Low Long-term Complication Rate Research Articles

Late small bowel toxicity after aggressive abdominopelvic intensity modulated radiation therapy

PurposeWe retrospectively analyzed late small bowel toxicity in patients who received abdominal or pelvic intensity modulated radiation therapy (IMRT) to the small bowel with a maximum dose greater than the generally accepted maximal tolerable dose of 45 Gy. Methods and materialsAll patients (N = 94) who received IMRT with a point dose of at least 45 Gy to tightly contoured small bowel between 2005 and 2014 at our institution were included. The median prescribed treatment dose was 70.2 Gy. The median follow-up was 20.1 months. Late small bowel toxicity was assessed using the Common Terminology Criteria for Adverse Events Version 3.0. Dosimetric variables and clinical factors were assessed for their relationship to small bowel toxicity. ResultsThe median maximal small bowel point dose (Dmax) was 6546.5 cGy. The estimated 5-year rates of freedom from at least grade 1, at least grade 2, and at least grade 3 late small bowel toxicity were 72.4% (95% confidence interval [CI], 60.7%-86.5%), 91.9% (95% CI, 84.1%-100%), and 93.6% (95% CI, 86.2%-100%), respectively. One patient (1.1%) developed grade 3 late toxicity, and 2 patients (2.1%) developed grade 4 late toxicity. Use of capecitabine/5-fluorouracil treatment was a significant predictor (P < 0.001) of at least grade 1 and at least grade 2 small bowel toxicity. No other clinical factors were associated with toxicity. None of the dose-volume parameters were significant predictors of small bowel toxicity. ConclusionIt may be possible with IMRT to deliver high doses to small volumes of small bowel with low rates of significant long-term complications. Further studies should explore tolerable dose-volume relationships in cases in which aggressive abdominal or pelvic treatment may be warranted to treat the underlying malignancy.

Children with mandibular fractures seem to have a low rate of long-term complications

Children with mandibular fractures seem to have a low rate of long-term complications

Early adverse events and long-term outcomes of endoscopic sphincterotomy in a pediatric population: a single-center experience.

Background and aims: The use of endoscopic sphincterotomy (EST) in the management of pancreaticobiliary disease in children is increasing. However, studies of long-term outcomes are limited in pediatric patients. Therefore, this study evaluated the early adverse events and long-term outcomes following EST in pediatric patients. Patients and methods: We retrospectively analyzed data from 198 pediatric patients who underwent ESTs at Asan Medical Center Children's Hospital between 1994 and 2013. The median age was 8.7 years (range 18 months to17 years). We evaluated the indications, success rates, early adverse events, and long-term outcomes. Results: Long-term information was available in 198 patients with a median follow-up duration of 42 months (range, 1.8 - 232.1 months). Early adverse events (< 30 days) following 294 ESTs among 198 patients included pancreatitis in 17 (5.7 %), hemorrhages in 6 (2.0 %), sepsis in 3 (1.0 %), and perforations in 2 (0.7 %). Long-term complications ( > 30 days) developed in 12 patients (6.1 %), including cholangitis with or without bile duct stone (n = 7), and minor papilla restenosis (n = 5). The cumulative incidence rates of long-term complications were 3.1 %, 6.1 %, 9.3 %, and 9.3 %, at 1, 5, 10, and 15 years. There were no procedure-related pancreaticobiliary malignancies or deaths. All adverse events and long-term complications improved with appropriate management. Conclusions: In pediatric patients with pancreaticobiliary disease, EST has a high level of technical success. In addition, pediatric EST showed low rates of early adverse events and long-term complications, which could be managed safely. Our results suggest that EST is a safe method for treating pancreaticobiliary disease, even in the pediatric population.

What are the long-term results 8 years after sleeve gastrectomy?

BackgroundLaparoscopic sleeve gastrectomy (LSG) became the most frequent bariatric procedure performed in France (2011) and in the United States (2013), but studies reporting long-term results are still rare. SettingPrivate hospital, France. MethodsThis is a retrospective analysis of a prospective cohort of 168 patients who underwent LSG between 2005 and 2008. The objective of this study was to present the 8-year outcome concerning weight loss, modification of co-morbidities, and to report the revisional surgery after sleeve. ResultsThe preoperative mean body mass index was 42.8 kg/m2 (31.1–77.9), 35 patients were super obese, and 64 patients had a previous gastric band. For LSG as a definitive bariatric procedure, 8 years of follow-up data were available for 116 patients (follow-up: 69%). Of the remainder, 23 patients underwent revisional surgery and 29 were lost to follow-up. For the entire cohort, the mean excess weight loss (EWL) was 76% (0–149) at 5 years and 67% (4–135) at 8 years, respectively. Of the 116 patients with 8 years of follow-up, 82 patients had>50% EWL at 8 years (70.7%). Percentages of co-morbidities resolved were hypertension, 59.4%; type 2 diabetes, 43.4%; and obstructive sleep apnea, 72.4%. Twenty-three patients had revisional surgery for weight regain (n = 14) or for severe reflux (n = 9) at a mean period of 50 months (9–96). Twelve patients underwent resleeve gastrectomy, 6 patients underwent conversion to a bypass, and 5 patients to duodenal switch (1 single anastomosis duodeno-ileostomy). A total of 31% of patients reported gastroesophageal reflux symptoms at 8 years. ConclusionsAt 8 years postoperatively, the LSG as a definitive bariatric procedure remained effective for 59% of cases. The results appear to be more favorable especially for the non-super-obese patients and primary procedures. LSG is a well-tolerated bariatric procedure with low long-term complication rates.

Abstract P3-14-02: Post mastectomy breast reconstruction in elderly women: Complications and the impact of individual surgeons

Abstract Purpose/Objective In the United States over 40% of incident breast cancer diagnoses are in women over 65 years of age. Effective breast cancer treatments allow elderly patients to live long, healthy lives; questions regarding long-term quality of life are increasingly important. In women over 65, post-mastectomy breast reconstruction (PMBR) is uncommon with reported rates of 6-30%. The goal of this study is to report complication rates in elderly PMBR patients and to evaluate the impact of individual surgeons on PMBR in elderly patients. Material/methods We identified 19,417 Medicare beneficiaries diagnosed with localized breast cancer between 2005 and 2011 who underwent mastectomy. Medicare claims were used to identify PMBR, post-operative complications after PMBR (within 30 days of surgery), and long-term complications related to reconstruction (within three years following surgery). Mastectomy surgeon was identified from Medicare claims with surgeon characteristics identified through linkage to the American Medical Association (AMA) Masterfile. Multi-level, multivariable logistic models clustered by surgeon and geographic area were used to determine the impact of surgeons on the likelihood of reconstruction. The intraclass correlation coefficient (ICC) and median odds ratio (MOR) were used to describe the relative impact of the individual surgeon. The ICC estimates the proportion of variability explained by the surgeon on PMBR rates. The MOR quantifies the likelihood of a patient having a different PMBR outcome if the patient were to change surgeons (or geographic area); it is directly comparable to odds ratios. Odds ratios (OR) were used to describe the impact of fixed demographic and clinical covariates. Results Among the entire cohort, 1,234 (6.4%) patients underwent PMBR. The post-operative complication rate was 8.4% and the long-term complication rate was 19.9%. Eighteen percent of the variability in PMBR use was attributed to the individual surgeon (ICC 0.181). The MOR for surgeon was found to be 1.85 (95% CI [1.70,1.99]), indicating that a patient had an 85% chance of having a different outcome (receiving or not receiving PMBR) if the patient saw a different mastectomy surgeon. The MOR for geographic area indicated that a patient had a 32% chance of having a different outcome if the patient saw a surgeon in a different geographic area (1.32, 95% CI [1.17, 1.47]). Patients who were Asian, single, older, of lower socioeconomic status, and underwent radiation therapy were less likely to undergo PMBR. Patients who had pre-operative MRI or received chemotherapy were more likely to undergo PMBR. Patients who were treated by female surgeons or plastic surgeons were significantly more likely to undergo PMBR. Overall, the individual surgeon was the most predictive of PMBR, except for the use of pre-operative MRI and mastectomy surgeon's specialty being plastic surgery. Conclusion A small minority of older women undergo PMBR despite having low post-operative and long-term complication rates. The individual surgeon and geographic area significantly influences whether older breast cancer patients will undergo PMBR. Future research should focus on surgeon characteristics that may influence a patient's decision to undergo PMBR. Citation Format: Schoenbrunner AR, Fero KE, Boero IJ, Matsuno R, Kronstadt N, Lance S, Reid C, Wallace AM, Gosman AA, Murphy JD. Post mastectomy breast reconstruction in elderly women: Complications and the impact of individual surgeons [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-14-02.

Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion.

IntroductionFifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown.AimTo assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA.Material and methodsWe included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months.ResultsThe study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%.ConclusionsThe retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications.

Temporary Inferior Vena Cava Filters: How Do We Move Forward?

Despite their widespread use, the indications for the selective use of temporary inferior vena cava (IVC) filters remains uncertain with few trials supporting their use. Additionally, the risks of long-term temporary IVC filter insertion are being increasingly discussed amongst the mainstream media and through multiple class action lawsuits. Retrievable IVC filters were specifically designed to have a less secure implantation in order to facilitate retrieval. However, multiple reports have demonstrated significant filter-related complications, most commonly related to duration of implantation. Furthermore, the risk is not isolated to one manufacturer alone. The incidence of filter-related complications is linearly related to its duration of time on the market. Currently, the FDA recommends that IVC filters be removed within 25-54days of their implantation. Unfortunately, little evidence exists to show that this recommendation is followed routinely. Recently, the PRESERVE Trial (NCT02381509) was initiated as a multicenter non-randomized open label study to determine the safety and effectiveness of commercially available IVC filters (both temporary and permanent) in individuals who require mechanical prophylaxis against pulmonary embolism. Until such evidence is developed, temporary IVC filters should be implanted based on best available evidence and routinely removed within the guidelines of the FDA of 25-54days. A fair question at this point is whether the design features themselves that are required to manufacture a low profile removable IVC filter can achieve effective prophylaxis against pulmonary embolism at a low rate of short and long-term complications.

7-year survey after percutaneous dilatational tracheotomy on a medical intensive care unit.

Percutaneous dilatational tracheotomy (PDT) is a well-established procedure in intensive care medicine. Several reports confirm a low acute and long-term complication rate. However, dilatational tracheotomy is still often postponed even in patients that are under ventilator support for more than 2 weeks. We present a retrospective study analyzing the subjective long-term results after percutaneous tracheotomy performed at our medical intensive care unit between 2002 and 2008. We used a modified method described by Ciaglia for tracheotomy. We selected 649 patients eligible for the survey among those who had received PDT between 2002 and 2008 and had been dismissed from hospital alive. The return rate was 38.5% with 29.8% of the questionnaires being completed by the patients; in 32 cases, relatives reported of the patients' death. No patient experienced wound infection; none needed surgical wound revision. Dysarthria was reversible in all 16 cases; 2 patients reported a persistent hoarseness that was preexisting in both cases. One patient experienced a tracheal stenosis and received a tracheal stent; one other required a permanent tracheotomy because of a nonresectable granulation tissue. The overall rate of long-term complications associated with the long-term ventilation and the PDT was 1.8%. Percutaneous dilatational tracheotomy is an easily performed, cost-saving method for long-term ventilated patients with a low rate of acute and long-term complications even in old and multimorbid internal medicine patients.

Safety and efficacy of 1020 consecutive laparoscopic sleeve gastrectomies performed as a primary treatment modality for morbid obesity. A single-center experience from the metabolic and bariatric surgical accreditation quality and improvement program.

LSG is widely accepted as a definitive treatment for obesity. Due to lack of large series with long-term follow-up, disagreement remains regarding its safety and efficacy. We present a series of 1020 consecutive LSGs performed with long-term follow-up. A retrospective review of a prospectively collected database was conducted on patients who underwent LSG from January 2005 to February 2014. Data included weight, height, BMI, ideal body weight, comorbid conditions, intraoperative complications, mean length of hospital stay (LOS), early (<30days) readmission, early and late (>30days) postoperative complications, and percentage of excess weight loss (%EWL). Of the 1020 patients, 66.6% (n=679) were female, with a mean age of 38.4±16.5years. Mean BMI at the time of first visit was 43.4±5.8kg/m(2). The most common comorbid conditions identified were diabetes mellitus (89.4%), sleep apnea (86.4%), hypertension (80.3%), and hyperlipidemia (70%). Over the entire follow-up period, 57% of diabetic patients experienced significant improvement or remission. There was no mortality in this series. Early postoperative complications within 30days of surgery included leak in 0.1% (n=1), stricture in 0.1% (n=1), emesis in 23% (n=234), dehydration in 19% (n=194), prolonged ileus in 18% (183), and self-limited bleeding in 3% (n=30). Mean LOS was of 3.4±2.1days, with a 3.8% overall rate of early readmissions. Long-term morbidity was found in 3.9% of patients (n=40) and included stricture in 0.49% (n=5) and GERD in 6% (n=61). The overall 30-day mortality rate was 0%. Mean %EWL at 3months to 1, 3, 5, and 8years was 72±16.8, 86±22.3, 63±19, 61±11, and 52±9.2, respectively. This study confirms that LSG is safe and has very low rates of early and long-term complications when compared to other well-established procedures. Additionally, LSG that appears results in significant improvement of obesity-related comorbid conditions.

A5186 - Comparisons of Health Related Quality of Life Before and After Bariatric Surgery: What do Patients Gain by Losing?

Bariatric surgery is now regarded as the most effective method to control morbid obesity. However, lack of large series of bariatric surgery with long-term follow-up in Taiwan. We present a series of 1638 consecutive laparoscopic bariatric surgery performed with 7 years follow-up. Method: A retrospective review of prospectively collected database was conducted on patients who underwent Laparoscopic Bariatric Surgery from 2007 to 2014 in Taipei Medical University Hospital, Taiwan. Data included weight, height, BMI, idea body weight, comorbid conditions, intraoperative complications, mean length of hospital stay(LOS),readmission, postoperative complications, and percentage of excess weight loss(%EWL) Result: Of the 1638 patients,65.3%(n1⁄41071) were female, with mean age of 35.The preoperative mean body mass index was 39.8 kg/m.The comorbid conditions identified were diabetes mellitus (19.3%) ,sleep apnea (19.6%) , hypertension(38.6%), hyperlipidemia(10.5%),family history of diabetes mellitus (43.5%), family history of diabetes mellitus (43.5%), family history of hypertension(49.2%), family history of cancer(11.2%).There was no mortality in this series. Early post operative complications with leakage was 0.3%(n1⁄45). Mean LOS was1.8 3 4 days, with a 0.79% of readmission,1.11% at 90 days postoperative complication.Mean %EWL at 12 months was 61.8 20.9 % respectively. Decrease in following hemoglobin A1C level showed better blood sugar control in diabetes patients after surgery. Conclusions: In our study, the results suggest that patients who have received laparoscopic bariatric surgery has very low rates of early and long-term complications .The adequate weight loss had showed a better control of blood sugar in Diabetes patient and improvement of obesity-related comorbid conditions. After the surgical procedure performed, patients with higher follow-up visit rates had greater extend of body weight loss than low visit rates. More studies are needed to monitor the long-term effects.

Transpapillary Gallbladder Stents Can Stabilize or Improve Decompensated Cirrhosis in Patients Awaiting Liver Transplantation.

To describe the short-term and long-term outcomes in 34 consecutive decompensated cirrhotic patients with symptomatic gallbladder disease undergoing transpapillary gallbladder stent (TGS) placement. Endoscopic TGS placement is a minimally invasive means of treating symptomatic gallbladder disease in poor surgical candidates. Between June 2005 and June 2011, 34 patients with cirrhosis and symptomatic gallbladder disease underwent attempted TGS placement. Median patient age was 52 years, 56% were hospitalized, and 48% were listed for liver transplantation. The median model for end-stage liver disease (MELD) score was 15 (range, 6 to 40) and 88% were Child-Turcotte-Pugh class B/C. A double pigtailed stent was successfully placed in 94% of the patients. At 1-month follow-up, clinical improvement was noted in 82% of the treated subjects and the MELD scores in 14 of 22 (64%) evaluable subjects improved or stabilized. Actuarial transplant-free survival was 53% in the liver transplant candidates with a mean follow-up of 352 days, whereas survival was 44% in the 18 nontransplant candidates with a mean follow-up of 1.5 years. Periprocedural complications included pancreatitis in 5 patients, cholangitis in 3, and 1 patient with cystic duct perforation. In addition, 2 subjects had symptomatic bleeding from traumatic duodenal ulcerations 2 years after TGS placement that necessitated stent removal. Endoscopic TGS placement was technically feasible in 94% of decompensated cirrhotics and was associated with a relatively low rate of periprocedural (26%) and long-term complications (6%). Stabilization or improvement in clinical status and MELD scores was seen in the majority of treated patients.

Complicaciones de la colocación de malla sintética vaginal para la incontinencia urinaria de esfuerzo

BackgroundSurgical mesh has been used for treating urinary incontinence (UI) despite the lack of level i evidence in the literature evaluating its long-term safety and efficacy. Mesh-related complications were responsible for a warning issued by the FDA in 2008 and they stopped being considered rare events. The most common complications are acute urinary retention, bleeding, recurrence or persistence of UI, erosion of the urethra, and mesh infection. AimsTo determine the complications derived from surgical UI treatment with the placement of suburethral mesh in women. Material and methodPatients diagnosed with UI that underwent anti-incontinence surgery with the placement of vaginal mesh within the time frame of 2007 and 2014 were analyzed. Mesh placement complications and the recovery of continence were evaluated. ResultsA synthetic mesh sling was placed in 58 patients with a mean age of 56 years. A total of 51% of the patients had stress urinary incontinence and 49% had mixed urinary incontinence. Early complications were: 4 patients with acute urine retention. Late complications were: urethral or vaginal pain (12.2%), dyspareunia (20%), and mesh extrusion (10%) that was managed through mesh removal; 2 of those patients required surgical procedures. Twelve percent of the patients presented with de novo urgency, 90.2% progressed with no incontinence, 9.7% presented with postoperative UI, and 2 patients had no improvement. DiscussionAlthough small, our case series showed a low long-term complication rate with the use of surgical mesh, compared with the majority of case series that demonstrate a re-operation rate>70%, as well as numerous cases of mesh removal. Thus, it is our experience that suburethral slings continue to be an adequate UI management option. ConclusionsSuburethral slings are a safe and effective option in UI management.

Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes.

Despite advances in medical management and endovascular therapies, including the introduction of statins, antiplatelet agents, and drug-eluting stents, some patients experience medically refractory vertebrobasilar insufficiency and may benefit from robust surgical revascularization. The aim of this study was to evaluate such patients after surgical revascularization, emphasizing long-term outcomes and rates of complications. The authors retrospectively identified 22 patients (5 women and 17 men) whose mean age was 69.1 years (range 48-81 years) who underwent revascularization of the posterior circulation via a proximal vertebral artery-carotid artery transposition between 2005 and 2013. The patients' conditions before surgery were clinically summarized, and long-term outcomes and complication rates after surgery were evaluated. All the patients were symptomatic before surgery although they received the best medical therapy as defined by their primary care physician. Presenting symptoms consisted of stroke, transient ischemic attacks (TIAs), and/or findings attributable to posterior circulation hypoperfusion. There were no deaths associated with revascularization surgery. The postoperative complication rate was 45.5%, which included 3 cases of recurrent laryngeal nerve palsy, 1 case of thoracic duct injury, 2 cases of TIA, and 4 cases of Horner's syndrome. The thoracic duct injury was identified intraoperatively and ligated without sequelae, all the TIAs resolved within 24 hours of surgery, all 4 sympathetic plexus injuries resolved, and all but 1 of the recurrent laryngeal nerve palsies resolved, resulting in a 4.5% complication rate in a mean follow-up period of 8.8 months. All the patients had resolution of their presenting symptoms, and a single patient had symptomatic restenosis that required stenting and angioplasty, resulting in a restenosis rate of 4.5%. Despite the optimization of medical therapies and lifestyle modifications, a select subset of patients with posterior vascular circulation insufficiency remains. In the authors' experience, vertebral artery-carotid artery transposition provides a surgical option with relatively low long-term complication and restenosis rates that are comparable or lower than those reported with endovascular treatment.

Laparoscopically Assisted Neovaginoplasty in Vaginal Agenesis: A Long-Term Outcome Study in 240 Patients

Study ObjectiveTo assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis. DesignCombined retrospective and prospective study. SettingUniversity hospital. Participants240 patients with congenital vaginal agenesis. InterventionsPatients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device. Main Outcome MeasuresLong-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections. ResultsDuring median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intraepithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up. ConclusionsOur technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.

Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment

To compare the results of early and delayed extension orthosis fabrication in closed tendinous mallet injuries. Between March 1992 and May 2011, 45 patients with isolated closed tendinous mallet finger injuries were treated with orthosis fabrication. The patients were classified into 2 different groups based on their date of presentation. Group 1 consisted of 28 patients who presented within 2 weeks of sustaining the trauma, and group 2 consisted of 17 patients who received treatment beginning between 2 and 4 weeks after sustaining the trauma. During the final assessments, the patients were assessed clinically using the Crawford classification scale and satisfaction ratings. The mean delay between initial injury and presentation to our center was 3 days (range, 1-14 d) in group 1 and 19 days (range, 15-30 d) in group 2. There were no significant differences between the groups regarding their ages, initial extension lag, and arc of flexion. According to the Crawford classification criteria, 72% of the patients in group 1 had excellent results, and 59% of the patients in group 2 had excellent results. There was no significant difference between the groups. The treatment results of patients with different presentation times have been reported for heterogeneous groups of osseous and nonosseous mallet finger injuries. Our results suggest that conservative management of tendinous mallet finger injuries that have been neglected for 2to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. Therapeutic III.

Long-term clinical study of thulium laser resection of prostate-tangerine technique in the treatment of begin prostatic hyperplasia

To evaluate the long-term efficacies and complications of thulium laser resection of prostate-tangerine technique (TmLRP-TT) in the treatment of benign prostatic hyperplasia (BPH). From November 2004 to December 2009, a total of 348 BPH patients undergoing TmLRP-TT at our hospital were evaluated retrospectively for long-term efficacies and complications. The follow-up data included international prostate symptom score (IPSS), quality of life score (QOL), maximum urinary flow (Qmax) and post void urinary residual (PVR). After 4 years, IPSS decreased 70% (22.7 ± 7.7 vs 6.8 ± 5.1) , QOL decreased 65% (4.3 ± 0.7 vs 1.5 ± 1.0), Qmax increased 212% (6.0 ± 2.6 ml/s vs 18.7 ± 4.6 ml/s) and PVR decreased 83% (104.7 ± 34.3 ml vs 17.7 ± 10.7 ml). Cumulative incidences of long-term complications was 6.0% (n = 21), including a second TmLRP-TT due to BPH recurrence (n = 4, 1.2%), urethral stricture (n = 8, 2.3%) and bladder neck contracture (n = 9, 2.6%). Overall, 93% were satisfied with surgical outcomes. TmLRP-TT has excellent efficacies with a low rate of long-term complications. Most patients are satisfied with surgical outcomes.

The Transblepharoplasty Subperiosteal Midface Lift

INTRODUCTION: To present a reliable technique for midface rejuvenation and to review the associated short- and long-term outcomes. The technique seeks to restore youthful volume to the midface by employing a subperiosteal release of the cheek, four-point bony suspension along the orbital rim, and post-septal fat redraping. METHODS: This is a retrospective review of a single surgeon’s subperiosteal midface lifts between 1998 and 2011, and includes 137 patients (average age = 53 ± 24). Standardized medical records and pre- and post-operative photographs were reviewed for demographics, co-morbidities, concomitant procedures, complications and outcomes. RESULTS: Complications were divided into short-term (lasting less than 6 weeks) and long-term (lasting greater than 6 weeks or requiring re-operation). The most common short-term post-operative sequelae were chemosis (38%), transient scleral show (21%), and lagophthalmos (8%). Long-term complications included hematoma requiring evacuation (0.7%), persistent scleral show deemed non-operative (0.7%), and lateral scar webbing requiring minor revision (0.7%). CONCLUSION: The described technique optimizes control of the suspension vector for the midface subunit, provides stable fixation to the orbital rim, and does so without requiring alteration to the lateral canthus. It represents an effective means for rejuvenating the lower eyelids and cheek while maintaining a low long-term complication rate (Figures 1 and 2).Figure 1: Figure 1.Figure 2: Figure 2.

Medium to long term results following single stage Snodgrass hypospadias repair

The Snodgrass technique for primary hypospadias repair was described in 1994 and involves dorsal incision and tubularisation of the urethral plate distal to the meatus. While the advantages of good short-term outcome and good cosmesis have been reported, there is little data on long-term results in patients who have undergone a Snodgrass repair as a primary procedure for hypospadias. Our aim is to retrospectively review our medium to long-term results of primary tubularised incised-plate urethroplasty for hypospadias repair over a two-year period with up to eight-year follow-up. We conducted a case note review of 74 patients who had undergone single-stage Snodgrass hypospadias repair, performed by a single surgeon (AB), from April 2000 to January 2003. The mean documented follow up was 56 months (3-103 months). The mean age of patients at time of surgery was three and a half years. 95% (70) of patients had a distal (glanular, coronal, sub-coronal, distal shaft) meatus and 5% (4) had a proximal (mid-shaft) meatus. The overall complication rate was 7% (5). Two patients developed fistulae, which was noted and repaired at six months post-op with no further surgical intervention required. One patient underwent an EUA and meatal advancement glansplasty at 6 months for mild glanular dehiscence. Two further patients required EUA and dilatation procedures at two and three years respectively, both for mild meatal stenosis. Again, no further intervention was required. From a cosmetic perspective, two patients were noted to have some residual bulkiness of the skin around the corona and a further two patients were noted to have a small meatus, but with no functional symptoms. Our study has shown a low long-term complication rate in patients undergoing Snodgrass repair as a primary procedure for distal and midshaft hypospadias repair. This supports the results of earlier studies that have shown good functional and cosmetic outcome in the short-term for this procedure which persists into the medium/long term.

Long-term follow-up after elective adult umbilical hernia repair: low recurrence rates also after non-mesh repairs

The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair. Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011. A total of 162 patients (female/male 35 %/65 %) were operated, and 144/162 (89 %) answers were gathered, mean follow-up time 70 months; 77 % were sutured, non-mesh repairs; 94 % of all AUHs were smaller than 3 cm; and 49 % of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4 %). 7/144 (4.9 %) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3 % in suture-based repairs, the difference, however, not statistically significant (p = 0.141); 2 % reported persistent pain at follow-up, 89 % were overall satisfied with the outcome. AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2 cm and mesh-based repairs considered if larger than that.

Central venous port system-related complications in outpatient chemotherapy for colorectal cancer.

The current standard chemotherapy for metastatic colorectal cancer is the FOLFOX or the FOLFIRI regimen. Although these regimens include the continuous infusion of an anticancer agent, chemotherapy is possible by using implantable central venous port systems with a portable disposable pump in an outpatient setting. This study is an evaluation of the usefulness of implantable central venous port systems for colorectal cancer chemotherapy. An implantable central venous port system was placed in 93 consecutive patients with metastatic colorectal cancer. All patients received modified FOLFOX6 ± bevacizumab or FOLFIRI ± bevacizumab regimens via the port system. Follow-up continued for each patient until removal of the port system, death or unavailability of further information. The incidence and details of the complications were investigated retrospectively. Out of 1,246 treatments, a total of 16 incidents of port system-related complications were identified (1.28%). Incidents involved infections (n=12), catheter pinch off (n=2), fibrin sheath (n=1) and drug leakage (n=1). A port system removal was required in 14 cases. Implantable central venous port systems are safe and have a low long-term complication rate. We consider port systems, such as modified FOLFOX6 ± bevacizumab or FOLFIRI ± bevacizumab regimens, useful for colorectal cancer patients receiving chemotherapy.