 years in the laparoscopy and the open surgery groups. General status of patients, early and late results of surgical treatment, mainly complications and quality of life, were analyzed. There was no difference between the groups in hospital stay (10.3 ± 3.3 vs. 11.2 ± 3.7 days) and need for transfusion (2.6 ± 2.2 vs. 2.8 ± 1.7 units). During the follow-up period, the time to the recovery of the bowel function (1.2 ± 0.5 vs. 1.6 ± 0.7 days), the number of days spent in the intensive care unit (2.1 ± 0.9 vs. 2.5 ± 1.6 days) and the occurrence of late complications, such as intestinal obstruction, septic condition, postoperative hernias and 'other' complications were significantly lower in the laparoscopically operated group of patients. In the case of acute operations, the laparoscopic technique provided significantly better recovery of the bowel function (1.2 ± 0.4 vs. 1.8 ± 0.7 days). During the surgical treatment of ulcerative colitis, the minimally invasive technique provided more favourable perioperative results and a better long-term quality of life due to the lower rate of late complications and the more stable psychic status. Orv Hetil. 2020; 161(33): 1363-1372.

Laparoscopic preperitoneal alloplasty of postoperative ventral hernias

Objective. To raise the efficacy of surgical treatment of postoperative ventral hernias, performing laparoscopic preperitoneal allohernioplasty.
 Materials and metods. Analysis of the surgical treatment results was conducted in 126 patients, suffering postoperative ventral hernias, ageing from 30 to 75 yrs old, who were operated on in the Clinic of Department of Surgery and Proctology of Shupyk National Medical Academy of Postgraduate Education in 2012 - 2019 yrs, was conducted. There were 80 (63.5%) women-patients, and 46 (36.5%) men-patients. Average age of the patients have constituted (54.7 ± 3.3) yrs old.
 In accordance to classification of European Association of Surgeons-Herniologists (The European Hernia Society - EHS, Gent, Belgium, 2008 yr) distribution of postoperative hernias was following: hernias M1W1R0 were diagnosed in 6 (4.8%) patients, M2W1R0 - in 12 (9.5%), M2W2R0 - in 14 (11.1%), M3W1R0 - in 10 (7.9%), M3W2R0 - in 11 (8.7%), M3W3R0 - in 8 (6.3%), M4W1R0 - in 7 (5.6%), M4W2R0 - in 3 (2.4%), M4W3R0 - in 5 (4.0%), M5W1R0 - in 8 (6.3%), M5W2R0 - in 4 (3.2%), M2-3W2R0 - in 19 (15.1%), M3-4W2R0 - in 8 (6.3%), M3-4W3R0 - in 4 (3,2%), M1-4W3R0 - in 4 (3.2%), M3-5W3R0 - in 3 (2.4%). The patients with large POVH (W3) and diastasis of abdominal rectal muscles more than 5 cm were not included in the investigation. Depending on procedure of allohernioplasty performed for postoperative ventral hernias the patients were distributed into two Groups. In Group I in 63 (50%) patients the improved laparoscopic preperitoneal allohernioplasty with transfascial suturing of the abdominal wall defect edges was performed. In Group II in 63 (50%) patients open preperitoneal allohernioplasty was done. In both Groups of the patients light polypropylene nets were used for allohernioplasty.
 Results. Laparoscopic alloplasty of postoperative ventral hernias with transfascial sutures, which were applied in Group I, have had essential advantages: significant lesser intensity of postoperative pain, reduction of the seroma rate by 94% - relative risk 0.06 (0.01 - 0.28), p<0.001; risk of suppuration in postoperative wound by 90% - relative risk 0.10 (0.01 - 1.98), p=0.211; risk of chronic infiltrate occurrence by 86% - relative risk 0.14 (0.01 - 2.70), p=0.369. In general, concerning morbidity (immediate results), the risk lowering for their occurrence have enhanced by 93% - relative risk 0.07 (0.02 - 0.28), p<0.001 in patients of Group I in comparison with patients of Group II. Late results of surgical treatment of postoperative ventral hernias also confirms the advantage of laparoscopic preperitoneal allohernioplasty with transfascial suturing of the defect edges over open preperitoneal alloplasty: reduction of risk in chronic pain development in part of anterior abdominal wall by 68% - relative risk 0.32 (0.03 - 3.18), p=0.617 and risk of the recurrent hernia development by 87% - relative risk 0.13 (0.01 - 2.67), p=0.367.
 Conclusion. Performance of laparoscopic preperitoneal allohernioplasty for postoperative ventral hernias (Group I of patients) due to minimization of surgical dissection of the abdominal wall tissues is accompanied by significantly lesser intensity of postoperative pain and lesser rate of morbidity, comparing with open preperitoneal allohernioplasty (Group II), especially: in Group I a seroma rate have constituted 3.2%, in Group II - 34.9%, in Group I suppuration of postoperative wound was not noted, inflammatory infiltrate of abdominal wall, in Group II a rate of these complications have constituted 6.4 and 4.8% accordingly, in Group I chronic postoperative pain was noted in 2.1% of patients, in Group II - in 6.3%, in Group I hernia recurrence was absent, in Group II hernia recurrence rate have constituted 6.3%.

Surgical treatment of bile duct injuries associated with cholecystectomy

Background: Bile duct injuries can be treated with percutaneous, endoscopic or surgical interventions. The aim of this study was to analyze demographic data, clinical presentation, and early and late Results of surgical treatment. Methods: A retrospective analysis of 57 bile duct injuries managed between 2005-2016 in three university hospitals was performed. Of these 51(89%) injuries were seen during laparoscopic and 6 were seen during open cholecystectomy. There were 40 (70%) female and 17 male patients with a median age of 48 (range 18-82) years. Only 16 (28%) of these injuries could be diagnosed during cholecystectomy. Strasberg classification of biliary injuries was 23 type E2, 11 type E4, 9 type E1, 7 type E3 and 7 either type B, C or D. Results: Median time of surgical repair after biliary injury was 51 days (range 0-5200). Four patients had also right hepatic artery injury. Majority of patients (n:47) had undergone Roux-Y hepaticojejunostomy. The most common early complications were wound infection and bile leaks which were manifest in 16 (28%) and 8 (14%) patients respectively. In hospital mortality was seen in 2 elderly patients. With a mean follow-up of 32 months (range 1-120) excellent or good results were achieved in 45 patients (79%) (Terblanche grading 1 and 2 are 30 and 15 respectively). Conclusion: Although excellent or good long-term outcomes can be achieved with biliary reconstructive surgery in many patients, the morbidity and mortality of surgical interventions should be taken into consideration.

New methods of surgical operations on large bowel

Objective. To improve the immediate and late results of surgical treatment in patients, suffering the large bowel (LB) diseases, using improvement of standard and elaboration of new methods of radical, оrgan-preserving, restorational and reconstructive-restorational operations.
 Маterials and methods. New methods of radical, оrgan-preserving, restorational and reconstructive-restorational operations on LB were elaborated, taking into account peculiarities of the diseases morphogenesis, аnatomical and functional details of the LB separate parts. The operations mentioned were performed in 497 patients, suffering LB cancer, ulcerative colitis, Crohn’s disease, familial adenomatous polyposis, chronic decompensated colostasis, complicated by the LB diverticular disease.
 Results. Due to implementation into clinical practice of the surgical interventions elaborated, the postoperative morbidity occurrence rate have reduced down to 2.4%, postoperative lethality - to 0.2%, the functional results improved, the occurrence rate and the severity degree for pathological postoperative syndromes have lowered (reflux-ileitis, postcolectomy syndrome, syndrome of low anterior resection, secondary anal incontinence), the governing of the outflow process after rectal extirpation was guaranteed, the operated patients quality of life improved essentially due to introduction of the surgical interventions elaborated.
 Conclusion. Improvement of the surgical treatment results for the LB diseases is possible while applying of new methods of radical, organ-preserving , restorational and reconstructive-restorational operations, what promotes the essential reduction of the occurrence rate for the LB diseases recurrence occurrence, pathological syndromes morbidity and their severity degree, significant improvement of functional results and quality of life in the patients operated.

Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis.

Native mitral valve infective endocarditis (IE) is a complicated disease with high mortality and morbidity rates. Mitral valve repair (MVRep) is feasible when limited valve destruction is present. However, recurrent valve dysfunction and reintervention are common. Between January 2000 and March 2016, 83 patients underwent surgery for isolated active native mitral valve IE. We applied an early surgery, MVRep-oriented approach with progressive utilization of patch techniques to secure a durable repair; MVRep was attempted in 67% of patients. Fifty-one (61%) patients underwent MVRep (including full-ring annuloplasty in 94%) and 32 (39%) patients underwent mitral valve replacement. Early mortality was 13%. No cases of early recurrent IE occurred. Predischarge echocardiography demonstrated good MVRep function in all, except 1 patient with residual (Grade 2+) regurgitation. The mean duration of follow-up was 3.7 years (interquartile range 1.5-8.4). For hospital survivors, 8-year overall survival rates were 92.4% (95% confidence interval 84.0-100%) and 74.2% (95% confidence interval 53.8-94.6%) for the MVRep and mitral valve replacement groups, respectively. Propensity score-adjusted Cox regression analysis revealed no significant difference in survival between the 2 groups (hazard ratio 0.359, 95% confidence interval 0.107-1.200; P = 0.096). Four reinterventions occurred, 2 in each group. Echocardiographic follow-up demonstrated excellent MVRep durability; no cases of mitral regurgitation and 1 case of mitral valve stenosis were seen. Native mitral valve IE is linked to high mortality and morbidity rates. A durable MVRep is feasible in most patients and provides excellent mid-term durability. Mitral valve replacement is a reasonable alternative when a durable repair is not likely.

Complex corrective procedure in surgical treatment of asymmetrical pectus excavatum.

AimIn this study we analysed the early and late results of surgical treatment of asymmetrical pectus excavatum using complex surgery combining the Ravitch procedure and the Nuss procedure in the same general anaesthesia.Material and methodsEighty out of 938 patients with pectus excavatum operated on between 2002 and 2013, 67 males and 13 females aged 11 to 49 years (mean: 19.2), underwent a complex surgical procedure. During surgery the Nuss procedure was usually performed first (one corrective bar was implanted in 35 patients and two bars were inserted in 45 patients). Because of the unsatisfactory cosmetic effect, additionally the Ravitch procedure was started. The bars were electively removed 3 years after the primary operation.ResultsNo mortality was observed in the early postoperative period. Non-life-threatening and transient postoperative complications occurred in 44 (55%) patients. The most common was pleural effusion (21%), which in 50% of patients required pleural drainage. A satisfactory and stable correction effect was achieved in 88% of cases. Six of those patients required repeat surgery due to recurrence of deformity.ConclusionsA complex corrective procedure is a successful method of surgical treatment in patients with asymmetrical pectus excavatum and is characterized by satisfactory postoperative results. The use of corrective bars enhances the cosmetic effect. The frequency of early, mostly non-life-threatening postoperative complications after a complex procedure is insignificantly higher than that after the Nuss procedure.

Surgical treatment for pulmonary aspergilloma - early and long-term results.

IntroductionPulmonary aspergilloma is a difficult therapeutic problem due to the low effectiveness of conservative treatment and high surgical morbidity.AimTo analyze the early and late results of surgical treatment for pulmonary aspergilloma.Material and methodsFrom 2005 to 2015, 49 patients were treated surgically for pulmonary aspergilloma. Symptoms occurred in 85.7% of cases, including recurrent hemoptysis in 53%. A history of immunosuppressive therapy or chemotherapy was noted in 24.5% of patients. Complex aspergilloma was diagnosed in 79.6% of cases. Immunological test results were positive in 10.2%, and bronchoalveolar lavage samples were positive for Aspergillus species in 18.5% of cases. In 59.2% of patients, the surgical risk was assessed as ASA 3. Thirty seven patients underwent lobectomy, 3 – pneumonectomy, 7 – wedge resection, 1 – decortication, and 1 – cavernostomy.ResultsIn-hospital mortality was 4.1%. Postoperative complications occurred in 63.3% of patients. The most common complications were: prolonged air leak (26.3%), arrhythmias (20.4%), residual pneumothorax (16.3%), respiratory failure (14.3%), atelectasis (12.3%), and bleeding (12.3%). Of the three patients that underwent pneumonectomy, one died, two required repeat thoracotomy because of bleeding, and all three required prolonged mechanical ventilation. Two patients died during the follow-up period. Aspergilloma did not recur in any of the patients who underwent pulmonary resection.ConclusionsDue to the high risk of complications, surgical treatment of pulmonary aspergilloma should be restricted to symptomatic patients in whom lobectomy can be performed. The long-term results of surgical treatment are good, preoperative symptoms abate in most patients, and the rate of aspergillosis recurrence is very low.

Acute traumatic patellar tendon rupture: Early and late results of surgical treatment of 38 cases

IntroductionAcute patellar tendon rupture is easy to diagnose but is still often overlooked. The aim of this study was to assess early and late results of surgical treatment of acute patellar tendon rupture. Our hypothesis was that functional outcome is satisfactory. MethodsA retrospective study included 38 knees in 37 patients (4 female, 33 male). Mean age was 42.6±9.9years (range, 23–81years). Lesions comprised 15 tendon body ruptures, 20 avulsions from the tip of the patella and 3 avulsions from the anterior tibial tuberosity. Tendon repair was protected in more than 95% of cases by a reinforcement frame: hamstring (21 cases), synthetic ligament (12 cases) or metallic wire (3 cases). Results were evaluated in 2 steps: on patient files at a mean follow-up of 7.1months (range, 3–24months) to assess complications and early functional and radiological results; and by phone at a mean follow-up of 9.3years (range, 19–229months) in order to assess long-term functional outcome on Lysholm score and patient satisfaction. ResultsThirty-one knees were assessed at a mean 7.1months. Mean knee flexion was 128.5°±7.5° (range, 85°–150°), extension −1° (range, −15° to 0°) and Caton-Deschamps index 0.96 (range, 0.57–1.29). Twenty-three knees were further assessed at a mean 9.3years. Mean Lysholm score was 93.7 points (range, 61–100). Ninety-six percent of patients were satisfied or very satisfied with the result. All had returned to their previous job, and 20 had returned to sports activities, including 8 at pretrauma level. ConclusionPatellar tendon rupture has good prognosis if diagnosis and surgical treatment is early. Level of evidenceIV: retrospective study.

Early and Late Results of Surgical Treatment for Ventricular Septal Rupture With and Without Use of the Infarction Exclusion Technique-Experience With Two- and Three-Sheet Modification

Ventricular septal rupture (VSR) is an infrequent but life-threatening situation. Although outcomes have improved with the introduction of infarction exclusion, we have experienced difficulty in determining the optimal patch size and shape for obtaining good outcomes. Therefore, we modified the infarction exclusion technique. Herein, we review our experience on the basis of early closure of VSR with and without use of the infarction exclusion technique. We retrospectively analyzed the hospital records of 33 patients who underwent surgical treatment for VSR. We employed Dagget's method from 1982 to 1995, and then introduced the infarction exclusion technique in 1995. We have developed two modifications: the two-sheet single-patch technique and the three-sheet double-patch technique. Overall hospital mortality was 41.9% and that of the infarction exclusion group was significantly lower than the hospital mortality rate of the noninfarction exclusion group (21% and 63%, respectively, p = 0.0266). Late mortality of survivors was low in all groups during the observation period. The three-sheet double-patch group showed no residual shunt. This difference in outcomes between the single-patch and double-patch groups was statistically significant (p = 0.0174). The two-sheet method facilitates the restoration of ventricular geometry. A double-patch using the three-sheet method may be useful for reducing residual shunt.

Spine deformities in patients with Ehlers-Danlos syndrome, type IV - late results of surgical treatment

BackgroundSpinal deformities in Ehlers-Danlos syndrome are usually progressive and may require operative treatment. There is limited number of studies describing late results of surgery in this disease.MethodsThis is a retrospective study of the records of 11 patients with Ehlers-Danlos syndrome type IV, treated surgically between 1990 and 2007. All patients underwent surgical treatment for spinal deformity. Duration of operation, type of instrumentation, intraoperative blood loss, complications and number of additional surgeries were noted. Radiographic measurement was performed on standing AP and lateral radiographs acquired before surgery, just after and at final follow up.ResultsThe mean follow up period was 5.5 ± 2.9 years (range 1-10 years). The mean preoperative thoracic and lumbar curve were 109.5 ± 19.9° (range 83° - 142°) and 75.6 ± 26.7° (range 40° - 108°) respectively. Posterior spine fusion alone was performed on 6 patients and combined anterior and posterior fusion (one- or two stage) on 5 cases. Posterior segmental spinal instrumentation was applied with use of hooks, screws and wires. The mean postoperative thoracic and lumbar curve improved to 79.3 ± 16.1° (range 56° - 105°) and 58.5 ± 27.7° (range 10° - 95°) respectively, with a slight loss of correction during follow up. The average thoracic and lumbar correction was 26.4 ± 14.9% (range 5.3 - 50.4%) and 26.3 ± 21.2% (range 7.9 - 75%). Postoperatively, the mean kyphosis was 79.5 ± 40.3° (range 21° -170°), and lordosis was 50.8 ± 18.6° (range 20° -79°). Hyperkyphosis increased during follow up while lordosis remained stable. Mean Th12-L2 angle was -3.5 ±9.9° (range -19° - 15°) postoperatively and did not change significantly during follow up.ConclusionsHuge spinal deformities in patients with Ehlers-Danlos syndrome require complex and extensive surgery. There is a big risk of sagittal imbalance in this group.

Resultados del tratamiento quirúrgico del cáncer de colon: Análisis de 439 pacientes

Resumen es: Mortality for colon cancer duplicated in the last 15 years in Chile. Aim: To analyze im- mediate and late results of surgical treatment of colon cancer. ...

Resection of the primary tumour or other palliative procedures in incurable stage IV colorectal cancer patients?

The aims of the study were to analyse the early and late results of surgical treatment in patients with stage IV colorectal cancer (CRC) and to evaluate the effect of primary tumour resection and other clinical factors on survival. A group of 134 patients with stage IV CRC was electively operated on between 1996 and 2000. The first group underwent resection of the primary tumour (52 patients; mean age 63.4 +/- 10.3) and the second group of patients underwent procedures without resection (82 patients; mean age 62.6 +/- 10.6). Postoperative morbidity occurred significantly more often (P = 0.041) in the first group--in 26 patients (50%) than in the second group - 19 patients (23.1%). The resection of the primary tumour increased the survival probability; hazard ratio (HR): 1.78; 95% confidence interval (CI): 1.21-2.78%; P = 0.004. Bi-lobar metastases increased mortality risk compared with uni-lobar; HR 2.32; 95% CI: 1.47-3.68; P = 0.0003. The 2-year survival rate in patients with uni-lobar metastases in the first group was 44.2%, in the second group: 30.7%; P = 0.023. Primary tumour resection in stage IV CRC increases the risk of postoperative complications. In the given setting, however, it results in an increased 2-year survival rate but it may not influence the 5-year survival rate. In patients with bi-lobar liver metastases resection of the primary tumour does not prolong survival time.

Basis for Intervention on Functional Tricuspid Regurgitation

Functional tricuspid regurgitation is a complex valvular lesion. Its optimal management remains controversial in the current era as the result of uncertainties regarding accurate diagnosis, surgical indication, the appropriate surgical procedure, and the late results of surgical treatment. It is no longer regarded a benign problem and does not resolve spontaneously after correction of left-sided heart valve lesions as once believed. It carries a significant morbidity and has an adverse impact on survival. Current techniques to repair functional tricuspid regurgitation are associated with a significant degree of residual or recurrent regurgitation mainly because of failure to address all the components of this challenging entity. This review article highlights emerging concepts and advances that provide an insight into the understanding of this perplexing lesion and attempts to define the basis of intervention on functional tricuspid regurgitation.

Quality of life evaluation after selected bariatric procedures using the Bariatric Analysis and Reporting Outcome System

Introduction: Morbid obesity leads to significant decrease in quality of life. The Bariatric Analysis and Reporting Outcome System (BAROS) was created for objective evaluation of surgical treatment for morbid obesity outcomes. Aim: Evaluation of late results of surgical treatment for morbid obesity with laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) procedures, together with evaluation of quality of life in the postoperative period. Material and methods: Sixty patients treated surgically for morbid obesity were included in the study. Group 1 constituted patients who underwent LAGB – n = 30 patients with mean age 34 ±9.67, mean BMI 44.3 ±3.7. Group 2 constituted patients who underwent RYGB – n = 30 patients with mean age 50.9 ±7.8 years, mean BMI 54.5 ±6.72. Patients were operated on in the period 2007-2008. At least 6 months after the operation, they received questionnaires based on the BAROS scale in the authors’ own modification. Results: In both groups of patients treated with LAGB and RYGB, an excellent result of surgical treatment was achieved in 17% of patients, very good in 57%, good in 23%, fair in 1.5% and failure in 1.5%. In the final evaluation of quality of life (QoL) in both groups treated with LAGB and RYGB, QoL was significantly better in 55% of patients, better in 42%, while in 3% QoL was unchanged. Conclusions: The quality of life of patients with morbid obesity, evaluated at least six months after the surgery, improves significantly following the bariatric operations performed most often so far, in both laparoscopic and classic technique.