Lengthy Surgery Research Articles

Portable Absorbable Electrical Stimulation System for Enhanced Peripheral Nerve Repair

AbstractPeripheral nerve injury significantly impairs sensory and motor functions, leading to diminished quality of life. Traditional treatments like nerve suturing and grafting often have limited efficacy and require long recovery. Recent advances in electrical stimulation technology show promise in speeding nerve repair, but current devices usually require lengthy surgeries, risking secondary nerve injury from prolonged nerve exposure during electrode installation and removal. This study introduces a portable, absorbable electrical stimulation system (PAESS) that integrates a battery‐free, wirelessly powered flexible printed circuit board chip with a biodegradable organic electrode. PAESS enables multiple self‐administered nerve stimulation without the need for electrode installation or removal. Using animal models, its electrical performance, biocompatibility, and efficacy in nerve repair are evaluated. The findings indicate a considerable enhancement in the recovery of nerve function, as demonstrated by improved electrophysiological measurements, decreased muscle atrophy, and positive histological results. Transcriptomic analysis indicates that the PAESS initiates the nerve regeneration process. This research presents an innovative platform for electrical stimulation, laying the groundwork for exploring electrical parameters and their mechanisms. This may deepen understanding of nerve regeneration and foster innovation in therapies.

Excision of a supergiant spinal schwannoma: illustrative case.

The authors report on a patient who presented with an extremely large presacral schwannoma and subsequent mass effect-induced hydronephrosis and kidney failure. To the authors' knowledge, this case represents the largest radiographically verified spinal schwannoma in the medical literature. The tumor presented here was more than three times as large as a typical giant schwannoma. While smaller presacral schwannomas are usually uncomplicated surgical cases, the supergiant schwannomas described here create significant surgical challenges. The extremely large size of this nerve sheath tumor introduced a level of surgical complexity not seen in most spinal schwannoma cases. The authors hope that this case informs surgeons regarding the approach to excision of giant spinal schwannomas. The resection of giant spinal schwannomas is likely to involve one or more lengthy surgeries, and the resection volume can be limited by excessive bleeding. Physicians approaching these large, benign spinal tumors should be aware of the challenges of surgery duration and hemostasis before approaching a tumor of this kind. https://thejns.org/doi/10.3171/CASE24224.

Intraoperative redosing of antibiotics for prevention of surgical site infections: A systematic review and meta‐analysis

AbstractBackgroundAppropriate antibiotic prophylaxis is essential for preventing surgical site infections (SSI); however, the clinical benefit of intraoperative redosing remains unclear and controversial owing to insufficient reliable evidence. Therefore, we performed a systematic review and meta‐analysis to assess the effectiveness of prophylactic antibiotic redosing in lengthy surgical procedures.MethodsWe systematically searched the PubMed, Cochrane Library, Web of Science, and Ichushi‐Web databases for articles published until 31 December, 2023. We compared the incidence of SSI between patients receiving and not receiving intraoperative redosing of antibiotics in surgeries lasting ≥3 h. Subgroup analyses were conducted across study characteristics. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random effects model. The risk of bias was assessed using the ROBINS‐I.ResultsOverall, seven observational studies involving 4,671 patients were included. Intraoperative antibiotic redosing significantly reduced the risk of SSI compared with non‐redosing (OR = 0.65, 95% CI = 0.45–0.94, p = 0.02). Subgroup analyses showed that intraoperative redosing decreased SSI risk in studies with a minimum 4‐h operative time, no postoperative antibiotic continuation, and a moderate risk of bias. However, the statistical heterogeneity of the analyses was high among the studies.ConclusionsIntraoperative redosing with prophylactic antibiotics during lengthy surgeries may be associated with a lower risk of SSI than non‐redosing. Therefore, we recommend intraoperative redosing for surgeries lasting beyond 3–4 h to reduce the risk of infection. Further research is required to clarify the optimal redosing interval, which should be prioritized in future studies.

Risk factors for allogeneic red blood cell transfusion in adult spinal deformity surgery.

Retrospective study. To investigate the risk factors for allogeneic red blood cell (RBC) transfusion in adult spinal deformity (ASD) surgery. Studies have not thoroughly explored the roles of intraoperative hypothermia, autologous blood donation, and hemostatic agent administration, which would provide a better understanding of the risk for perioperative RBC transfusion in ASD surgery. The medical records of 151 patients with ASD who underwent correction surgery between 2012 and 2021 were retrospectively reviewed. Estimated blood loss and perioperative allogeneic transfusion were examined. Patients were categorized into two groups based on whether they received perioperative allogeneic blood transfusion. Logistic regression analysis was employed to investigate the effect of age, sex, blood type, body mass index, American Society of Anesthesiologists' physical status, preoperative hemoglobin level, autologous blood donation, global spine alignment parameters, preoperative use of anticoagulants or antiplatelet medicine and nonsteroidal anti-inflammatory drugs, number of instrumented fusion levels, total operative duration, three-column osteotomy, lateral interbody fusion, pelvic fixation, intraoperative hypothermia, use of gelatin-thrombin based hemostatic agents, and intraoperative tranexamic acid (TXA) with simultaneous exposure by two attending surgeons. The estimated blood loss was 994.2±754.5 mL, and 71 patients (47.0%) received allogeneic blood transfusion. In the logistic regression analysis, the absence of intraoperative TXA use and simultaneous exposure (odds ratio [OR], 26.3; 95% confidence interval [CI], 7.6-90.9; p<0.001), lack of autologous blood donation (OR, 21.2; 95% CI, 4.4-100.0; p<0.001), and prolonged operative duration (OR, 1.6; 95% CI, 1.3-1.9; p<0.001) were significant independent factors for perioperative allogeneic blood transfusion in ASD surgery. Autologous blood storage, intraoperative TXA administration, and simultaneous exposure should be considered to minimize perioperative allogeneic blood transfusion in ASD surgery, particularly in patients with anticipated lengthy surgeries.

Entry into A Cardiac Surgery Set Up: The Associated Risks and Difficulties for Inexperienced New Medical Staff

Background: Cardiac Surgery is one of the most sophisticated branches of medical science, which is continually being updated. With very little inclusion in medical course curriculum, medical graduates have limited orientation of this pristine subject. Capacity building is lengthy and cardiac surgery units often contain unrelated junior doctors due to scarcity of cardiac surgeons. New residents may also face similar difficulties. The objectives of this article are to describe the difficulties faces by newly posted doctors and offer some solutions. Methods: This study was conducted in the Department of Cardiac Surgery, Chittagong Medical College &amp; Hospital (CMCH) between January 2020 and December 2022. A confidential self-report system questionnaire was used to interview 30 newcomers in CMCH and other cardiac surgery set ups and their findings are compiled in the article. Results: The interviewed doctors and residents have described individualities of cardiac surgery department and the difficulties they faced while working here. They also offered some solutions of the problems faced by them. Conclusion: Cardiac surgery is a stressful job. The new residents and unrelated doctors face various problems while beginning here. This is more troublesome for the female doctors, but doctors trained in cardiology or other surgical disciplines suffered least. Orientation initiatives by the cardiac surgery department and publishing a complete manual handbook to provide guidelines will be helpful in this regard. Cardiovasc j 2024; 16(2): 81-85

Two-Stage Radical Cystoprostatectomy in a Complicated Patient: A Case Report

Introduction: Radical cystectomy plays the main role in the treatment of muscle-invasive and high-grade bladder cancers; however, it still has significant rates of perioperative complications and mortality. The risk of complications is higher in elderly patients with multiple comorbidities. In certain patients, due to simultaneous comorbidities, it becomes challenging to perform long-term orthotopic radical cystectomy surgery. Case Presentation: In this article, we analyzed a 61-year-old man who was a candidate for radical cystectomy surgery due to muscle-invasive bladder cancer. However, due to simultaneous comorbidities and the lengthy surgery time, it was not feasible to perform orthotopic surgery in a single stage. Consequently, the patient's surgery was carried out in two separate stages. Conclusions: Conducting a radical cystectomy in two stages may aid in minimizing surgical complications, thus enabling patients to benefit from the advantages of urinary diversion through an orthotopic neobladder.

Photodynamic Therapy for Eye, Ear, Laryngeal Area, and Nasal and Oral Cavity Diseases: A Review.

Photodynamic therapy (PDT) has emerged as a promising modality for the treatment of various diseases. This non-invasive approach utilizes photosensitizing agents and light to selectively target and destroy abnormal cells, providing a valuable alternative to traditional treatments. Research studies have explored the application of PDT in different areas of the head. Research is focusing on a growing number of new developments and treatments for cancer. One of these methods is PDT. Photodynamic therapy is now a revolutionary, progressive method of cancer therapy. A very important feature of PDT is that cells cannot become immune to singlet oxygen. With this therapy, patients can avoid lengthy and costly surgeries. PDT therapy is referred to as a safe and highly selective therapy. These studies collectively highlight the potential of PDT as a valuable therapeutic option in treating the head area. As research in this field progresses, PDT may become increasingly integrated into the clinical management of these conditions, offering a balance between effectiveness and minimal invasiveness.

Diversion colostomy in obstructed Rectal cancer with dilated colon: A Novel technique to avoid faecal spillage.

Background: Rectal lesions can present to the emergency room in obstruction. Diversion stoma is necessary to allow neoadjuvant radiation or to avoid a lengthy surgery in a compromised patient. However, many a times, the colon is grossly dilated, and during the maturing of the stoma, faecal spillage can happen into the stoma wound or intraperitoneally. To avoid spillage, either you must do a controlled decompression or a formal laparotomy rather than a trephine. It will be excellent if we can do the stoma by trephine technique and still avoid faecal spillage.

A Proactive Explainable Artificial Neural Network Model for the Early Diagnosis of Thyroid Cancer

Early diagnosis of thyroid cancer can reduce mortality, and can decrease the risk of recurrence, side effects, or the need for lengthy surgery. In this study, an explainable artificial neural network (EANN) model was developed to distinguish between malignant and benign nodules and to understand the factors that are predictive of malignancy. The study was conducted using the records of 724 patients who were admitted to Shengjing Hospital of China Medical University. The dataset contained the patients’ demographic information, nodule characteristics, blood test findings, and thyroid characteristics. The performance of the model was evaluated using the metrics of accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC). The SMOTEENN combined sampling method was used to correct for a significant imbalance between malignant and benign nodules in the dataset. The proposed model outperformed a baseline study, with an accuracy of 0.99 and an AUC of 0.99. The proposed EANN model can assist health care professionals by enabling them to make effective early cancer diagnoses.

Manajemen Anestesi Reseksi Tumor Cerebello-pontine Angle Vestibular Schwannoma dengan Posisi Lateral

Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannoma (acoustic neuromas). The preferred treatment for symptomatic vestibular schwannoma has been surgical excision. Craniotomy for vestibular schwannoma resections in lateral position gave better surgical field exposure, but also posed increased risk of ventilation-perfusion mismatch and atelectasis of the dependent lung in lengthy surgery. A 25 years old woman, with loss of hearing function, disturbed sense of balance, left hemiplegia, difficulties to swallow, on magnetic resonance imaging (MRI) examination had solid lesion in the cerebello-pontine angle size 5,6 cm x 5 cm x 4.5 cm which is diagnosed as Cerebello-pontine angle vestibular schwannoma sinistra. Patient underwent surgical resection in right lateral position under general anesthesia and the surgical resection performed in 6 hour 40 minutes. The goals of anesthetic management in vestibular schwannoma tumor resection are to facilitate ideal surgical condition and provide brain protection by maintaining cerebral perfusion pressure, avoid hemodynamic instability, enable intraoperative neuro-monitoring and ensure the early detection and prompt management of potential complications.

Renal Water Conservation and Plasma Creatinine in Colorectal Cancer Surgery: A Single-Group Clinical Study.

Elevation of plasma creatinine after surgery is associated with postoperative morbidity and mortality. We studied whether lengthy surgery might induce renal conservation of water strong enough to exceed the renal capacity to excrete creatinine. Colorectal cancer surgery was performed via laparoscopy in 126 patients. Blood and urine were sampled before surgery, in the postoperative care unit, and 1 day after surgery. The Fluid Retention Index (FRI), which is a composite index of renal water conservation, was calculated. The mean FRI before surgery was 2.4, indicating that patients were well-hydrated. The FRI increased to 2.8 after surgery, and further to 3.5 on the first postoperative day. Plasma creatinine increased in 66 (52%) of the patients while plasma proteins were diluted by 15%. Patients with urinary creatinine > 8.5 mmol/L before surgery were more likely to later show elevation of plasma creatinine (68 vs. 46%, P < 0.04). The final FRI was higher in those with perioperative elevation of plasma creatinine (median 3.7 vs. 3.4; P < 0.01) and a similar difference was found for the final urinary creatinine concentration (8.5 vs. 7.2 mmol/L; P < 0.01). The gastrointestinal recovery time was prolonged when >2 L of Ringer's had been infused during the surgery. We conclude that colorectal surgery initiated a process of renal water conservation that extended into the postoperative period. The water conservation was more intense and the urinary concentration of creatinine was higher in those who had a perioperative rise in plasma creatinine.

Early Detection and Management of Venous Thrombosis in Skull Base Surgery: Role of Routine Doppler Ultrasound Monitoring.

Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), causes postoperative morbidity and mortality in neurosurgical patients. The use of pharmacological prophylaxis for DVT prevention in the immediate postoperative period carries increased risk of intracranial hemorrhage, especially after skull base surgeries. To investigate the impact of routine Doppler ultrasound monitoring in prevention and tiered management of VTE after skull base surgery. We retrospectively analyzed a large cohort of consecutive adult patients who were prospectively and uniformly managed with routine monitoring by Doppler ultrasound for DVT after resection of a skull base tumor. A total of 389 patients who underwent 459 surgeries for intracranial tumor resection were analyzed. Skull base meningioma was the most common pathology. Forty-four (9.59%) postoperative VTEs were detected: 9 (1.96%) with PE with or without DVT and 35 (7.63%) with DVT alone. Four cases of subsegmental PE were diagnosed without evidence of lower extremity DVT, possibly in the setting of peripherally inserted central catheters maintenance. One patient had a preoperative proximal DVT and underwent a prophylactic inferior vena cava filter but expired from PE after discharge. Prior history of VTE (risk ratio [RR] 5.13; 95% CI 2.76-7.18; P < .01), anesthesia duration (RR 1.14; 95% CI 1.03-1.27; P = .02), and blood transfusion (RR 1.95; 95% CI 1.01-3.37; P = .04) were associated with VTE development on multivariate analysis. Routine postoperative venous ultrasound monitoring detects asymptomatic DVT guiding management. This is an alternative strategy to prescribing pharmacological VTE prophylaxis immediately after lengthy surgeries for intracranial tumors. Peripherally inserted central catheters were associated with subsegmental PE.

Patient-Customized Theatre Mattress Supports for Spinal Surgery: A Pilot Study Presenting a Novel Engineering Virtual Design and Manufacturing Technique

Abstract Optimal patient positioning for spine surgery is vital for surgical success and the minimization of complications intra-/postoperatively. In patients with complex comorbidities, commercially available surgical positioning equipment is inadequate. To overcome this, a novel method was developed to create custom-fit patient-specific theater mattresses for patients undergoing spine surgery. An innovative digital workflow involving three-dimensional (3D) surface scanning, 3D simulation, and computer-aided design was developed to manufacture customized theater supports with patient-specific requirements. These supports offered the surgeon an enhanced ability to relieve load bearing on prominent anatomical features or where desired, to tailor the support surface to the patient's anatomy for lengthy surgery. The bespoke theater mattress was evaluated by whether the support resulted in a complication-free surgery. Using this new workflow, case examples for two patients with complex comorbidities were described. The spine surgeon and anesthetist reported the patient-specific custom mattresses were fit as per the required design, provided sufficient clearance around anatomical prominences and areas that required to be unloaded, had sufficient clearance for the anesthetic method and cannulation, provided excellent surgical access and stability during surgery, and postoperatively no soft tissue overload over bony prominence and implanted devices. Positive patient outcomes after successful lengthy surgical interventions were associated with these patient-specific, contoured mattress supports. Future projects will seek to utilize this technology for other types of surgeries and intra-operative positioning requirements, and for a broader demographic of patients in both the pediatric and adult setting.

Use of advanced intravenous conscious sedation techniques in complex oral surgery procedures: Comparison of midazolam, midazolam‐propofol and midazolam‐propofol‐alfentanil combinations

AbstractAimThis retrospective observational study evaluates the safety and efficacy of intravenous sedation using midazolam only or combinations of two or three drugs including propofol and alfentanil for complex dental surgery such as implant placement or sinus augmentations.MethodsThe study analyses 60 patients aged 42–79 who required advanced sedation techniques for complex oral surgery procedures. Twenty patients had midazolam only (M), 10 patients a 2‐drug combination of midazolam and propofol (MP) and a third group of 30 patients had the combination of midazolam, propofol and alfentanil (MAP). The last two regimens were carried out under the supervision of a dedicated consultant anaesthetist.ResultsHigher mean minimum heart rate (beats/min) was observed in the midazolam group compared to the group sedated with the three‐drug regimen (p &lt; 0.05). The time between the last drug administration (LDA) and end of surgery (EOS) was significantly longer (p &lt; 0.005) in group M (≤45 mins) compared to the other two sedation groups MP and MAP (≤15 min). The final titration of midazolam of 11.2 ± 4 mg (5–20 mg) was significantly greater in group M than in either of group MP or MAP (p &lt; 0.05).ConclusionIn patients requiring conscious sedation to undergo complex and lengthy oral surgery, a combination of agents (midazolam, propofol and alfentanil) can provide a predictable steady state of sedation up to the end of the surgery resulting in better operating conditions for the surgeon and improved patient co‐operation. The shorter duration of action drugs propofol and alfentanil improved haemodynamic stability, sedation quality and reduce the final doses of each sedative agent.

Novel Interventional Techniques for Chronic Pain with Minimally Invasive Arthrodesis of the Sacroiliac Joint: (INSITE, iFuse, Tricor, Rialto, and others)

Acute and chronic pain are public health issues that clinicians have been battling for years. Opioid medications have been a treatment option for both chronic and acute pain; however, they can cause unwanted complications and are a major contributor to our present opioid epidemic. The sacroiliac (SI) joint is a common cause of both acute and chronic low back pain. It affects about 15–25% of patients with axial low back pain, and up to 40% of patients with ongoing pain following lumbar fusion. Recent advances in the treatment of SI joint pain have led to the development of a wide variety of SI joint fusion devices. These fusion devices seek to stabilize the joints themselves in order that they become immobile and, in theory, can no longer be a source for pain. This is a minimally invasive procedure aimed to address chronic pain without subjecting patients to lengthy surgery or medications, including opioids with the potential for addiction and abuse. Minimally invasive SI fusion can be performed by a lateral approach (i.e., iFuse, Tricor) or posterior approach (i.e., CornerLoc, LinQ, Rialto). The posterior approach requires the patient to be in the prone position but allows for less disruption of muscles with entry. More data are necessary to determine which fusion system may be best for a particular patient. SI fusion devices are a promising way of treating chronic lower back pain related to the SI joint. This narrative review will discuss various types of SI fusion devices, and their potential use in terms of their safety and efficacy.

Cervico-facial flap: a versatile option among various reconstructive options for skin defects in parotid surgery-our experience in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cutaneous defects of the cheek and external ear present a reconstructive challenge. Even when free flap reconstructions and tissue transfer are commonly proposed, fewer patients with these malignancies are candidates for lengthy reconstructive surgery. The cost effectiveness, time consumption, long waiting period of head and neck malignancy patients and less availability of reconstruction teams in developing countries like India, are challenging factors.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In our study, retrospectively 46 cases operated for parotid neoplasm were identified and the operative reports were reviewed from September 2018 to April 2021. Data on patient demographics, pathological diagnosis, defect type, type of flap used, co-morbid disease, and smoking history was collected. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean defect size was 4×5 cm, however for defects larger than 4×4 cm and lesser than 7 cm a cervico-facial flap was used for reconstruction. The average time for surgery was 2 and a half hours extra for the free flap reconstruction. Post-operative wound complications were higher in free flap reconstruction. Partial/DTN was observed in 16% patients and necrosis that needed intervention- 6% of all patients. Patients with cervico-facial flap reconstruction had an excellent final functional and cosmetic result, with good skin color and texture match.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The cervico-facial flap is a versatile technique with excellent vascularity and good esthetic outcome, which should be utilized liberally in the reconstruction of facial defects, slight modifications in the flap harvesting and careful selection of patient can give excellent results in moderate defects after parotid surgeries, especially in a resource limited country like India.&lt;/p&gt;

Utilizing Patient-Specific 3D Printed Guides for Graft Reconstruction in Thoracoabdominal Aortic Repair

Background: In thoracoabdominal aortic aneurysm repair, repairing the visceral and segmental arteries is challenging. Although there is a pre-hand-sewn and multi-branched graft based on the conventional image-based technique, it has shortcomings in precisely positioning and directing the visceral and segmental arteries. Methods: We introduce two new reconstruction techniques using patient-specific 3D-printed graft reconstruction guides: 1) model-based technique that presents the projected aortic graft, visualizing the main aortic body and its major branches and 2) guide-based technique in which the branching vessels in the visualization model are replaced by marking points identifiable by tactile sense. The graft reconstruction guides cover the segmentation, design, fabrication, post-processing, and clinical application of open surgical repair of thoracoabdominal aneurysm, and proved to be efficient for accurately reconstructing customized grafts. Findings: This study is demonstrated to the effectiveness and efficiency by evaluating conventional and new techniques with digital model. The accuracy, reproducibility, and satisfaction of the two new techniques were higher than that of the conventional technique, and the marking time requirement for graft reconstruction was reduced. Interpretation: The two new reconstruction techniques have the potential to improve outcome as they can solve anatomical hurdles for individual anatomical variation and focus on important procedures by reducing the level of fatigue of operating surgeons for lengthy and exhausting surgery. Funding Information: This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI18C2383). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The institutional review board for human investigations at Asan Medical Center approved this study with a waiver of informed consent from patients because of the use of retrospective clinical and imaging data. The data were de-identified, in accordance with the Health Insurance Portability and Accountability Act privacy rule.

Learning from COVID-19 experience: a study amongst ENT surgeons’ COVID behaviour

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Health care services across the world have undergone several modifications in view of ongoing COVID-19 pandemic. Otolaryngology needs special mention in this context owing to its proximity to virus’s natural habitat. Various ENT procedures are significantly aerosol generating and hence appropriate precautions and procedural modifications are needed. We aimed to determine attitude and practices of ENT professionals during COVID-19 pandemic and their level of preparedness towards resuming practice, teaching and training activities.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted an online survey through Google forms, participants were asked to fill up a multiple choice questionnaire. Responses collected were analysed and interpretations made on basis of most favoured options. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of respondents was aware of the potential risks and precautions to be taken during Outpatient and surgical procedures and was willing to adapt their clinical setups to protect themselves and their patients. Few of them wanted to follow stricter protocols like doing endoscopies for therapeutic purposes only, using a PAPR for lengthy surgeries, not allowing trainees to assist in surgeries etc. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that fresh guidelines are needed taking in account the opinion of government and private practitioners, with provisions for continuing training activities.&lt;/p&gt;

CLINICAL AND PATHOLOGICAL FEATURES OF COLONIC ILEUS FROM OBSTRUCTIVE COLORECTAL CANCER. ACTUAL CHARACTERISTICS

Purpose: The purpose of this study is to analyze the possible change in the characteristics of patients with colonic ileus from obstructive colorectal cancer in UMHATEM "N. Pirogov ". Material and Methods: For two separate periods of 2 years in the Department of General, Visceral and Emergency Surgery in University Hospital "N. I. Pirogov" from ileus caused by colorectal carcinoma were operated respectively: Group A (1.1.2010-31.12.2011) - 187 patients (average 71.2 years, women were 88, men 99) Group B (1.1.2014-31.12.2015) - 141 patients (average 73.5 years, women were 69, men 72). Results: In group B there was an increase in the infected patients at an earlier stage. There was no significant difference in the localization of the tumor process in the two groups. In contrast to the increased number of patients hospitalized at an earlier ileus stage, there was no difference in the two groups according to the tumor stage. Conclusions: Emergency surgery is indicated for cases with full bowel obstruction and significant prediction of rupture. Surgery procedure like proximal colostomy is reccomended for elderly patients and complicated comorbidity. Primary procedure like segmental and subtotal colectomy is appropriate for patients in good condition. Segmental resection is favorable in elderly patients and those with shock who may not tolerate lengthy surgery.

How is staging of ALIF following posterior spinal arthrodesis to the pelvis related to functional improvement in patients with adult spinal deformity?

Retrospective cohort. To compare postoperative functional improvement in patients who underwent staged versus non-staged anterior-posterior spinal arthrodesis for adult spinal deformity (ASD). In patients with ASD, spinal arthrodesis can be performed in 2 stages to avoid the physiologic insult of a lengthy surgery. The association between staged surgery and postoperative functional improvement has not been well studied. We included 87 patients (59 women) with ASD who underwent anterior-posterior spinal arthrodesis of > 5 levels with fixation to the pelvis from 2010-2014. Primary outcomes were the frequency of achieving at least a minimal clinically important difference (MCID) in the Scoliosis Research Society-22r (SRS-22r) Activity domain and the timeframe in which it was achieved. The secondary outcome was patient satisfaction (SRS-22r Patient Satisfaction domain). A Cox proportional hazard model was used to compare functional improvement over time between staged and non-staged groups. Our study was powered to detect a relative hazard ratio of 0.53, β = 0.20. α = 0.05. The frequency of achieving an MCID in SRS-22r Activity score did not differ significantly between the staged group (33/41 patients) and the non-staged group (34/46 patients) (hazard ratio 0.74; 95% confidence interval 0.41-1.36). Median times to achieving an MCID in SRS-22r Activity score were 191days (interquartile range: 86-674) in the staged group and 181days (interquartile range: 72-474) in the non-staged group (p = .75). The staged and non-staged groups had similar SRS-22r Patient Satisfaction scores at 3-9months postoperatively and at final follow-up (both, p > .05). Patients with ASD who underwent staged anterior-posterior spinal arthrodesis within 3months after index surgery were similarly likely to experience functional improvement in the same timeframe as patients who underwent non-staged surgery. Patient satisfaction did not differ significantly between staged and non-staged groups. III.