Low Complication Rate Research Articles

Long-Term Results in Minimally Invasive Non-Resectional Mitral Valve Repair for Barlow Mitral Valve Disease

Objective: The aim was to assess the long-term outcomes, safety, and durability of total endoscopic mitral valve repair for Barlow mitral valve disease. Methods: A retrospective analysis of 98 patients undergoing minimal invasive total endoscopic mitral valve repair for Barlow mitral valve disease was conducted between May 2009 and December 2023. A non-resectional repair approach using artificial neochordae and/or ring annuloplasty was performed. Clinical and echocardiographic follow-ups were completed. Rates per patient-years with 95% confidence intervals (CI) for all time-to-event outcomes were calculated. Results: The mean age was 59 ± 12, and 43% were female. Minimally invasive mitral valve repair was successfully performed in all 98 patients with no conversions to sternotomy or mitral valve replacement. There was no mitral valve-related reoperation during the hospital stay. Procedural safety was as follows: no in-hospital mortality, no stroke, and no perioperative myocardial infarction. The mean follow-up was 4.1 ± 3.1 years. Survival at seven years was 87% (95% CI 63% to 96%). Freedom from myocardial infarction, stroke, and congestive heart failure was 89% (95% CI 60% to 97%), 93% (95% CI 82% to 97%), and 100%, respectively. Recurrent mitral valve insufficiency at Grade ≥ 2 was diagnosed in n = 4 (4.1%) of cases. Conclusions: Minimally invasive mitral valve repair using a non-resectional technique for Barlow disease can be performed with a low complication rate. The total endoscopic approach is safe in the long term, with minimal risk of reoperation and recurrent mitral valve insufficiency.

Contemporary outcomes of open thoracoabdominal aortic repair: single centre experience.

Untreated cases of thoraco-abdominal aortic aneurysms pose significant challenges, often leading to severe morbidity and high mortality. While promising, endovascular treatment is not suitable in all cases, particularly younger patients and those with collagen disorders. This study reports on the contemporary outcomes of open thoraco-abdominal aortic aneurysm repair at our academic medical center from 2015 to 2023. All patients with thoraco-abdominal aortic aneurysm (Crawford-Safi Types I-V), including elective and non-elective cases, who underwent open surgical repair between January 2015 and December 2023 were included. Patient characteristics, intraoperative variables, and postoperative outcomes were prospectively recorded and analyzed retrospectively. The primary end-point was operative mortality; secondary end-points included rates for spinal cord injury, stroke, tracheostomy, need for dialysis and a comparison of outcomes between elective and non-elective cases. 190 patients (146 elective/44 non-elective) were included, with a mean age of 63.8 years (standard deviation 11.5), and 58% were male. Operative mortality was 7.9%, with 7.5% in elective cases and 9.1% in non-elective cases. Stroke with persisting symptoms at discharge occurred in 5.8% of patients, and tracheostomy was required in 3.7%. Spinal cord injury symptoms were observed in 7.4%, with persistent paraparesis in 2.1% and paraplegia in 1.6% at discharge. Acute kidney injury occurred in 38.4% of patients, with 6.9% requiring dialysis and 3.7% continuing dialysis at discharge. Open thoraco-abdominal aortic aneurysm surgery, supported by a multidisciplinary team approach and strict perioperative protocols, remains effective in managing this complex patient population, demonstrating low rates of mortality and severe complications.

Reconsidering Abdominal Drainage After Left Pancreatectomy - The Randomized Controlled PANDRA II Trial.

Intraabdominal drainage following left pancreatectomy (LP) has been a longstanding practice to mitigate postoperative complications, particularly postoperative pancreatic fistulas (POPF). Recent studies challenge the necessity of routine drainage, suggesting potential benefits in omitting drains. The PANDRA II trial was a randomized controlled non-inferiority study conducted at the University Hospital Heidelberg between 2017 and 2023. It compared outcomes between patients undergoing open or minimally-invasive LP with and without abdominal drainage. The primary endpoint was overall postoperative morbidity assessed by the Comprehensive Complication Index (CCI). A total of 246 patients were included in the intention-to-treat analysis (125 with drainage, 121 without drainage). The no-drain group demonstrated non-inferiority to the drain group in terms of CCI (13.90 ± 16.51 vs. 19.43 ± 16.92, P<0.001 for non-inferiority). Moreover, the no-drain group had lower overall complication rates (50.41% vs. 78.40%, P<0.001). Specific complications such as POPF (14.88% vs. 20.8%, P=0.226) and postpancreatectomy hemorrhage (PPH) (4.96% vs. 4.80%, P>0.999) did not differ significantly between groups. The results of the PANDRA II trial demonstrate that omitting routine abdominal drainage after LP is non-inferior to placing a routine abdominal drainage regarding morbidity measured by the CCI. Omitting a routine abdominal drainage even led to a significant reduction of the overall complication rate.

Comparison of short-term outcomes of robotic versus laparoscopic right colectomy for patients ≥ 65years of age: a systematic review and meta-analysis of prospective studies.

Robotic right colectomy (RRC) has been researched and compared in the past to the laparoscopic approach (LRC). However, it remains unclear whether RRC outperforms LRC in patients aged 65 or older with colon cancer or adenoma. Thus, this systematic review and meta-analysis aims to compare the short-term outcomes of RRC to LRC in this particular age group. PubMed, Scopus, and Cochrane Library were searched for related literature. Studies and data were extracted by two independent reviewers. Inverse variances weighted mean differences (WMD) with random effects model were used for continuous values, and odds ratios (OR) with random effects model using the Mantel-Haenszel's formula were used for dichotomous values. Heterogeneity using Higgins I2 and p values were calculated. A sensitivity analysis was performed for operative duration and number of harvested lymph nodes. In total 382 patients, 157 in RRC and 225 in LRC, were included in this study. A statistically significant increase of 43.91min [95%CI: 19.61, 68.22], P = 0.001, was observed regarding operative duration in the RRC group, compared to LRC, but with high heterogeneity, I2 = 89%. However, a statistically significant decrease of 42% [OR = 0.58 (0.34, 0.98), P = 0.04, I2=2%] was observed with regard to overall complications in RRC compared to LRC. Non-significant differences between the two approaches were observed in the number of harvested lymph nodes [WMD = 0.44 (95%CI: -3.94, 4.82), P = 0.85, I2 = 52%], wound infections [OR = 0.63 (95%CI: 0.11, 3.52), P = 0.60, I2 = 13%], rate of ileus [OR = 0.29 (95%CI: 0.08, 1.00), P = 0.05, I2 = 0%], length of hospitalization [WMD = 0.18 (95%CI: - 0.74, 1.11), P = 0.70, I2 = 0%], and anastomotic leakage [OR = 0.52 (95%CI: 0.09, 3.11), P = 0.47, I2 = 0%]. The results of the operative duration and number of harvested lymph nodes remained statistically significant and non-significant, respectively, after sensitivity analysis. Robotic right colectomy appears to require a longer operative duration, but possibly offers lower rates of overall complications, compared to laparoscopic right colectomy in patients ≥ 65years of age. Due to the lack of studies identified in the literature, and the ones included being non-randomized, no solid conclusions can be drawn and cautious interpretation of the results is advised. Future studies are necessary to further examine both short- and long-term outcomes. Prospero registration: CRD42024603354.

Comparison of the mid-term outcomes of laparoscopic and percutaneous nephroscopic laser unroofing for the treatment of single renal cyst: a single-center retrospective study.

Renal cysts are the most common benign disease of the kidneys, and their increasing size cause compression symptoms that require surgical intervention. In this study, we compared the safety, efficacy and prognosis of percutaneous nephroscopic laser unroofing (PNLU) with those of laparoscopic unroofing (LU) for simple renal cysts. Data from patients with single renal cysts who underwent PNLU or LU between Jan 2018 and Dec 2023 were collected and followed up thereafter. Baseline characteristics, perioperative events, blood test results and postoperative complications were compared. Recurrence-free survival (RFS) was also compared via survival analysis. Subgroup analyses were conducted in the PNLU group, including the 980nm laser and Holmium laser groups. A total of 75 patients were included, 35 of whom underwent PNLU and 40 of whom underwent LU. Compared with LU, PNLU requires only one surgical incision and is a shorter procedure, causes less blood loss, requires fewer urinary catheter days, is known for quicker drainage tube removal, requires a shorter postoperative hospital stay, has lower hospitalization costs, induces a weaker postoperative inflammatory response, and is associated with a lower incidence of abdominal distension. There was no significant difference in RFS between the PNLU and LU groups. In the subgroup analyses of PNLU, no significant differences were observed between the 980nm laser and Holmium laser groups. PNLU is safe, effective and cost-effective for single renal cysts and known for a low complication rate, and its mid-term prognosis is similar to that of laparoscopic surgery.

Surgical Complications After Fronto-orbital Advancement for Craniosynostosis: Analysis of a National Database.

Fronto-orbital advancement (FOA) is the standard surgical intervention for patients with craniosynostosis and associated fronto-orbital dysmorphology. Although previous studies have provided insights into center-specific complications, comprehensive, large-scale analyses remain limited. This study utilizes a national database to address these gaps, offering a large-scale perspective on FOA outcomes. Patients aged 0 to 16 years who underwent FOA from 2007 to 2015 were identified using the PearlDiver database. Patients were divided into early (0-5 y) and late (6-16 y) groups. Complications were identified using a combination of ICD and CPT codes. Intraoperative complications, including hematoma/hemorrhage, cerebrovascular infarction, and cardiac arrest, were defined as those occurring within 48 hours of the procedure. Postoperative complications analyzed at intervals of 0, 30, 90, 180, and 365 days post-operation included cerebrospinal fluid leak, hardware-related complications, hemorrhage, seizure, surgical site infection, wound dehiscence, and death. Summary statistics were conducted utilizing Bellwether software in PearlDiver. A total of 2026 patients underwent FOA, with a mean of 1.5 years in the younger cohort (n=1905) and 9.0 years in the older cohort (n=121). Although rare, hemorrhage was the most common intraoperative complication. One-year postoperative complications were predominantly related to wound dehiscence and surgical site infection in the younger (5.10%) and older (14.1%) cohorts. The 1-year reoperation rate was 7.2% for the younger cohort and 19.0% for the older cohort. FOA is a safe operation with an overall low complication rate. However, older patients demonstrate a higher rate of reoperations, emphasizing the need to identify the optimal timing for FOA in patients with craniosynostosis.

Microwave Ablation of T1a and T1b Renal Masses: A Retrospective Study

AbstractThe aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of T1a and T1b renal masses, with size ranges between 1.2 and 6.5 cm. A retrospective review was performed at a single tertiary comprehensive cancer center between June 2019 and June 2023 of 49 consecutive patients (53 total procedures) who underwent MWA for renal masses. The Solero microwave tissue ablation system (Angiodynamics, Latham, NY, United States) was utilized. Patient demographics, renal mass characteristics, and procedural outcomes were collected. Serum creatinine and estimated glomerular filtration rate (eGFR) were utilized to assess renal functional outcomes. Oncologic outcomes were assessed using evidence of local tumor recurrence on contrast-enhanced cross-sectional imaging, local recurrence-free probability at 1 and 2 years, and overall survival (OS) using the Kaplan–Meier analysis.Forty-nine patients (57% males and 43% females) with a median age of 72 years (range, 38–84 years) underwent 53 MWA procedures. The mean renal mass size was 2.8 ± 0.94 cm (range, 1.2–6.5 cm). Most of the renal tumors were T1a. Three of the 53 total renal tumors were larger than 4 cm (T1b) and the remaining 50 were less than 4 cm in size (T1a). The largest tumor that was ablated was 6.5 cm in size. All the patients were placed under general anesthesia (intubated) before the MWA procedure. A median microwave energy of 100 W (range, 60–140 W) was used. The mean duration of the MWA was 3.9 ± 1.5 minutes, with a 100% technical success rate. Four patients (8.2%) experienced complications, two (4.1%) of whom experienced a major complication. There was no clinically significant change in renal function from pre- to postablation on day 1 or at 3 months. Furthermore, local tumor recurrence was observed in three (6.1%) patients at 2.5, 15, and 25 months postablation. Local recurrence-free probability was 98 and 93% at 1 and 2 years, respectively. The OS was 98 and 87% at 1 and 2 years, respectively. MWA continues to prove to be an effective technique that can be used to treat small renal masses including oncocytomas, with high technical success, low complication rate, low risk of adverse renal functional outcomes, and encouraging results for sustained tumor control.

Comprehensive Management of Bowel Endometriosis: Surgical Techniques, Outcomes, and Best Practices

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity.

Clinical outcomes of circumcisions and prevalence of complications of male circumcisions: A five-year retrospective analysis at a teaching hospital in Ghana.

Male circumcision is increasing in popularity due to its medical benefits, including reducing HIV prevalence. It is commonly performed by both health and non-health professionals, with most circumcisions occurring during the neonatal period. Studies suggest the benefits outweigh the risks, though complications can occur. This study aimed to determine the clinical outcomes of circumcisions and the prevalence of adverse events of circumcision in the Volta region of Ghana. A five-year retrospective descriptive and analytic study was conducted at Ho Teaching Hospital, using a structured data extraction sheet to collect demographic, clinical, and circumcision-related data from 186 cases. Among 186 circumcision cases, 23 (12.37%) experienced complications, with the most common being partial circumcision (43.48%), post-circumcision bleeding (21.74%), and urethrocutaneous fistula and/or wrongfully circumcised congenital hypospadias (13.04%). Low heamoglobin levels and infections were also noted. A significant relationship was found between the circumcision provider and complication rates (Chi-square = 16.975, p = 0.00). Doctors conducting circumcision had the lowest complication rates (4.3%), while nurses and traditional circumcisers had higher complication rates (39.1% and 34.8%, respectively). Circumcision-Revision surgery was the most common salvage surgery for circumcision mishaps (31.82%), with urethroplasty and hypospadias repair (for wrongful circumcised neonates born with hypospadias) accounting for 15.91%. Meatoplasties, glansplasties, fistulectomy plus primary repair and chordae-release surgeries were also performed. The success rate for salvage surgeries (first attempt) was 70%. Prompt initial management strategies were significantly associated with good outcomes. Under less-trained hands, circumcision could be catastrophic. Salvage surgeries for circumcision mishaps are associated with less favourable outcomes in about one-third of the cases, suggesting that circumcision mishaps are better prevented than salvaged. Training, guidance, and policy interventions are needed to reduce the incidence of circumcision-related mishaps. Public health campaigns to dissuade non-surgeon circumcisers to refrain from circumcising children with hypospadias but refer them, are urgently needed.

Patient and parent satisfaction after surgical repair of concealed penis in children

BackgroundConcealed penis in children is a morbid condition that needs special attention due to its negative psychological impact on both parents and patients. It represents a unique challenge due to the multifactorial nature of its etiology that requires different surgical approaches tailored to each case. The aim of this study was to evaluate parents’ satisfaction after surgical repair of concealed penis in children.MethodsThe study was carried out on male patients, aged < 18 years, diagnosed with concealed penis. All patients were subjected to repair of concealed penis. Adolescents and parents’ satisfaction were measured 3 months after concealed penis repair by 4 tools including a pre-validated questionnaire to evaluate outcome of the surgical treatment, the pediatric penile perception score for penile morphology, the patient’s global impressions of improvement scale, and rating the satisfaction with the final penile appearance by an expert independent urologist.ResultsThere was a significant negative correlation between the age of children and the global impressions of improvement (r = 0.358; P = 0.038) (better levels of parents’ satisfaction are associated with lower age group of children). The mean exposed penile length was significantly higher after surgical correction of concealed penis (P = < 0.001). Postoperative satisfaction with penile morphology according to obesity and circumcision before surgical repair was significantly different between patients (P < 0.05).ConclusionsSurgical repair of concealed penis generally has high rate of excellent surgical outcomes. It has good cosmetic results with low rate of postoperative complications and achieve high grades of parents satisfaction.

Bilateral Lumbar Micro-Foraminotomy and Micro-Discectomy with 18 Months Postoperative Follow-Up: A Series of 27 Cases

Background: Bilateral lumbar micro foraminotomy and bilateral micro-discectomy is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) with lateral recess stenosis (LRS) although various types of treatment are being developed. Objective: This study aimed to investigate the safety and efficacy of bilateral lumbar micro-foraminotomy and bilateral micro-discectomy for the treatment of patients with lumbar disc hernia (LDH). Methodology: This was a retrospective cohort study conducted in the Department of Neurosurgery &amp; Neuro-ICU at Enam Medical College &amp; Hospital, Savar, Dhaka during the period of January 2019 to December 2020. All data were collected from patient files. Data were collected pre-designed data collection sheet. Results: This study shows shows maximum (48.1%) were 41 to 50 years followed by 37.0% were 31 to 40 years and 14.8% were 20 to 30 years. The average age was 39.66±9.25 years. Majority (77.8%) were male and 22.2% cases were female. The most common levels affected by soft disc prolapse recess stenosis are L4-5 and L5-S1 segments. This study shows the mean Oswestry Disability Index (ODI) were 76.11±12.81 in preoperative and 5.00±7.72 postoperative. The decrease in values has been found to be significant in preoperative and postoperative (P&lt;0.001). Study found only 3.7% was complications. Conclusion: Bilateral lumbar micro foraminotomy and bilateral micro-discectomy is an effective and safe method in the treatment of soft disc prolapse with lateral recess stenosis as it has low complication rates. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):17-20

Application of enhanced recovery after surgery in pediatric patients with obstructive sleep apnea-hypopnea syndrome

Background Enhanced Recovery After Surgery (ERAS) has demonstrated effectiveness in accelerating recovery and reducing complications across surgical fields, with limited application in Ear-Nose-Throat surgeries. Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), a prevalent condition affecting pediatric patients, calls for innovative management due to its impact on health and the need for surgical interventions like tonsillectomy. Objective The present study aimed to investigate the efficacy of ERAS in pediatric patients with OSAHS. Methods Review and analyze 1100 cases of pediatric patients with OSAHS who underwent plasma-coblation tonsillectomy and adenoidectomy using nasal endoscopy from June 2016 to June 2022 in our hospital. Among these cases, a total of 564 patients were managed according to ERAS theory, while 536 patients were treated with classical theory. The incidence of preoperative discomfort, postoperative pain, bleeding, and other complications between the two groups were compared. Results ERAS group showed comparable preoperative-discomfort rates to the control ( P = 0.799). However, ERAS patients exhibited significantly lower pain scores at 24-, 48-, and 72-h post-operation ( P &lt; 0.05). Mental state scores were similar between ERAS and control 4 h pre-surgery ( P &gt; 0.05), but notably lower in ERAS at 30 min pre-op and 6-, 12-, and 24-h post-operation ( P &lt; 0.05). ERAS had lower complication rates and intra/postoperative bleeding, quicker ambulation/oral intake, and shorter hospital stays than control ( P &lt; 0.05). Conclusion ERAS management in patients with OSAHS resulted in notable reductions in postoperative pain and incidence of complications, along with improved postoperative recovery and shorter hospital stays.

Enhancing Patients Satisfaction and their outcomes through implementing Nurse-Caring Behavior Protocols in Acute Diabetic Crisis Management

Background: Integrating nurse-caring behavior protocols in acute diabetic crisis management enhances patient satisfaction and outcomes by addressing both clinical and emotional care needs. Aim: evaluate the effect of implementing nurse-caring behavior protocols on enhancing patients’ satisfaction and their outcomes in acute diabetic crisis management. Design: Quasi-experimental research design was used in the present study. Setting: ICU and emergency care unit at Aswan university hospital. Sample: This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. Tools: Tree tools were used to collect data include Tool (I): Patient assessment tool contained personal characteristic. Tool (II): Patients satisfaction with NCBs evaluation scale. Tool (III) Patients Outcomes assessment tool. Results: the majority being aged 50-60 years in study and control group (70.1% and 66.7% respectively), Gender distribution was nearly equal, with slightly more females in (56.0 % and 50%) respectively, a higher percentage of participants with higher education (33.3% and 50%) respectively. A higher percentage of patients in the study group reported satisfactory levels of satisfaction (73.3%) compared to the control group (33.3%) Conversely. The study group had a significantly higher percentage of patients staying less than 5 days (63.3%). The study group had significantly more patients discharged to home (76.7%). A significantly lower rates of complications, including hypoglycemia, hypokalemia, cerebral edema, arrhythmia and acidosis among study group. Conclusion: The nurse-caring behaviors have a positive impact on patient satisfaction, outcomes, and a reduction in complications associated with acute diabetic crises. Recommendation: Implementing and evaluating nurse-caring behavior protocols, to enhance early discharge and complication management in acute diabetic crisis management

Endovascular Recanalization in Patients With Vertebral Artery Stump Syndrome: A Single-Center Experience.

To evaluate the feasibility, success rate, and safety of endovascular revascularization of patients with vertebral artery stump syndrome (VASS). This single-center retrospective study analyzed clinical and imaging data from consecutive patients with VASS who underwent endovascular recanalization from January 2020 until June 2023. Our study enrolled 30 patients [mean age 69 (range 51-84) years; 26 men]. The rate of successful technical revascularization was 96.7% (n = 29), and the rate of complications was 3.3% (n = 1). At the 6-month follow-up, the patients with successful endovascular revascularization of VASS did not have any neurological symptoms, and computed tomography angiography showed 3/29 (10.3%) re-occlusions and 4/29 (13.8%) restenosis of the stent, which was confirmed by digital subtraction angiography. Endovascular recanalization in patients with VASS is feasible in selected patients and has a high procedural success rate and low rate of complications. A large, multicenter, randomized study is warranted to confirm these findings.

Evolving treatment paradigms of cerebral aneurysm stasis in flow diversion.

Flow diversion is an effective first-line treatment for intracranial aneurysms; however, the rate of incomplete occlusion is not insignificant. Data in neuroendovascular literature is limited regarding the implications of persistent incomplete occlusion despite flow diversion. We conducted a retrospective analysis of a prospectively maintained database and identified 125 consecutive patients with treatment naïve intracranial aneurysms who underwent flow diversion with the PED from April 2014 - November 2022. Patients were divided into 3 groups based on the duration of stasis: venous, capillary, and no stasis. Comparative and multivariate analyses were performed between the three groups. At latest follow-up, complete occlusion occurred in 69.6% and 82.4% showed progression of occlusion. Retreatment was required in 2.4%. There was no significant difference in retreatment (p=0.667), complete occlusion (p=0.774) or progression of occlusion (p=0.848) at latest follow up. No patients experienced subarachnoid hemorrhage post-treatment. On multivariate analysis, hypertension was a negative predictor for complete occlusion (p=0.006) and progression of occlusion (p=0.017), while duration of stasis was noncontributory. The mean latest follow up was 12.55months. Flow diversion is a safe and effective first line treatment for intracranial aneurysms with a relatively low complication rate. Hypertension was a negative predictor of complete occlusion and progression of occlusion, while the degree of occlusion post-flow diversion may not be predictive of future rupture risk and the Raymond Roy Occlusion classification may not apply. The degree of stasis after initial treatment was not predictive of future occlusion, retreatment, nor aneurysm rupture risk. However, stasis degree may be worth additional analysis given this studies sample size, lack of long-term follow-up, and the lack of predictive factors in current literature to guide post-flow diversion management.

Cementless fixation in total joint arthroplasty: Factors impacting osseointegration.

•The success of cementless fixation in TJA depends on a multitude of factors including biological, mechanical, implant, surgical, and material properties.•Biologic fixation has become the primary mode of fixation for the majority of primary total hip arthroplasty (THA) surgeries done today in the United States (US) due to its low complication rate and superior longevity compared to cemented fixation.•Cementless fixation has yet to gain wider acceptance in total knee arthroplasty (TKA) and hip hemiarthroplasty due to several factors including host bone quality, implant design, and surgical technique.•Understanding a) the properties of the different biomaterials, b) the bone-implant interface characteristics of the different ingrowth and ongrowth surfaces, and c) the various factors that affect osseointegration can lead to:i)appropriate choice of implants for individual patients with consequent increase in revision-free survival, andii)the development of new techniques that can reduce the risk of aseptic loosening.

Microsurgical Reconstruction of Complex Scalp Defects With Vastus Lateralis Free Flap.

Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening. In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap. From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed. Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (n = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (n = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months. In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate.

Modified Frailty Index (mFI-5) as a prognostic tool of mortality, complications, and readmissions in patients undergoing hepatic ablation for hepatocellular carcinoma.

610 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths, often diagnosed late, limiting curative options. Transarterial chemoembolization, Y-90 radioablation, radiofrequency ablation, and thermoablation are commonly used for downstaging, transplant bridging, and palliation in unresectable HCC. Frailty, linked to postoperative complications, has not been studied in hepatic ablation patients. This study evaluates the predictive value of the modified frailty index (mFI-5) for mortality, readmissions, complications, redo procedures, and discharges. Methods: We utilized the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2019, querying cases of hepatic ablation for CPT codes: 47370 (closed hepatic ablation, single site) and 47380 (open hepatic ablation, single site). Selected cases were analyzed for frailty using the mFI-5 criteria. A multivariate analysis was performed using mFI-5 frailty scores, stratified into non-frail (0), pre-frail (1), frail (2), and severely frail (3+). The outcomes analyzed included mortality, discharge to a destination other than home, major complications, minor complications, readmission, and reoperation. Results: We identified 1921 patients as: 737 non-frail, 701 pre-frail, 442 frail and 41 severely frail. The rates of readmission (5.4%), reoperation (1.4%), major (5.3%) and minor (3.5%) complications were low. Eight patients died following hepatic ablation, and 79 patients were discharged to a destination other than home. In multivariate analysis, most outcomes were not significantly associated with increasing frailty. However, discharge to a destination other than home was significantly more likely in patients with higher frailty scores. In frail patients, the odds ratio (OR) was 2.325 (95% CI 1.228–4.402), and in severely frail patients, this increased to 8.720 (95% CI 3.389–22.435). Conclusions: Hepatic ablation is generally well tolerated with low complication rates; however, frailty significantly influences postoperative outcomes. Frail and severely frail patients are more likely to be discharged to care facilities rather than returning home, suggesting that even in the absence of major complications, these patients require a higher level of post-procedural care. This underscores the need for tailored discharge planning and resource allocation based on patient frailty.

Comparison of antithrombogenic coated and uncoated flow diverters in ruptured and unruptured cerebral aneurysms.

Flow diversion has become a key treatment option for complex intracranial aneurysms. Recent advancements include coated flow diverters (FDs), designed to potentially reduce the need for dual antiplatelet therapy, thereby removing the associated secondary risks while maintaining patency and low complication rates. Comparing coated and uncoated FDs may offer insights into long-term outcomes and treatment optimization. In this retrospective single-center study, we investigated the data of 21 consecutive patients with cerebral aneurysms, treated between 2021 and 2023 with the coated Derivo 2heal Embolization Device and the uncoated Derivo Embolization Device (both Acandis). We described the procedure and analyzed clinical and radiological data, along with long-term outcomes after 18months of follow-up. Nine patients (42.9%) had incidental, while 12 (57.1%) had symptomatic aneurysms, including 10 with World Federation of Neurosurgical Societies classification IV subarachnoid hemorrhages. Aneurysm locations included mostly the internal carotid (n=9) and the vertebral artery (n=7). All FDs were successfully deployed: 11 patients received the coated and 10 the uncoated device. After 18months, 73.3% of patients had favorable outcomes (modified Rankin Score 0-2). One coated FD occluded asymptomatically after 6months, and one uncoated FD occluded immediately but could be recanalized. We observed favorable occlusion rates for both coated and uncoated FDs. The role of dual antiplatelet therapy remains debated. Large multicenter studies are essential to evaluate the patency of coated compared to uncoated FDs and determine whether they can reduce thrombogenicity, potentially allowing for less or no antiplatelet therapy in emergencies.

Influence of surgeon experience on the incidence of tip fold-over with slim preformed cochlear implant electrodes.

To assess whether increasing experience with implantation of a thin preformed electrode array for perimodiolar insertion reduces the incidence of tip fold-over (TFO). The retrospective study included 100 patients who received a cochlear implant (CI) with the Slim Modiolar (SM) electrode array (Cochlear, Sydney, Australia) at a university CI centre between November 2015 and December 2022. Postoperative radiological imaging was performed to verify electrode position. Surgical reports and radiological images were reviewed and the incidence of TFO was analyzed for three experienced CI surgeons. In addition, the incidence of intraoperative measurements showing evidence of electrode malposition and the mean duration of surgery over time were documented. 129 SM implantations in 100 patients were included. In seven cases (5.4%) TFO was radiologically detected and successfully revised. In eight cases (6.2%), electrophysiological measurements indicated misplacement and the position was corrected during the same surgery. For one surgeon, five out of 67 implantations (7.5%) were affected by TFO, with the frequency of this complication decreasing over time. The average surgery time for all surgeons was 122.2 (± 44.2) minutes, with two surgeons showing a decrease over time. The results show a tendency that the SM electrodes can be implanted with a lower complication rate and faster over time. Therefore, it can be assumed that the implantation of the SM electrode requires a certain amount of practice, even for experienced surgeons. As intraoperative electrophysiological measurements detected 71.4% of all radiologically confirmed TFOs, their use is highly recommended.