Long-term Outcomes Of Surgical Management Research Articles

555. SUPRACLAVICULAR NODE INVOLVEMENT, A NODAL OR METASTATIC DISEASE? - A 10-YEAR EXPERIENCE IN ESOPHAGEAL CARCINOMA AT A TERTIARY REFERRAL CENTRE

Abstract Background Despite the advance in neoadjuvant chemothepray/chemoradiotherapy and favourable outcomes of surgical management in supraclavicular lymph node (SCLN) involvement reported in recent studies, the latest AJCC/UICC TMN classification still regards SCLN metastasis as extra-regional i.e Stage IVB (M1) disease. The role of SCLN dissection and surgical management remain controversial. At National University Hospital of the present study, bilateral supraclavicular lymphadenectomy is routinely performed for resectable thoracic ESCC. The aim of this retrospective cohort study is to investigate the long-term outcome of surgical management in pathological SCLN metastasis and its survival benefit comparing to Stage IIB-IVA diseases. Methods Patients with ESCC who underwent esophagectomy and 3-field lymphadenectomy with curative intent between January 2013 and January 2023 at the single centre were included; cases of salvage esophagectomy post-definitive concurrent chemoradiotherapy, palliative resections, and concurrent head and neck cancers were excluded. Neoadjuvant treatments were considered in cases staged clinically as T2 and/or N1 or greater. Pathological status of lymph nodes was recorded according to JES classification. Demographics and prognostic factors were examined using univariant analysis of overall survival (OS). Patients with SCLN metastases and other LN involvements were compared and OS were analysed using Kaplan-Meier method. Results 544 patients were included. 183 had one or more pathological LN metastasis (pN1:126, pN2 46, and PN3: 11) in which 55 patients had SCLN metastasis. Patients with LN metastasis had poorer prognosis than those without (pN0) with a Hazard Ratio (HR) of 2.68 (95% CI, 1.12-3.40, p<0.01); similar pattern was seen in patients with SCLN metastasis (HR 2.28, p<0.01). The 3-year and 5-year OS of patients with SCLN metastasis was 18.5% and 11.6% respectively whereas those of other LN metastasis was 21.4% and 15.8%; the difference between the groups was not statistically significant (p=0.525) (graph 1). Conclusion Lymph node status (pN) is a well-recognised prognostic factor as reaffirmed, however, within the pN positive cohort, long-term survival of patients with SCLN metastasis, considered as stage IVB (M1), was comparable (p<0.05) to those with other LN metastases. This supports the survival benefit of surgical resection with neoadjuvant therapy in SCLN metastases as following nodal disease treatment algorithm; further evaluation including systemic therapy and lymph node sub-group analysis is being conducted. Whilst randomised controlled trials such as Japanese JCOG2013 provides level I evidence, the present study provides complementary real-world experience for SCLN dissection.

Long-term outcome of surgical management in neovascular glaucoma: A retrospective, multicentric study.

This study aimed to evaluate and compare surgical outcomes among neovascular glaucoma patients undergoing trabeculectomy (Trab), glaucoma drainage device (GDD) implantation, or trans-scleral cyclophotocoagulation (TSCPC). This study analyzed the records of 176 neovascular glaucoma cases treated surgically between January 2017 and December 2021 at four Indian centers. Procedures included trabeculectomy with MMC in 80 eyes, GDD implantation in 25 eyes, and TSCPC in 71 eyes. Outcome measures comprised intraocular pressure (IOP) reduction, antiglaucoma medication (AGM) usage, complications, and best-corrected visual acuity (BCVA). Following surgery, all groups exhibited a significant reduction in IOP. One year postoperatively, complete success rates were 42.9% for the implant group, 54.3% for the Trab group, and 33.3% for the TSCPC group, with corresponding qualified success rates of 57.1%, 36.7%, and 58.9%, respectively. Improvement in postoperative vision was noted, with an increase of 0.24 LogMAR in the Trab group, 0.11 in the GDD group, and a decrease of 0.35 in the TSCPC group. Complications occurred in 27% of Trab and 14% of TSCPC cases, while the GDD group experienced a hypertensive phase in 40% of eyes. In managing neovascular glaucoma, trabeculectomy, GDD, and TSCPC provide comparable IOP control, with GDD showing a higher medication dependency. Trabeculectomy yields superior vision outcomes but carries a higher risk of postoperative complications, emphasizing the importance of individualized treatment selection and vigilant postoperative care.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ПОВРЕЖДЕНИЙ МОЧЕТОЧНИКА В АКУШЕРСКОЙ И ГИНЕКОЛОГИЧЕСКОЙ ПРАКТИКЕ

Introduction. Ureteral injury (UI) during obstetric and gynecological surgical procedures is one of the most serious and severe complications. Objective. To improve the outcomes of management of UI identified after obstetric and gynecological surgical procedures. Material and methods. A study of long-term outcomes of surgical management of 47 women aged 19 to 62 (median 48.5) years with ureteral injury (UI) was carried out in wards of the department of urology. All women underwent prior surgical procedures in gynecological (n=40) and obstetric (n=7) departments. Results. On the day of admission to the urological hospital, optical uretheroscopy and retrograde ureteropyelography were conducted on all women, and an attempt to insert double J-stent was made. The results of these procedures show that 6 women underwent reconstructive surgical repair, 33 had double J-stent insertion, and 8 had a percutaneous nephrostomy. On average, after 3 months, all patients underwent follow-up examinations, which showed that complete restoration of urodynamics on the side of the injury did not occur in 20 patients; they were reoperated. The final distribution of the procedures carried out is as follows: open access reconstructive surgical repair - in 15 patients, double J- stent insertion - in 23, ureteral bougienage and stent placement - in 6, laser dissection and endoureteroplasty - in 3. Good outcomes were observed in 38 (80.9%) patients, and satisfactory outcomes - in 9 (19.1%). Conclusions. The most significant investigations in the diagnosis of UI and options of the management plans were identified. The analysis of the outcomes of the use of X-ray endoscopic methods in the management of UI identified after obstetric and gynecological surgeries shows that their use in most cases help to restore urodynamics in the ureter avoiding more difficult reconstructive surgical repair procedures.

Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy

Singh, Pankaj K MCh; Chandra, Sarat P MCh; Agrawal, Mohit MCh; Sawarkar, Dattaraj MCh; Kumar, Rajender MCh; Kumar, Amandeep MCh; Verma, Satish MCh; Kale, Shashank S MCh

Long-term outcomes of surgical management in subtypes of Chiari malformation

ABSTRACT Objective: Chiari malformations (CMs) are a heterogeneous group of disorders defined by anatomic anomalies of the cerebellum, brainstem, and craniovertebral junction (CVJ). The aims of this study are to establish the demographic and clinical features, incidence, surgical procedures, and outcomes in large series of old and new subtypes of CMs. Material and Methods: All patients were evaluated and operated on for CM-0, 1, and 1.5 between 1985 and 2016. The patients were grouped into various subtypes. Demographic data, additional diseases, clinical features, surgical procedures, complications and outcomes were recorded. Results: 191 patients who underwent various surgical procedures were evaluated. Their mean age was 37.21 ± 9.89. We detected 15 cases of CM-0 (7.8%), 121 cases of CM-1 (63.4%), 55 cases of CM-1.5 (28.8%). In total there were 191 cases, and 220 surgical procedures were performed. 29 (13.2%) of all surgical procedure was reoperations and secondary operations. SM Cyst is found to be decreased in 72 (76.5%) patients, unchanged in 14 (14.8%) and increased in 8(8.5%) of 94 patients radiologically. Clinical outcomes are better for 131 (65.8%), same for 31 (16.2%) and worse for 9 (15%). Conclusion: This study with 172 patients is a large series that includes CM-0, 1, and 1.5 subtypes. CM-1.5 also differs for symptom presentation and durations from CM-1. There are more neurological abnormalities in patients with SM. CVD alone are an effective, useful and safe surgical procedure for CM-0, CM-1 and CM-1.5. Surgical procedure, SM existence, and symptom duration have powerful effects on outcomes.

Long-term outcome after en bloc resection and reconstruction of the spinal column and posterior chest wall in the treatment of malignant tumors

BackgroundMalignant tumors occurring around both the spinal column and posterior chest wall are uncommon. Surgical resection of chest wall tumors adjacent to the spinal column is still challenging due to the surrounding anatomical structures. The purpose of the present study was to evaluate the long-term outcomes of surgical management in malignant tumors involving the spinal column and posterior chest wall. MethodsBetween 1999 and 2007, 10 consecutive patients underwent en bloc resection combined with the posterior chest wall in the treatment of malignant tumors around the spinal column. There were 6 males and 4 females with a mean age at the surgery of 40.9 years old (range, 14–62 years old). The mean postoperative follow-up period was 159.7 months (range, 84–245 months). The clinical history, physical examination, laboratory data, radiological findings, and operative findings for each patient were retrospectively reviewed. ResultsAll surgeries were performed via a combined anterior and posterior approach. The mean numbers of partially resected vertebrae and ribs were 3.1 and 4.1, respectively. Lower or upper lobectomy was performed in four patients, and the diaphragm was partially resected in two patients. The surgical margin was wide in seven patients and marginal in two patients. Although five patients had postoperative respiratory problem, all patients improved immediately without life-threatening complications. There were no patients with respiratory insufficiency after surgery. One patient with osteosarcoma died of lung metastases 99 months after surgery. At the final follow-up, only one patient had local recurrence, five had been continuously disease-free, and three were alive with no evidence of disease. ConclusionsEn bloc resection and reconstruction in selected patients with malignant tumors involving both the spinal column and posterior chest wall demonstrated good long-term results for local control and the respiratory function.

Postinflammatory Medial Meatal Fibrosis: Histopathologic Features and Outcomes of Surgical Management.

The aims of our study were to investigate the clinical and audiometric outcome of the surgical treatment of postinflammatory medial meatal fibrosis (PIMMF) and to review the histopathologic changes in the specimens of the fibrotic plug, in order to try to shed light on the pathogenesis of the disease. The clinical records and the histopathologic specimens of all patients who underwent tympanomeatoplasty for PIMMF at the ENT Clinic of the University of Erlangen between 2006 and 2020 were evaluated retrospectively. Thirty-four patients (41 primary surgical procedures) made up our study cohort. Of this, 28 cases were managed by means of meatoplasty and 13 cases with tympanomeatoplasty. The mean preoperative air-bone gap (ABG) was 27.8 dB (10-44 dB). Postoperative ABG was significantly improved compared to preoperative values at both short- and long-term follow-ups (P < .001 for both). No significant difference was noted between short-term and long-term ABG (P = .240). An ABG ≤20 dB was achieved in 65.8% of patients (short term) and 50% (long term). The overall rate of revision surgery for restenosis was 29.3% (12/41). Histopathologic reevaluation of the fibrotic plugs revealed a mosaic of patterns with frequent occurrence of secondary cholesteatoma-like lesions and keloid-like tissue changes. Lichenoid submucosal inflammation and increased ectopic ceruminous gland lobules were seen less frequently. The moderate long-term outcome of surgical management and the identification of histologic changes with therapeutic implications might pave the way for alternative nonsurgical treatment options.

Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy.

Vertebral hemangiomas are benign, highly vascular lesions of the vertebra, rarely seen in the pediatric age group. To analyze the long-term (>3 yr) outcome of patients of pediatric vertebral hemangioma presenting with myelopathy and to describe our surgical strategy to treat such cases. All patients up to 18 yr of age with a symptomatic vertebral hemangioma treated at our hospital from May 2003 to August 2016, with at least 3-yr follow-up were included. Functional clinical outcomes were measured using American Spinal Injury Association (ASIA) score. There were 7 male and 7 female patients. All hemangiomas were located in the thoracic spine with single-level involvement. Upper thoracic spine involvement was more common (12 cases: 85.71%) than lower thoracic spine involvement (2 cases: 14.29%). All patients had features of myelopathy. The mean age was 14.57 yr, ranging from 10 to 18 yr. The mean follow-up was 62.21 mo, ranging from 36 to 90 mo. All patients had improvement in motor strength of both lower limbs postoperatively. Local pain, which was present in 1 patient, resolved, and the bladder symptoms present in 5 patients also resolved. Our experience in treating symptomatic pediatric vertebral hemangiomas, along with the long-term follow-up data, suggests that good postoperative results can be achieved with minimal complications in carefully selected patients.

Long-term Outcomes of Surgical Management of Insulinoma: Single Center Experience

Objective: Limited data are available in regards to the surgical management and outcomes of insulinoma. This study aimed to assess the outcomes associated with surgical treatment of insulinoma, as the most common pancreatic endocrine tumor. Methods: Medical records of patients who diagnosed as insulinoma from 2000 to 2010 at General Surgery Department of Cukurova University Hospital were retrospectively reviewed. Surgical treatment (resection vs. enucleation) was based on preoperative radiological investigations (abdominal spiral contrast tomography, ultrasound, selective angiography for selected cases) and intra-operative ultrasound imaging once indicated. Results: Surgically treated thirteen patients (F/M:9/4) who diagnosed with insulinoma were assessed with a mean follow-up of 5.3 (0.5-10) years. Enucleation and distal pancreatectomy were performed for 11 and 2 (one of those is spleen-preserving) patients, respectively. No mortality was recorded. All patients became normoglycemic after surgery without re-operation and with acceptable complication rates (n=3 pancreatic fistula, n=1 pancreatitis). Conclusion: Surgical treatment of insulinoma is associated with favorable outcomes. Intra-operative ultrasound with manual palpation is still the gold standard for localizing insulinoma. Location, size and relationship with main pancreatic duct of the lesions are key components for the selection of optimal surgical procedure.

Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors.

We evaluated the short-term and long-term outcomes of emergency operations for peptic ulcer (PUD) complications in a period of time in which the need for surgery is infrequent. Retrospective review of operated patients (2007-2015) in one medical center. 81 patients were included (8.9 patients/year): 70 (86.4%) male; 11 (13.6%) female. Indications for operation were hemorrhage in 18 (22.2%), perforation in 62 (76.5%) and gastric-outlet obstruction in one (1.2%). Only 16 (19.8%) operations included a procedure to reduce gastric acid secretion. Six (7.4%) patients had a second operation for recurrent or persistent complication. Of these, two had a procedure to reduce gastric acid secretion in their first operation. 16 (19.8%) patients died during the index hospitalization. Three (3.7%) patients were rehospitalized for a PUD complication following 3-24months. One patient, who had surgery for a second perforation 3months following the first operation, was treated empirically for Helicobacter Pylori (HP) between the two operations. In comparison to perforation, patients with hemorrhage were older (69.9 ± 20.3 vs. 52.1 ± 19.9years; p = 0.0015), more commonly had a history of PUD or treatment by nonsteroidal anti-inflammotry drugs (55.6 vs. 19.4%; p = 0.0054), more commonly had a procedure to reduce gastric acid secretion during their index operation (61.1 vs. 6.5%; p < 0.0001), and had a higher mortality (38.9 vs. 14.5%; p = 0.0406). Mortality is high following surgery for the complications of PUD, moreso in patients undergoing surgery for hemorrhage. Reoperations and repeated hospitalizations for complications are not uncommon, even in patients who have had procedures to reduce gastric acid secretion and HP eradication.

Surgical management and long-term outcome of umbilical infection in 65 foals (2010-2015).

To report the short- and long-term outcomes of surgical management of umbilical infection in foals. Retrospective case series. Foals (n = 65). Medical records (2010-2015) of foals up to 1 month of age, surgically treated for an umbilical infection were reviewed. Short-term (at the time of discharge from hospital) and long-term (1 year after surgery) survival rates were obtained. Clinical variables influencing survival were assessed. Chi-square or Fisher's exact test were used to evaluate the relationship between the data retrieved and outcome. P ≤ .05 was considered statistically significant. Sixty-five foals were included in the study, representing 17.2% of all foals admitted to the hospital. Fifty foals were discharged from hospital (77%) and 43 foals (66%) were alive 1 year after surgery. Lower long-term survival rates were associated with: younger age at presentation, septic joints, multiple pathologies, higher creatinine level, higher heart rate, umbilical infection diagnosed at the hospital rather than prior to referral, prolonged hospitalization, longer period between arrival and surgery, and postoperative complications. The most common surgical findings were urachal enlargement followed by right arterial enlargement. Younger foals with worse systemic condition and concurrent disorders are at higher risk for treatment failure. Early diagnosis improves the outcome. Surgical treatment yields good results and should be considered upon diagnosis, after taking into account the clinical situation. Based on the results of this study, diagnosis and surgical management of umbilical infection in neonatal foals should be performed as early as possible, and a good outcome can be expected after surgery.

Contemporary In-Hospital and Long-Term Outcomes of Surgical Management for Fungal Endocarditis.

Fungal endocarditis (FE) is a rare and fatal disease. The contemporary in-hospital and long-term surgical outcomes of FE have not been adequately evaluated. This study describes our experience with the surgical management of FE.Eight FE patients who underwent surgery in our center from January 2004 to November 2016 were included in this study. Seven had fungal prosthetic valve endocarditis (PVE) and one fungal native valve endocarditis (NVE). The Bentall operation, Cabrol operation, and mitral valve replacement were performed in 4, 3, and 1 patient, respectively. The overall in-hospital mortality rate was 25% (2/8). The follow-up was completed in all surviving patients and the mean follow-up time was 55.5 ± 63.3 (range, 1-154) months. Two late deaths occurred at 2 months and 4 months after discharge. The other patients recovered well during the follow-up.FE is a devastating disease and surgical treatment has acceptable in-hospital and long-term mortality rates.

Long-Term Outcomes of Surgical Management of Pancreatic Neuroendocrine Tumors with Synchronous Liver Metastases

Long-Term Outcomes of Surgical Management of Pancreatic Neuroendocrine Tumors with Synchronous Liver Metastases

Výsledky dlouhodobého sledování po operačním léčení pro symptomatický fibulární diskoidní meniskus v dětském věku

Výsledky dlouhodobého sledování po operačním léčení pro symptomatický fibulární diskoidní meniskus v dětském věku

Long-Term Outcomes of Surgical Management of Pancreatic Neuroendocrine Tumors with Synchronous Liver Metastases

Background: The value of surgical resection in the management of pancreatic neuroendocrine tumors (PNET) with liver metastases (LM) is still debated. The aim of this study was to evaluate the outcomes of surgery of PNET with LM. Methods: Patients with PNET with synchronous LM between 2000 and 2011 from 4 high-volume institutions were included. The patients were divided into 3 groups: curative resection, palliative resection, and no resection. Results: Overall, 166 patients were included. Eighteen patients (11%) underwent curative resection, 73 patients (43%) underwent palliative resection, and 75 patients (46%) underwent conservative treatment. The median overall survival (OS) from the time of diagnosis was 73 months. Patients who underwent curative resection had a significantly better median OS from the initial diagnosis compared with those who underwent palliative resection and those who were conservatively treated (97 vs. 89 vs. 36 months, p = 0.0001). The median OS from the time of diagnosis in those patients who underwent radical or palliative resection was 97 months, with a 5-year survival rate of 76%. On multivariate analysis, factors associated with OS from the time of diagnosis were the presence of bilobar metastases, tumor grading, and curative resection in a first model. On a second model, curative or palliative surgery was an independent predictor of OS. Among 91 patients who underwent surgery, the presence of pancreatic neuroendocrine carcinoma G3 was the only factor independently associated with a poorer survival after surgery (median OS: 35 vs. 97 months, p < 0.0001). Conclusions: Patients with LM from PNET benefit from surgical resection, although surgery should be reserved to well- or moderately differentiated forms.

Deep endometriosis inflicting the bladder: long-term outcomes of surgical management

To assess the efficacy and safety of laparoscopic treatment of bladder endometriosis, especially in cases of full thickness endometriotic nodules. Retrospective review of medical records. Tertiary medical center and a referral center for endometriosis. Sixty-nine patients with bladder endometriosis that underwent surgery between January 2005 and December 2011. The records of all patients with bladder endometriosis were reviewed and the pre-, intra- and postoperative information of patients who underwent surgery was collected. Efficacy, safety and long-term outcome of laparoscopic treatment of bladder endometriosis. The mean age of 69 patients with bladder endometriosis was 31.3 ± 4.6 years. Preoperative urinary symptoms (such as frequency, urgency, dysuria and others) were present in 28 (40.0%) patients. Laparoscopy was performed in all patients. Deep detrusor involvement was found in 45 (65.2%) patients. Of these, 21 patients underwent partial cystectomy due to a full thickness lesion. Deep nodule resection without bladder invasion was performed in 24 (34.8%) patients and bladder nodule coagulation and ablation in the remaining 24 (34.8%) patients with superficial involvement. No intraoperative complications were noted. Postoperative follow-up results were available for all patients. After a median (range) follow-up period of 60 (4-92) months, 92.7% of the patients were asymptomatic or reported improvement in symptoms. After a long-term follow-up surgical management of bladder endometriosis is strongly recommended. During surgery, careful inspection and full excision of bladder lesions should be performed. Laparoscopic excision is a safe and efficacies approach.

Long-term outcome of surgical management of adult Chiari I malformation

Chiari I malformation continues to inspire controversy. Debate still exists about surgical options. The aim of this study is to evaluate the long-term outcome of posterior fossa decompression procedure (PFD) in the treatment of adult Chiari I malformation, focusing on some factors or technical aspects which might influence the outcome. Forty-six adult patients with Chiari I malformation operated by PFD are the subject of this study. The group included 21 males and 25 females, with mean age of 37.4 years. Patients were divided into two groups: group I (32 cases) with syringomyelia and group II (14 cases) without syringomyelia. Group I was further subdivided into three subgroups according to the surgical procedure adopted: group Ia (12 cases) operated by PFD only, group Ib (14 cases) operated by PFD with fourth ventricular shunt, and group Ic (six cases) operated by PFD and syringosubarachnoid shunt. All cases included in group II were operated by PFD only. In group I, symptoms improved in 14 cases (43.8 %) and stabilized in 18 cases (56.3 %), whereas in group II, symptoms resolved in ten cases (71.4 %) and improved in four cases (28.6 %). Postoperative magnetic resonance imaging showed that the syrinx was resolved in 21 cases (65.6 %), improved in seven cases (21.9 %), and unchanged in four cases (12.5 %). Among the mean follow-up period (5.8 years), recurrence of symptoms occurred in five cases (10.9 %), all of them are included in group I, and were reoperated again. Posterior fossa decompression is recommended as the treatment of choice in adult Chiari I malformation with or without syringomyelia. The presence of syringomyelia predicts a less favorable response to surgical intervention. Syringosubarachnoid shunting did not improve the long-term outcome either clinically or radiologically. Implanting a fourth ventricular shunt in cases of syringomyelia associated with adhesions at the foramen of Magendie decreases the long-term incidence of recurrence significantly. For recurrent cases, re-exploration of the initial posterior fossa decompression is recommended before any consideration is given for direct management of the syrinx.

Use of the Pediatric Outcomes Data Collection Instrument to Evaluate Functional Outcomes in Arthrogryposis

The Pediatric Outcomes Data Collection Instrument (PODCI) is a subjective measurement tool designed to provide a standardized method of assessing outcomes in pediatric musculoskeletal conditions. It has earlier been shown to be useful in several pediatric musculoskeletal conditions, but there is currently no widely accepted subjective outcome measurement tool for children with arthrogryposis. The PODCI was administered to parents of 74 children diagnosed with amyoplasia. The score distributions were compared with values published earlier for children without musculoskeletal disorders. For those patients with repeated PODCI administrations over time, the initial score was compared with the most recent score. Comparisons were made using the Student t test. PODCI scores in children with amyoplasia were significantly lower than those for typically developing children in all 6 domains. The scores were also more normally distributed than those for typically developing children in all 6 domains. Over an average follow-up period of approximately 3 years, children with amyoplasia had a statistically significant increase in scores for upper extremity function, sports participation, and global functioning. These results show that the PODCI is useful in evaluating functional outcomes of children with amyoplasia, and is sensitive to change in function over time. The PODCI shows promise as a tool to evaluate long-term outcomes of surgical management in amyoplasia. Diagnostic Study, Level III.

Fournier's Gangrene: Population Based Epidemiology and Outcomes

Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene. We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated. We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean +/- SD 0.6 +/- 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively. Patients with Fournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers.

Long-term Result of Surgical Treatment for Crohn's Enteritis

Purpose: We sought to determine the long-term outcome of surgical management for gastrointestinal Crohns’s disease (CD) and to find out whether there is any improvement over the time period. Methods: We analyzed the records of the 102 patients who underwent surgery for gastrointestinal CD excluding perianal CDbetween 1978 and 2007. A cumulative surgical recurrence rate was analyzed by Kaplan-Meier plots and log-rank tests. Results: The main sites of CD were ileocecal area in 54.5%, followed by small bowel (29.7%) and large bowel (7.9%). Common indications for operation were obstruction (25.7%), diagnostic purpose (20.8%), and failure of medical treatment (12.9%). The operation performed were ileocolectomy including right hemicolectomy in 53 cases (45.3%), small bowel resection in 38 cases (31.7%), and strictureplasty 12 cases (10.0%, including 11 cases combined with bowel resection). The average follow-up period after operation was 6.4years (range: 0.5∼29 yr, median: 5.3 yr). Among all patients, 22 (21.6%) underwent operations for recurrence. The re-operation rate was higher in the younger patients group (age at diagnosis less than 25 years) (34.1% vs. 12.1%, P＜0.05), and in case of the patients whose length of initial intestinal resection was less than 40 cm (27.9% vs. 7.7%, P＜0.05). The overall cumulative re-operation rates at 5years, 10years and 15years were 15%, 25%, and 60%, respectively. Conclusions: Despite recent advances in medical therapy, the cumulative re-operation rate of patients operated for gastrointestinal CD remains similar to our previous report in 1997.