Low Complication Rate Research Articles

Percutaneous removal of hardware after orthopedic surgery: Is it safe? and What are patients saying?

To analyze our patient's complication profile and rate after removal of hardware (ROH) surgery, and survey our patients to ask their overall status and improvement in symptomatology post-operatively. Retrospective chart review and survey. Academic, tertiary referral center. 173 patients with 314 pieces of hardware. Seventy-six patients (43.9%) responded to our survey. ROH surgery. Patient demographics and complications were recorded. All patients were sent a brief 3-question survey which asked: (1) Why did you get your hardware removed? (2) How did your overall status change after ROH? (3) How did the ROH affect your stiffness, pain, swelling, and mobility? There were 10 complications (5.5%): 5 infections, 2 with unresolved pain, 1 hematoma, 1 chronic regional pain syndrome exacerbation, and 1 recurrent deformity. All infections were treated with oral antibiotics and improved. All other complications resolved with treatment except for the patient who developed recurrent deformity. Patients underwent ROH surgery because their doctor suggested it (76.3%) and to improve mobility (39.5%). 86.9% reported their overall status improved after ROH. They improved regarding stiffness (73.7%), pain (73.6%), swelling (61.8%), and mobility (76.3%). Similar results were seen among different implants removed. The majority of patients who underwent percutaneous ROH were satisfied. They reported improvement in stiffness, pain, swelling and mobility (greatest improvement). The complication rate was low (5.5%). ROH can be a meaningful operation to patients allowing them to improve their quality of life with a low complication rate. Level IV.

Low rates of complications and β-lactam resistance in viridans group streptococci bloodstream infection among cancer patients receiving chemotherapy.

Viridans group streptococci (VGS) bloodstream infection (BSI) frequently occurs in cancer patients receiving chemotherapy, and is associated with infective endocarditis (IE) in up to 20% of cases in the general population. In cancer patients receiving chemotherapy with VGS BSI, we aimed to: (i) determine the incidence of infective complications including IE, (ii) assess the utility of echocardiography in this patient population, (iii) determine the duration and type of antimicrobial therapy received for monomicrobial infections, and (iv) determine the evolution of antimicrobial resistance. VGS BSIs (excluding Streptococcus pneumoniae and Streptococcus pseudopneumoniae) in cancer patients receiving chemotherapy were identified from a statewide public pathology database between 2013 and 2022 at our tertiary centre. Medical records were accessed for clinical, microbiological and radiological data. Of 581 patient episodes screened, 183 episodes involving 171 patients met inclusion criteria. Of these, 51% were bone marrow transplantation (BMT) patients, 40% were non-BMT haematology patients, and 8% were solid organ malignancy patients. The median age was 55 years, and 96% were neutropenic at the time of blood culture collection. A transthoracic echocardiogram was performed for 71% of episodes, and one patient met modified Duke's criteria for definite IE, although this diagnosis was not suspected on clinical grounds. Other complications were uncommon. Benzylpenicillin resistance was rare (2.9%) and did not change over time. Most episodes (75%) were treated with piperacillin/tazobactam. For monomicrobial BSIs, the median antibiotic duration was 5 days (IQR 2-7) post-neutropenia resolution. Infective complications and antimicrobial resistance are rare in cancer patients with VGS BSI. This may provide a safe opportunity to limit both investigations (e.g. echocardiogram) and prolonged exposure to broad-spectrum antimicrobials.

Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis

Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker’s (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, evidence in the Middle East and North Africa remains limited. This study aims to evaluate the feasibility and safety of intramural surgery techniques within this region. Methods: This retrospective cohort study was conducted with approval from the institutional review board. All patients who underwent esophageal peroral endoscopic myotomy, gastric peroral endoscopic myotomy, and peroral endoscopic myotomy for Zenker’s from January 2016 to August 2023 were included. Results: In total, 119 patients underwent intramural surgery procedures during this period. The esophageal peroral endoscopic myotomy group had 81 (68%) patients, the gastric peroral endoscopic myotomy had 34 (28.6%) patients, and the peroral endoscopic myotomy for Zenker’s had 4 (3.4%) patients. The full cohort was 48.7% female, with a mean overall age of 40.5 years. The mean overall body mass index was 27.5 kg/m2. The chief complaint was dysphagia (n = 80, 67.2%). All cases were successfully completed endoscopically. During the first 30 days, the most common complications were nausea/vomiting requiring admission (n = 4, 4.76%) and pneumomediastinum (n = 2, 2.38%). At a follow-up of 19 months, there were four mortalities; the causes of death were cardiac arrest (three cases) and end-stage prostate cancer (one case). Conclusions: Intramural surgery techniques are safe and technically feasible with low complication rates. Our study suggests that clinical success in the Middle East and Northern Africa population is comparable to larger international series.

Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.

We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.

Risk Factors, Antithrombotic Management, and Long-Term Outcomes of Patients Undergoing Endovascular Treatment of Unruptured Intracranial Aneurysms.

Patients receiving endovascular treatment for unruptured intracranial aneurysms (UIAs) face varying risks and benefits with antithrombotic management. This study aimed to evaluate the perioperative and long-term effects of antithrombotic strategies, identify the populations that would benefit, and explore the predictive factors affecting the long-term outcomes. UIA patients undergoing endovascular treatment including stent-assisted coiling or flow diversion between June 2019 and June 2022 were enrolled. We compared perioperative and long-term complications between tirofiban and dual antiplatelet therapy groups. Optimal candidates for each antithrombotic treatment were identified using multivariate logistic regression. Nomograms were developed to determine the significant predictors for thromboembolic complications during follow-up. Among 181 propensity-score matched pairs, the tirofiban group showed a trend toward a lower rate of thromboembolic complications than the DAPT group without elevating major bleeding risk in either period. Homocysteine (Hcy) level ≥10 μmol/L was a significant independent factor associated with thromboembolic complication in both periods. Subgroup analysis highlighted that in patients with high Hcy levels, tirofiban and sustained antiplatelet treatment for ≥12 months were protective factors, while a history of stroke was an independent risk factor for thromboembolic events in follow-up. Four variables were selected to construct a prognostic nomogram, history of hypertension, prior stroke, Hcy level, and the duration of antiplatelet therapy. Perioperative low-dose tirofiban and extended antiplatelet therapy demonstrated a favorable trend in long-term outcomes for UIA patients with preoperative Hcy levels ≥10 μmol/L undergoing endovascular treatment. The prognostic model offers reliable risk prediction and guides antithrombotic strategy decisions.

An Open-Label Phase II Study Assessing the Safety of Bilateral, Sequential Administration of Retinal Gene Therapy in Participants with Choroideremia: The GEMINI Study.

Choroideremia, an incurable, progressive retinal degeneration primarily affecting young men, leads to sight loss. GEMINI was a multicenter, open-label, prospective, two-period, interventional Phase II study assessing the safety of bilateral sequential administration of timrepigene emparvovec, a gene therapy, in adult males with genetically confirmed choroideremia (NCT03507686, ClinicalTrials.gov). Timrepigene emparvovec is an adeno-associated virus 2 (AAV2) vector encoding the cDNA of Rab escort protein 1 (REP1), augmented by a downstream woodchuck hepatitis virus post-transcriptional regulatory element (WPRE). Up to 0.1 mL of timrepigene emparvovec, containing 1×1011 vector genomes, was administered by subretinal injection following vitrectomy and retinal detachment. The second eye was treated after an intra-surgery window of <6, 6-12, or >12 months. Each eye was followed at up to nine visits over 12 months. Overall, 66 participants received timrepigene emparvovec and 53 completed the study. Visual acuity was generally maintained in both eyes, independent of intra-surgery window duration, even after bilateral retinal detachment and subretinal injection. Bilateral treatment was well tolerated, with predominantly mild or moderate treatment-emergent adverse events (TEAEs) and a low rate of serious surgical complications (7.6%). Retinal inflammation TEAEs were reported in 45.5% of participants, with similar rates in both eyes; post-hoc analyses found these were not associated with clinically significant vision loss at Month 12 versus baseline. Two participants (3.0%) reported serious noninfective retinitis. Prior timrepigene emparvovec exposure did not increase the risk of serious TEAEs or serious ocular TEAEs upon injection of the second eye; furthermore, no systemic immune reaction or inoculation effect was observed. Presence of anti-vector neutralizing antibodies at baseline was potentially associated with a higher percentage of TEAEs related to ocular inflammation or reduced visual acuity after injection of the first eye. The GEMINI study results may inform decisions regarding bilateral sequential administration of other gene therapies for retinal diseases.

Efficacy of Two Kinds of Scissor-Type Knives for Colorectal Endoscopic Submucosal Dissection: A Retrospective Comparative Study.

Scissor-type knives are spreading as safe devises in endoscopic submucosal dissection (ESD). We evaluated the efficacy of two kinds of scissor-type knives (Clutch Cutter: CC, Fujifilm Co.and SB Knife Jr2: SB, SB-KAWASUMI Laboratories. Inc.) in colorectal ESD. This single-center retrospective study analyzed 178 ESD cases treated with CC from January 2020 to August 2021 and 91 cases with SB from September 2021 to December 2023. The two groups were compared through propensity score matching. Therapeutic results, such as ESD procedure time, en bloc resection rate, perioperative bleeding frequency, and complications, were analyzed in each group. Risk factors for long ESD procedure time (≥ 90min) were also examined. After matching, 87 cases in each group were analyzed. There was no significant difference in the ESD procedure time (min, median [interquartile range]) between the CC and SB groups (54.0 [36.0-72.0] vs. 53.0 [39.0-72.0], p = 0.99). Additionally, there were no differences in the en bloc resection (100% vs. 100%, p = 1.00), perioperative perforation (1.1% vs. 1.1%, p = 1.00), or delayed bleeding (1.1% vs. 0.0%, p = 1.00). There was a significant difference in perioperative bleeding frequency (mean ± standard deviation: 1.8 ± 2.6 vs. 3.0 ± 3.5, p < 0.01). The significant risk factors (odds ratio [95% confidence interval]) for long ESD procedure time in patients treated with CC or SB were antiplatelet (7.51 [1.82-31.00]), large lesion size (1.08 [1.05-1.12]), severe fibrosis (24.30 [7.60-77.90]), and perioperative bleeding frequency (1.34 [1.14-1.56]). CC and SB in colorectal ESD enabled high en bloc resection and low complication rates. CC showed significantly less perioperative bleeding than SB.

Modern multiligament knee injury surgical reconstruction techniques can achieve excellent knee function and patient satisfaction, with low complication rates.

To report on the recovery of strength and functional capacity symmetry following multiligament knee surgical reconstruction (MLKR), as well as the capacity of athletes to return to sport. This prospective cohort study recruited 47 patients undergoing MLKR between February 2018 and July 2021. Forty patients had full outcome assessment postoperatively at 6, 12 and 24 months and were included in the analysis, 75% were knee dislocation one injuries and 60% were injured playing sport. Patient-reported outcome measures (PROMs) assessed included the International Knee Documentation Committee score, the Knee Outcome Survey, the Lysholm Knee Score and the Tegner Activity Scale (TAS). Patient satisfaction was also assessed. Objective assessment included assessment of active knee flexion and extension range of motion (ROM), the single (single horizontal hop for distance [SHD]) and triple (triple horizontal hop for distance [THD]) hop tests for distance and peak isokinetic knee flexor/extensor torque. All PROMs significantly improved (p < 0.001) from presurgery to 24 months postsurgery. At 24 months, 70% of patients were satisfied with their sports participation. Active knee flexion (p < 0.0001) and extension (p < 0.0001) ROM significantly improved over time, as did the limb symmetry indices (LSIs) for the SHD (p < 0.0001), THD (p < 0.0001), peak knee extensor (p < 0.0001) and flexor (p = 0.012) torque. While LSIs for the SHD, THD and knee flexor strength tended to plateau by 12 months, knee extensor strength continued to improve from 12 to 24 months. The majority of patients undergoing modern MLKR surgical techniques and rehabilitation can achieve excellent knee function, with low complication rates. Level IV.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

Performance of the Quadripolar CRT-D system: 5-Year Results from the Quadripolar Pacing Post Approval Study

BackgroundCardiac resynchronization therapy (CRT) is associated with challenges such as elevated capture thresholds, diaphragmatic stimulation, and lead instability. ObjectiveAssess the chronic safety and efficacy of the quadripolar CRT-D device system with the Quartet 1458Q Left Ventricular (LV) lead in a CRT-indicated population followed for 5 years and evaluate all-cause mortality and impact of baseline characteristics on survival through 5 years. MethodsPatients indicated for a CRT-D system were followed every 6 months post-implant for 5 years and assessed device performance and adverse events at each visit. The three primary endpoints were freedom from quadripolar CRT-D system-related complications through 5 years, freedom from Quartet 1458Q LV lead-related complications through 5 years, and the mean programmed pacing capture threshold at 5 years. ResultsThe study enrolled 1,970 subjects at 71 sites. The quadripolar CRT-D system was successfully implanted in 97.2% of subjects. Freedom from quadripolar CRT-D device system-related complications through 5 years was 89.7% and freedom from Quartet 1458Q LV lead-related complications through 5 years was 95.7%. 3.49 % of subjects had LV lead-related complications and an overall LV lead complication rate was 0.0122 events per subject-year. A mean LV pacing capture threshold was 1.52 ± 1.01 V at 5 years. The 5-year survival rate was 67.4%. ConclusionThe quadripolar CRT-D system with the Quartet 1458Q LV lead exhibited low rates of complications and stable electrical performance through 5 years of follow-up and suggested a higher 5-year survival rate compared to traditional CRT systems.

Pedicled Descending Branch Latissimus Dorsi Mini-Flap For Breast Reconstruction: Shoulder Functional and Aesthetic Outcomes

Abstract Background The cosmetic drawbacks of BCT are asymmetry, nipple or skin retraction, and volume loss which results in an unsatisfactory cosmetic outcome. Therefore, many volume replacement techniques were invented to counteract this. The commonest volume replacement technique for breast reconstruction is autologous LD flap in which skin paddle and subcutaneous tissue are harvested with the flap resulting in increased donor site morbidity. Objective To evaluate the latissimus dorsi mini-flap (LDMF) regarding the cosmetic outcomes and patient satisfaction. Moreover, it will evaluate procedure related complications and the benefit of using this procedure as a volume replacement to large breast defect after wide local excision in different breast quadrants excluding the lower inner quadrant (LIQ). Patients and Methods Our study was conducted on 15 patients to evaluate post-operative complications and patient satisfaction primarily. The results have demonstrated the safety of this procedure which is associated with a low rate of complications. Our study was designed to assess breast-sparing approaches using LD mini flap (LDMF) for reconstruction of the breast after wide local excision of large breast tumors that would result in otherwise unacceptable deformity. Results The LDMF generally is not a time-consuming technique as the average operative time was generally less than three hours. This time included the time for resection and the time waiting for frozen section results. The LDMF reconstruction was associated with considerable sensory preservation. This technique not only preserves most of the breast tissue but also, it spares us doing additional procedures such as nipple reconstruction. Avoidance the use of an implant is an additional advantage to the LDMF as this decrease the rate of infection and decrease the cost of the procedure. Conclusion LDMF volume replacement extends the role of breast-conserving surgery to a group of patients who are traditionally offered mastectomy. Despite the increasing use of Neoadjuvant chemotherapy, some patients have a disease that fails to respond or extensive DCIS and can, therefore, benefit from this oncoplastic technique. Frozen-section analysis of the tumor cavity is essential for surgical decision making. Our study had demonstrated the safety of this procedure which is associated with a low rate of complications. This technique has a high patient satisfaction rate wit agreeable cosmetic outcome. This technique can be used as a volume replacement to large breast defect in different breast quadrant except in lower inner quadrant which was not included in this study.

Surgical Outcome of the Endoscopic Endonasal Approach in Giant Pituitary Adenomas: A Systematic Review

Abstract Background Pituitary adenomas are the third most common intracranial tumors comprising about 10%–15% of all tumors. Giant pituitary adenomas (GPAs) are a subset of pituitary tumors. Most giant adenomas are slowly growing and histologically benign in nature despite the giant in size and difficulties to manage. Diverse surgical techniques including microscopic transsphenoidal, endoscopic transsphenoidal, transcranial transcavernous, and a combination of both suprasellar and infrasellar techniques have been developed to treat giant tumors with extension into surrounding structures. The development of the endonasal endoscopic approach for the resection of pituitary adenomas has been one of the most important advances for the treatment of pituitary tumors in the last decades since 1997. Aim of the Work analyze the collective outcomes from studies discussing endoscopic endonasal transsphenoidal approach in managing giant pituitary adenomas regarding extent of tumor resection, visual improvement and hormonal control. Methodology This systematic review included a discussion of all available studies meeting the eligible criteriaincluding: well conducted descriptive studies, cohort, articles, analytic studies and the literature of reviews. Results Surgical intent of gross or near total resection, primarily for the purpose of improving outcome, can be complicated by injuries that lead to a worse outcome and protracted clinical course. In this respect, patient-oriented outcomes (POEMs) are a point of emphasis in this review. Conclusion The endoscopic endonasal approach is an effective approach for giant pituitary adenomas with high rates of near or complete resection, visual improvement, and low rate of complications.

Assessment of Use of Subcutaneous Mastectomy with Silicon Prostheses as Treatment of Early Breast Cancer

Abstract Background Breast cancer is the most common cancer among women and the second most common cause of cancer death in the United States. Approximately 268,600 new breast cancer diagnoses and 41,760 cancer- related deaths in the U.S. were estimated for 2019. SSM (skin sparing mastectomy) is defined as a simple or radical surgery with modified minimal incisions that retain the widest possible coverage and sub-cutaneous breast groove but dry the NAC, flaws of previous biopsies and/or scarring caused by diagnostic percutaneous biopsies. Access to the armpit for a possible sentinel-node biopsy or axillary dissection is obtained through the same incision. An additional incision may be necessary to perform the reconstructive procedure (e.g., microsurgical axillary anastomosis). Objective To study the risks and benefits of use subcutaneous mastectomy with silicon prosthesis as treatment of early breast cancer: as regards the impact of radiotherapy administration on implant, psychological impact, operative time and post-operative complications including complication of silicon, effect on wound healing. Patients and Methods This prospective interventional study was conducted at tertiary care hospital at the general surgery department in Ain Shams University hospitals and Misr University for Science and Technology (MUST) hospital and from November 2021, till July 2022 and performed on total 15 females suffering from stage I-II infiltrating breast carcinomas. Results The current study revealed that mean ±SD of age of the studied cases was 46.3±7.4. Regarding tumor site, LOQ was the most frequent (40.0%), followed by UIQ (33.3%), then UOQ (20.0%) and lastly LIQ (6.7%). Concerning T grades, T1 was in (46.7%), while the remaining (53.3%) were T2. Concerning N grades, N0 was in (73.3%), while the remaining (26.7%) were N1. Sentinel lymph nodes done in 73.3% of cases. As regards operative characteristics, Axillary clearance done in less than half of cases (46.7%), while nipple sparing achieved in less than quarter of cases (20.0%). As regards post-mastectomy treatment, majority of cases (86.7%) received hormonal therapy, adjuvant radiotherapy to axilla was (46.7%), chemotherapy (33.3%), while immunotherapy was (6.7%). As regards postoperative side effects, Pain was the most frequent postoperative side effect; detected in (33.3%) of cases, followed by seroma (20.0%), then flap necrosis (13.3%), and the least frequent was hematoma (6.7%). As regards postoperative patients’ satisfaction, mean ±SD of Postoperative patients’ satisfaction was 7.3±1.5 with range 5.0 − 10.0. Near half of the studied cases (46.7%) had 7.0 − 8.0 satisfaction grade. Conclusion Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) with immediate subcutaneous silicon implantation are an acceptable and safe method for breast reconstruction. It offers a number of advantages including ease of dissection for surgeons, improved symmetry, and low complication rates. With improvements in surgical techniques in preserving mastectomy skin flap viability, the traditionally higher rates of complications in subcutaneous implants may be outdated. The present study can burden the knowledge and shed some light on future prospective studies with larger sample sizes to evaluate a cost benefit analysis and patient and surgeon assessment of outcomes to directly compare with traditional submuscular single- or 2- stage implant-based reconstruction.

654 Laparoscopic Cholecystectomy in Class III (Morbid) Obesity

Abstract Background High Body Mass Index (BMI) has been associated with increased operative-time, conversion to open-surgery and poorer outcomes. Criteria for day surgery often includes BMI, with centres excluding patients with BMI&amp;gt;40kg/m2 . However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being reviewed. Aim To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid obesity (Class-III;BMI&amp;gt;40 kg/m2) to those with lower BMI. Method Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South Wales, UK. Data on BMI, surgical indication, operative duration, length of admission and 30-day complications, amongst others, was collected. Results This study included a total of 1007 patients (77.92% female, 22.08% male). Patients were placed into 5 BMI categories: BMI&amp;lt;25(n=117),25-29(n=284),30-34(n=285),35-39(n=193), and&amp;gt;40(n=135). The median BMI was 31kg/m2 and overall complication-rate 5.36%. There were three 30-day mortalities, one in BMI category &amp;lt;25(p=0.19) and two in 25-29(p=0.06). When comparing patients with BMI&amp;gt;40 to those with lower BMI there was no significant difference in complications including bile-leak (0%vs1.79%;p=0.35), significant bleed (0.10%vs0.20%;p=0.41) or bile-duct injury (0%vs0.1%;p=0.71). The duration of surgery was increased, almost reaching statistical significance (83.5vs78mins;p=0.05). Due to existing Health board admission criteria, length of admission was significantly raised for BMI&amp;gt;40 (median1vs0days;p=0.00). Conclusions This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI&amp;gt;40 appears inappropriate.

A Comparative Study between Ultra mini Percutaneous Nephrolithotomy versus Stented Extracorporeal Shock Wave Lithotripsy for Treatment of Renal Stones in Egypt

Abstract Background Nephrolithiasis is the third most common disease of the urinary tract with a 1-year recurrence rate of 7% and 10-year recurrence rate of 50%. Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL) are different surgeries to treat renal stones. Percutaneous nephrolithotripsy (24- 30F) remains the standard procedure for treating large renal calculi. While achieving high SFR, it also has many drawbacks such as bleeding, postoperative pain, and a long recovery period due to its large access tract, so the Ultra mini percutaneous nephrolithotripsy (12-14F) with a smaller tract size came into existence to reduce renal parenchymal injury associated with standard PCNL. ESWL is a minimally invasive intervention with good patient tolerance; it is regarded as the first line treatment for nephrolithiasis &amp;lt; 20 mm in size. Aim andObjectives Compare results, safety and outcome of Ultra mini PCNL versus stented extracorporeal shock wave lithotripsy (ESWL) for the management of renal calculi from 10 – 20 mm. Materials and Methods This study was conducted at Urology department, Faculty of Medicine, Ain Shams University. Patients were recruited from the outpatient urology clinic between March 2021 till September 2022. Inclusion criteria included patients between 18 and 60 years, having radioopaque renal stones ranging from 10-20 mm with BMI not exceeding 40. Exclusion criteria were patients who had radiolucent stones, smaller than 10 mm or larger than 20 mm, with congenital renal anomalies or spinal deformity or BMI exceeding 40. Patients with uncorrected bleeding diathesis or pregnant females or untreated UTI were also excluded. After meeting our inclusion and exclusion criteria, 90 patients were thoroughly informed about the study, feeling well about participating in it, an informed written consent was taken from them. Patients were randomized to either Ultra-Mini-Percutaneous nephrolithotomy group or stented SWL group via the closed envelope method(each group 45 patients). Results Stone free rate was higher in the Ultra-mini-PCNL group compared to the stented ESWL group with no statistically significant difference with P-value = 0.316. As for the need for retreatment was slightly higher in the stented ESWL group compared to the Ultra-mini-PCNL group yet this difference was statistically insignificant with P-value 0.681. No statistical significant difference between both groups regarding post operative complications fever, hematuria and need for blood transfusion respectively. Operative time and hospital stay were significantly higher in the ultra-Mini-PCNL group compared to the stented ESWL group with P-value &amp;lt;0.001 for both. Conclusion Both stented ESWL and Ultra-Mini-PCNL are good treatment choices for renal stones less than 2 cm with low complication rates. Denying Ultra-Mini-PCNL from patients with medium sized stones for fear of complications is considered unwarranted. Stone size indices were significant predictor for the need of retreatment. Further studies to compare stone free rate based on stone size in both interventions are needed.

Comparison Between the Efficacy &amp; the Safety of Single Use Flexible Ureteroscopy Lithotripsy and Miniaturized Percutaneous Nephrolithotomy (Mini PCNL) for the Management of Renal and Proximal Ureteral Calculi of ≤ 2CM

Abstract Background Urolithiasis has become a common medical problem with about 2- 3% prevalence rate and still increasing in the general population. Renal calculi represent about 80- 90% of all urinary calculi with high recurrence rate. Single Use Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy Lithotripsy are recommended in the 2013 European Association of Urology guidelines as the first line in management of lower pole calculi when renal anatomy is unfavorable for Extracorporeal Shock Wave Lithotripsy. Furthermore, Single Use Flexible Ureteroscopy Lithotripsy is extremely effective for management of calculi of ≤ 2 cm in diameter and complex renal calculi. Aim of the Work The aim of our study is to compare the outcome of using Single Use Flexible URS versus Mini-PCNL with ≤22 Fr tract accessin management of pelvic, lower calyceal and proximal ureteral calculi ≤ 2cm. It was conducted on 40 patients that were randomly divided into 2 groups. Group A were treated with Mini-PCNL (20cases), whereas group B were treated with Single Use Flexible URS (20 cases). Patients and Methods A clinical trial, it was carried out at Ain Shams University, Urology department from October 2020 to October 2021 and done over 40 patients complaining of single pelvic, lower calyceal or upper ureteric stone ≤ 2 cm. The patients underwent either Mini-PCNL or Single Use Flexible URS randomly according to simple randomization using Gpowa computer program with ratio 1:1. Results Our study showed that Single Use Flexible URS achieves a comparable stone free rates to Mini- PCNL as there is no statistically significant difference between group A and group B in the stone free rate.Flexible URS reduces the risks associated with Mini-PCNL.Blood loss is highly significant in Mini-PCNL group more than in Single Use Flexible URS group.The incidence of post-operative fever and infection is non- significant between 2 groups. It is (15%)3 cases from 20 cases in group A although, (5%)1case from 20 cases in group B. There is highly significant difference between group A and group B in both operation time and hospital stay. This means that the patients take more intra operative time in Flexible URS group than in Mini-PCNL group,but more hospitalization in Mini- PCNL group than Single Use Flexible URS group.There is no statistically significant difference between 2 groups in the need for double J stent or auxiliary procedure such as ESWL. Conclusion Single Use Flexible URS is widely used nowadays and the treatment of choice for management of renal calculi due to its high efficacy and low morbidity in management of renal stones up to 20 mm. This study indicated that Single Use Flexible URS is an effective technique for management of renal and proximal ureteric calculi ≤ 2cm. In comparison to Mini-PCNL, it not only has a similar stone free rate, but also is associated with lower complication rates, more favorable recovery time. But it has longer operative time.

231 A Comparative Study Between Open Pre-Peritoneal Approach Versus Laparoscopic Trans-Abdominal Pre-Peritoneal Approach in Recurrent Inguinal Hernia Repair: A Prospective Cohort Study

Abstract Aim To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the post-operative outcomes. Method The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 at Ain Shams University Hospitals. Results There were 74 patients in our study 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ±11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ±18.03 (p=0.015). Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p=0.674). The wound infection was found in 5 (13.5%) patients in group(I) and zero patients in group (II)(p=0.021). Finally, recurrence after one year was found in 3(8.1%) patients in group(I) and 1(2.7%) patient in group (II) (p=0.615). Conclusions The results of this study demonstrate that both approaches are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform.

456 Comparison of Postoperative Outcomes Between Robotic and Laparoscopic Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract Aim To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD). Method A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters. Results Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00]. Conclusions Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.

A Systematic Review of Methods of Fixation of Greater Trochanter Fracture during Hip Arthroplasty

Abstract Background The rigid fixation of greater trochanter has been supported by more and more surgeons, but the choice of fixation is still controversial. Traditional steel wires and titanium is widely used because of its relatively simple procedure and low cost. But the high failure rate of internal fixation also led orthopedists to seek for other more effective fixation methods. Objective To compare between methods of fixation of greater trochanter during hip arthroplasty according to type and postoperative outcome. Patients and Methods Studies that meet the inclusion criteria were reviewed and data were analysed. We assessed the participants, methods, and intervention effects of included studies for heterogeneity. This enabled us to determine whether results can be pooled across studies. Results This review was on Non randomized and randomized controlled trials, prospective and retrospective studies which compare different methods of fixation of trochanter during hip arthroplasty. The search strategy identified 780 unique citations. Screening of titles and Abstracts identified 93 potentially relevant articles. Full text review of these articles identified 10 studies meeting the inclusion criteria. 10 studies were included 8 were retrospective and 2 prospective studies. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion The different fixation methods were successful in achieving proper reduction and fixation of greater trochanteric fractures during hip arthroplasty. We preferred the cable plates, which not only provides strongest fixation but also results in lower rate of postoperative complications. But further prospective randomized and cohort studies are needed to validate their safety and efficacy.

Impact of three-dimensional-printing technology guidance on surgical outcomes for retroperitoneal sarcoma: A propensity score-matched study.

The surgical treatment of retroperitoneal sarcoma (RPS) is highly challenging because of its complex anatomy. In this study, the authors compared the surgical outcomes of patients with RPS who underwent surgical resection guided by three-dimensional (3D) printing technology versus traditional imaging. This retrospective study included 251 patients who underwent RPS resection guided by 3D-printing technology or traditional imaging from January 2019 to December 2022. The main outcome measures were operative time, intraoperative blood loss, postoperative complications, and hospital stay. In total, 251 patients were enrolled in the study: 46 received 3D-printed navigation, and 205 underwent traditional surgical methods. Propensity score matching yielded 44 patients in the 3D group and 82 patients in the control group. The patients' demographics and tumor characteristics were comparable in the matched cohorts. The 3D group had significantly shorter operative time (median, 186.5 minutes [interquartile range (IQR), 130.0-251.3 minutes] vs. 210.0 minutes [IQR, 150.8-277.3 minutes]; p=.04), less intraoperative blood loss (median, 300.0 mL [IQR, 100.0-575.0 mL] vs. 375.0 mL [IQR, 200.0-925.0 mL]; p=.02), shorter postoperative hospital stays (median, 11.0 days [IQR, 9.0-13.0 days] vs. 14.0 days [IQR, 10.8-18.3 days]; p=.02), and lower incidence rate of overall postoperative complications than the control group (18.1% vs. 36.6%; p=.03). There were no differences with regard to the intraoperative blood transfusion rate, the R0/R1 resection rate, 30-day mortality, or overall survival. Patients in the 3D group had favorable surgical outcomes compared with those in the control group. These results suggest that 3D-printing technology might overcome challenges in RPS surgical treatment. The surgical treatment of retroperitoneal sarcoma (RPS) is highly challenging because of its complex anatomy. The purpose of this study was to investigate whether three-dimensional (3D) printing technology offers advantages over traditional two-dimensional imaging (such as computed tomography and magnetic resonance imaging) for guiding the surgical treatment of RPS. In a group of patients who had RPS, surgery guided by 3D-printing technology was associated with better surgical outcomes, including shorter operative time, decreased blood loss, shorter hospital stays, and fewer postoperative complications. These findings suggested that 3D-printing technology could help surgeons overcome challenges in the surgical treatment of RPS. 3D-printing technology has important prospects in the surgical treatment of RPS.