Major Late Complications Research Articles

Long Term Effects Of Covid-19 Pandemic On Management And Outcomes Of Distal Radius Fractures

Purpose: The purpose of this study was to assess the long-term effects of conservative orthopaedic practice during Covid-19 pandemic on management and long-term outcomes. Methods: Current longitudinal retrospective cohort study included patients at a single tertiary care center in India. Successive distal radius fractures of patients in pre-COVID (2018-19), COVID (2020-21) and postCOVID (2022-23) time period groups were treated and analysed. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and secondary outcomes included wrist range of motion, grip strength and pain. Cohort findings were compared employing Repeated-measures analysis of variance. Results: In pre-COVID group 97(82.4%) patients presented within 3 days of injury which significantly declined to 48(49%) in COVID and 94(71.2%) in post-COVID group. There was a significant reduction in admissions for inpatient care (p<0.05). The mean QuickDASH score at 1 year follow-up was 7.2(8.6) in COVID group that was clinically better than pre-COVID [8.5(9.2)] and post-COVID [9.7 (12.4)] cohorts. The number of reoperations or secondary surgeries required were significantly lower in the COVID group [1 (1%) patient]. Conclusions: COVID-19 pandemic had minimal long-term effects on results of distal radius fractures as the conservative treatment approach utilised was realistic and beneficial to patients as well as to the treating surgeons. Timely corrections of arising early treatment complications through efficient virtual clinics/telemedicine kept the prevalence of major late complications minimal. Comparatively minimal complications and prompt recovery were seen in patients being operated by percutaneous Kirschner wires fixation. Categories: Infectious Disease, Orthopaedics, Trauma

Breaking barriers: supporting hematopoietic stem cell transplant program through collaborative radiation therapy service from a physically distant center

BackgroundTotal body irradiation (TBI) for hematopoietic stem cell transplant (HSCT) has certain distinct advantages, such as uniform dose distribution and lack of drug resistance, but it is not widely available in resource-constrained settings. To overcome the limitations of in-house radiotherapy services in hematology centers, we evaluated the feasibility of conducting HSCT programs in coordination with two physically distant centers using a reduced-intensity TBI protocol.MethodsThirty-two patients with a median age of 20.5 years were included in the study. Fifteen patients were diagnosed with aplastic anemia, 10 patients with acute myeloid leukemia (AML), 3 patients with acute lymphocytic leukemia (ALL), and 4 patients with other hematological conditions. Conditioning regimens used were fludarabine plus cyclophosphamide in 29 cases, fludarabine-cytarabine ATG in 2 cases, and busulfan plus fludarabine in 1 case. The TBI dose was 3 Gy in 28 cases and 2 Gy in 4 cases. Patients were followed monthly after TBI, and the major toxicities were recorded.ResultsThe median follow-up was 22 months. The most common acute complication was acute graft-versus-host disease (GVHD), which occurred in 15.6% of patients. The major late complications were chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced secondary graft failure (6.2%). Seventy-five percent of patients were alive, 21.9% were dead, and 1 patient was lost to follow-up.ConclusionsHSCT based on TBI is feasible even if the center lacks a radiotherapy facility by coordinating with a remote radiotherapy facility. without compromising the patient's outcome.

Techniques and results of reconstruction of femoral head fractures: An Update

A narrative review of the literature was conducted to examine the data on femoral head fractures, with a particular focus on their management, complications and clinical outcomes.A PRISMA strategy was used. Medline and Scopus library databases were queried using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. The 50 eligible articles that met the predefined inclusion criteria reported on 1403 femoral head fractures. A detailed analysis of the surgical approaches used was performed in 38 articles with 856 fractures.Most fractures were treated surgically (90,8 %) with preferred anatomical reconstruction in 76,7 % of all operatively treated cases. Posterior approaches were the most common (52.5 %). This was evenly split between surgical hip dislocation and the classic Kocher-Langenbeck approach. 70.5 % of surgically treated cases achieved excellent or good result according to Thompson-Epstein criteria. Highest rate of excellent results showed minimal invasive osteosynthesis and surgical hip dislocation. Major late complications were avascular necrosis (10.8 %), post-traumatic arthritis (16.2 %) and heterotopic ossification (20.8 %). Secondary THA was necessary in 6.9 %. Highest rate of major complications was joined with anterior approach (77 %), lowest rate from frequently used approaches surgical hip dislocation (37.8 %).Conservative treatment recedes into the background. The Ganz flip osteotomy with surgical hip dislocation allows safe treatment of all types of fractures and should be considered the first choice, offering the lowest rate of complications and one of the best functional outcomes. Reconstruction of Pipkin Type III fractures should be reserved for very young patients due to high rate of major complications.

Safe Reduction of Intermammary Distance in Implant Breast Augmentation Without Fat Grafting.

Over the latest 15 years, breast augmentation with implant has been progressively refined technically and artistically. However, little attention is usually given to the intermammary space. The aim of this article is to report author's experience and technique in the safe reduction of the intermammary space in breast augmentation with implants without fat grafting. From July 2019 to July 2021, 62 consecutive patients undergoing cosmetic breast enhancement with implant and requesting a reduction of the intermammary space were retrospectively evaluated. Preoperatively, breast features were registered for all patients. Preoperative intermammary distance ranged from 2.3 to 7 cm (5.4 ± 0.74). The average follow-up time was 20 months (range 12 to 36 months). All implants were anatomical silicon-gel filled implants with micropolyurethane foam shell. No major early and late complications were experienced. The outcomes were graded as excellent in 45 breasts (72.6 %), very good in 15 (24.2%), good in the two cases (3.2%) with minor delayed wound healing (less than 1 cm) which solved conservatively within 1 month. Patients' satisfaction was high to very high. Postoperative intermammary distance was reduced in all cases and ranged from 1 to 4.5 (mean 2.6 ± 0.52 cm) CONCLUSION: The intermammary distance can be safely reduced with implant only in all cases who seek it, both via submuscular and via subfascial approach by a precise medial pocket dissection and implantation of micropolyurethane foam-coated implant, which guarantee device's stability during the healing process avoiding malposition. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cardiopulmonary exercise testing in repaired tetralogy of Fallot and supraventricular arrythmias

Abstract Background The arrhythmia burden in adult patients (Ps) with tetralogy of Fallot (TOF) is considerable, being a major late complication in repaired TOF. The incidence of atrial arrhythmias is relatively high and one of the main causes of morbidity. Our aim was to assess which cardiopulmonary exercise testing (CPET) parameters best correlate with supraventricular arrythmias (SVA) to potentially improve identification of high-risk Ps. Methods A single-center retrospective analysis was performed from 2009 to 2018 on adult Ps with repaired TOF who underwent maximal CPET. Ambulatory ECG monitoring was used to analyze the arrhythmic profile. Demographics, standard measures of CPET interpretation, and major cardiovascular outcomes were collected. Multivariate analysis for the prediction of SVA was performed using Cox Regression, by including all statistically significant variables in the univariate analysis and those considered clinically relevant. Results CPET was performed in 63 repaired TOF Ps (57% male, mean age of 34 ± 9 years), with a mean follow-up of 60 ± 33 months. 56% Ps had severe pulmonary regurgitation and 48% Ps underwent pulmonary valve replacement (PVR). Supraventricular arrhythmias occurred in 12 Ps (19%), mainly atrial fibrillation or atrial flutter (67%). There were no statistically significant differences regarding the clinical profile and baseline CPET parameters between both groups, namely: age (p=0.113), male gender proportion (p=0.581), proportion of Ps who underwent PVR (p=0.578), RV systolic dysfunction prevalence (p=0.854) and peak oxygen uptake (p=0.083). VE/VCO2 slope was an independent predictor of SVA (HR 1.41, CI 95% 1.08-1.84, p=0.012). Exercise capacity assessed by estimated metabolic equivalents (METS), as well as the peak heart rate (PHR) during exercise (HR 0.86, CI 95% 0.76-0.96, p=0.007), revealed a protective effect regarding SVA (HR 0.71, CI 95% 0.51-0.98, p=0.045). Neither peak oxygen uptake (p=0.090) nor cardiorespiratory optimal point (p=0.427) showed statistically significant correlation with SVA during follow-up. Ps with a PHR above 165 bpm had a significantly higher survival free of SVA (log-rank p=0.045). Conclusion In our population, VE/VCO2 slope was an independent predictor of SVA during follow-up, while both a higher PHR and a higher exercise capacity had a protective effect. CPET could be an accessible way of improving risk-stratification of TOP Ps and should therefore be included in their routine assessment.

A Mitochondrial Nanoguard Modulates Redox Homeostasis and Bioenergy Metabolism in Diabetic Peripheral Neuropathy.

As a major late complication of diabetes, diabetic peripheral neuropathy (DPN) is the primary reason for amputation. Nevertheless, there are no wonder drugs available. Regulating dysfunctional mitochondria is a key therapeutic target for DPN. Resveratrol (RSV) is widely proven to guard mitochondria, yet the unsatisfactory bioavailability restricts its clinical application. Tetrahedral framework nucleic acids (tFNAs) are promising carriers due to their excellent cell entrance efficiency, biological safety, and structure editability. Here, RSV was intercalated into tFNAs to form the tFNAs-RSV complexes. tFNAs-RSV achieved enhanced stability, bioavailability, and biocompatibility compared with tFNAs and RSV alone. With its treatment, reactive oxygen species (ROS) production was minimized and reductases were activated in an in vitro model of DPN. Besides, respiratory function and adenosine triphosphate (ATP) production were enhanced. tFNAs-RSV also exhibited favorable therapeutic effects on sensory dysfunction, neurovascular deterioration, demyelination, and neuroapoptosis in DPN mice. Metabolomics analysis revealed that redox regulation and energy metabolism were two principal mechanisms that were impacted during the process. Comprehensive inspections indicated that tFNAs-RSV inhibited nitrosation and oxidation and activated reductase and respiratory chain. In sum, tFNAs-RSV served as a mitochondrial nanoguard (mito-guard), representing a viable drilling target for clinical drug development of DPN.

Exploring a Novel Technique to Tackle the Shortage of Devices for Hepatic Arterial Infusion Chemotherapy: Early Results of an Alternate Approach for Percutaneous Arterial Port Catheter Placement.

Dedicated catheters for hepatic arterial infusion chemotherapy were removed from the market. The purpose of this study was to assess the results of a novel approach to overcome the shortage of dedicated catheters for hepatic arterial infusion chemotherapy in the treatment of colorectal cancer liver metastases. We retrospectively included patients who underwent a percutaneous placement of a hepatic intra-arterial port catheter in a single tertiary center from February 2021 to June 2022. We examined the patient baseline characteristics, technical features of the modified procedures, technical success rates, complications and oncological outcomes. Fourteen patients (median age: 60 years; q1 = 54; q3 = 70; range: 53-81 years) underwent 15 modified procedures. The main modification of our placement technique consisted of the use of an indwelling 5-Fr Vertebral catheter, on the tip of which we created a two-sided additional lateral hole. The catheter was connected to a pediatric port. The primary success rate was 100%, and the secondary success rate was 93.3%. There were two late major complications, graded IIIa according to the Clavien-Dindo classification. The median liver progression free survival was 6.1 months (q1 = 2.5; q3 = 7.2; range: 1.3-11.6). Our experience suggests that the derived utilization of the devices used routinely in interventional radiology provides an effective solution that can compensate for the shortage of dedicated devices.

Interest of acellular dermal matrices in immediate breast reconstruction: Comparison of quality of life and complications with and without matrix

Since 2001, acellular dermal matrices have been increasingly used in immediate breast reconstruction (IBR) because they allow for the placement of the ideal-sized definitive implant in one step. They are used in both retropectoral and prepectoral prosthetic breast reconstructions. The aim of this study was to evaluate the impact of dermal matrices on the quality of life and on complications. Two surveys were used to evaluate the quality of life: the BREAST-Q V2.0© and the QuickDASH. The surveys were sent to all patients who had an immediate prosthetic breast reconstruction at a University Hospital Center from 2010 to 2020. A case-control study was performed for comparison of responses between the "Matrix+" and "Matrix-" groups. Seventeen IBR with matrix (23.6%) and 55 IBR without matrix (76.4%) were analyzed. Patients in the "Matrix+" group had a better quality of life in terms of sexual well-being (p=0.038) and a significantly lower QuickDASH (p<0.01). They had better breast satisfaction (p=0.016) and better implant satisfaction (p<0.01). The likelihood of encountering major complications later in time was more important in the group with matrix (p=0.04). We found a satisfactory quality of life with scores of sexual well-being and satisfaction with the breast and the implants, and a better satisfaction with care thanks to the use of the matrices. However, due to a higher number of major late complications and a lack of follow-up, we believe that immediate prosthetic breast reconstruction with matrix should be discussed according to the comorbidities, medical treatments, and the vitality of the skin flaps of each patient.

Extraperitoneal Versus Intraperitoneal Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis.

This study aimed to compare perioperative and oncologic outcomes of extraperitoneal radical cystectomy (EPRC) and transperitoneal radical cystectomy (TPRC). A systematical search of multiple scientific databases was performed in September 2022. The systematic review and cumulative meta-analysis of the primary outcomes of interest were performed according to the PRISMA and AMSTAR guidelines and registered in the PROSPERO database (PROSPERO [CRD42022359322]). The review and analysis included eight studies with 989 participants. No significant differences were found between EPRC and TPRC in terms of operation time, estimated blood loss (EBL), hospital length of stay (LOS), or transfusion. A shorter exhaust time (standardized mean difference [SMD] - 0.59; 95 % confidence interval [CI] - 0.97 to 0.21; p = 0.002) and time to liquid intake (SMD, - 0.56; 95 % CI - 1.07 to 0.04; p = 0.03) were associated with EPRC. No clinically meaningful difference was observed in terms of postoperative infection, wound complications, postoperative genitourinary complications, late postoperative complications, early major complications, or late major complications. However, EPRC was related to lower incidences of early postoperative complications (odds ratio [OR], 0.66; 95 % CI 0.51-0.86; p = 0.002), gastrointestinal complications (OR 0.28; 95 % CI 0 0.17-0.46; p < 0.00001), and postoperative ileus (OR 0.38; 95 % CI 0.25-0.59; p < 0.0001). A higher incidence of postoperative lymphocele was associated with EPRC (OR 3.05; 95 % CI 1.13-8.25; p = 0.03). No clinically meaningful difference was found in terms of positive surgical margin (PSM), local recurrence, distant metastasis, or OS. Although EPRC had a higher incidence of lymphoceles than TPRC, it was found to have similar oncologic outcomes and fewer early complications, particularly in terms of postoperative gastrointestinal complications and ileus. These results suggest that EPRC is a safe option both functionally and oncologically.

Pure laparoscopic donor hepatectomy: Experience of 556 cases at Seoul National University Hospital

Pure laparoscopic donor hepatectomy (PLDH) has become a routine procedure at Seoul National University Hospital, and the pure laparoscopic method is now being applied to liver recipients as well. This study aimed to review the procedure and outcomes of PLDH to identify any areas that required improvement. Data from 556 donors who underwent PLDH between November 2015 and December 2021 and their recipients were retrospectively reviewed. Among these, 541 patients underwent pure laparoscopic donor right hepatectomy (PLDRH). The mean hospital stay of the donor was 7.2 days, and the rate of grade I, II, IIIa, and IIIb complications was 2.2%, 2.7%, 1.3%, and 0.9%, respectively, without any irreversible disabilities or mortalities. The most common early and late major complications in the recipient were intraabdominal bleeding (n = 47, 8.5%) and biliary problems (n = 198, 35.6%), respectively. Analysis of the PLDRH procedure showed that operative time, liver removal time, warm ischemic time, Δhemoglobin%, Δtotal bilirubin%, and postoperative hospital stay decreased significantly as the number of cases accumulated. In conclusion, the operative outcomes of PLDRH improved as the number of cases increased. However, continuous caution is needed because major complications still occur in donors and recipients even after hundreds of cases.

PD36-12 MEASURING OBJECTIVE RECOVERY OF ACTIVITY LEVELS USING WEARABLE DEVICES FOLLOWING OPEN VS INTRACORPOREAL ROBOTIC CYSTECTOMY: SECONDARY OUTCOMES ANALYSIS OF THE IROC RANDOMIZED TRIAL

PD36-12 MEASURING OBJECTIVE RECOVERY OF ACTIVITY LEVELS USING WEARABLE DEVICES FOLLOWING OPEN VS INTRACORPOREAL ROBOTIC CYSTECTOMY: SECONDARY OUTCOMES ANALYSIS OF THE IROC RANDOMIZED TRIAL

Successful surgical treatment in patients with late major vascular complications of missed minor vascular injuries

Aim: Vascular injuries can result from various causes, including trauma, surgery, or medical procedures, and can present immediate life-threatening risks. While some injuries are readily apparent and require urgent intervention, others may not display obvious signs of vascular compromise during the initial evaluation, potentially leading to delayed major complications. Analyse errors in the primary treatment of vascular injuries and delayed presentation of overlooked vascular injuries as surrogate indicators of the need for improved vascular surgical training for future surgeons. Material and Methods: At the Inönü University Cardiovascular Surgery Clinic between June 2011 and June 2019, a All instances of unidentified vascular injuries that present post-trauma in the form of pseudoaneurysm, arteriovenous fistula, and post-traumatic arterial occlusion were reported within the hospitals during the study duration. Results: This study included 28 patients undergoing multiple vascular repair interventions at our institution, including 14 penetrating, 10 blunt and 4 iatrogenic. Vessels of the lower limbs were involved in 18 cases (64.2%), vessels of the upper limbs in 7 cases (25%) and vessels of the neck in 2 cases (7.14%). All patients underwent surgical procedures without any fatalities or loss of limb function. There were no fatalities or unanticipated amputations. Conclusion: Vascular injuries may lead to noteworthy delayed complications occurring months or even years subsequent to the initial injury, including false aneurysms, dissections, occlusions, and fistulas, which may cause considerable disability, albeit, fortunately, they are typically not fatal. Patients with suspected injury, even in the absence of clear clinical signs of vascular injury, should be carefully monitored and a detailed examination is recommended to assess individuals with potential vascular injury.

Incidence and Patterns of Major Complications Following Spinal Instrumentation- A Retrospective Descriptive Study from a Tertiary Care Center in Nepal

Background: With the continuous uprise of spinal instrumentations within the global front, the complications they harbinger may have multispectral effects upon the patients as well as their caretakers. These are of prime significance in the context of low and middle-income nations. There is however drought of studies pertaining to the same in our subcontinent. Materials and methods: A retrospective descriptive study was undertaken to study the incidence and patterns of early and late major complications among 300 patients undergoing spinal instrumentation from the hospital database of the College of Medical Sciences (CMS), in Bharatpur, Chitwan, Nepal. Results: Trauma comprised 63.33% of cases in the study. 40% of the study cohorts were either in the American Spinal Injury Association (ASIA) ‘A’ or ‘B’ neurological status. The incidence of major complications in our study cohort was 20.33%. The posterior-only surgical approach was undertaken in 200 (66.67%). Surgical site infection was the most common type of complication observed (6.67%). Hardware-related complications were observed in 5.67%) of cases. The incidence of re-operation was 2.67%. The mortality rate observed in our study was 2%. Conclusion: Adequate preoperative planning, proper optimization of the patient, and adoption of procedure-specific, risk-adjusted predictive models may be pivotal for nullifying complications adherent to spinal instrumentation.

P-069 A SINGLE CENTRE RETROSPECTIVE 14 YEAR REVIEW OF PATIENT OUTCOMES FOLLOWING IPOM LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PVDF MESH

Abstract Aim Laparoscopic ventral hernia repair (LVHR) is a widely accepted minimally invasive technique. However, there remains debate regarding appropriate patient selection, the type of mesh used and for what size and type of defect. We aimed to review our experience of IPOM LVHR using PVDF mesh and compare our outcomes to the current literature. Material and Methods Operative records identified all patients who had undergone an IPOM LVHR with PVDF mesh from 2007–2021. The type, number and size of hernial defects, the sac contents, along with the size of mesh used and the type of fixation was collated. Length of stay (LoS), as well as early and late post-operative complications were also analyzed. Results A total of 287 patients are included in the study to date. 32.3% of patients were categorised within Obese Class II or III (BMI 35 – &amp;gt;40). Major early and late complications were observed in 4.6% and 3.1% of cases respectively. An 8.7% recurrence rate was observed. 87% of recurrences had an original defect classed as large (&amp;gt;4cm), with a median BMI of 30.5. Conclusion In conclusion, our post-operative outcomes are in keeping with those reported in the literature. In our experience, a high BMI does not preclude patients from undergoing a LVHR and having a good result. Debates are ongoing with regards to the timing and indication for LVHR in the obese and our results are encouraging, especially considering current national statistics estimate approximately 30% of the UK population are classed as obese.

EP-642 Case Report: Using the Novel Flamingo Device for Endoscopic Treatment of Buried Bumper Syndrome in high risk patients

Abstract Aim Buried Bumper Syndrome is a rare, major late complication of percutaneous endoscopic gastrostomy (PEG) occurring in 1% of cases. It occurs when the internal bumper of the PEG tube erodes into the gastric wall. This lead to a loss of patency, leakage and inability to change the tube endoscopically. Until recently, the treatment was surgical removal under general anaesthesia. However, patients with BBS are likely to have significant co-morbidities thus deeming the procedure high risk. Method We present a case report demonstrating successful treatment of BBS completed endoscopically using the Flamingo device with a good patient outcome. The Flamingo device is a new endoscopic tool that acts like a sphincterotome. Appropriate consent was taken from the patient. This was performed on a 56 year old patient suffering from multiple sclerosis causing dysphagia for which a PEG tube was inserted in 2018 for nutrition. Over time, his care home noticed significant leakage from the site. At gastroscopy, he was diagnosed with BBS. Due to his risk for surgical intervention, the Flamingo device was trialled to remove the buried bumper and allow insertion of a new PEG. Results As demonstrated in the photos, the mucosa was successfully cut allowing the buried bumper PEG to be retrieved. A new PEG was inserted without complication. The patient was discharged the following day and no complications have arisen 3 months later. Conclusion The Flamingo device has proven to be a safe and minimally-invasive method to treat BBS endoscopically in this patient.

A Retrospective Study Assessing the Outcomes of Immediate Prepectoral and Subpectoral Implant and Mesh-Based Breast Reconstruction.

Simple SummaryThe aim of the study is to compare the outcomes of implant and synthetic TIGR mesh-based breast reconstructions in breast cancer patients and women, who have higher lifetime risk for breast cancer, with mutated (changed) copy of genes: BRCA1, BRCA2, PALB2 or CHEK2. This study included 170 patients after 232 mastectomies and immediate breast reconstructions. Preoperative chemotherapy was associated with more frequent minor complications, but not major ones, while postoperative chemotherapy was related to more frequent serious postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications than no-radiotherapy. Our research found complications to be significantly associated with expander, big- volume breast, mastectomy in breast cancer patients vs risk-reducing mastectomy/prophylactic surgery in women with mutated gene and postoperative chemotherapy. Patients in whom prepectoral (prosthesis is placed above the pectoralis major muscle) surgeries were performed demonstrated shorter hospitalization time, and lower minor complication rates, but similar major complication rates. Implant-based breast reconstruction with the use of synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, further studies are needed to evaluate the benefits of such treatments.(1) Introduction: In response to patient concerns about breast cancer recurrence, increased use of breast magnetic resonance imaging and genetic testing, and advancements in breast reconstruction techniques, mastectomy rates have been observed to rise over the last decade. The aim of the study is to compare the outcomes of prepectoral and subpectoral implants and long-term, dual-stage resorbable mesh-based breast reconstructions in mutation carriers (prophylactic surgery) and breast cancer patients. (2) Patients and methods: This retrospective, two-center study included 170 consecutive patients after 232 procedures: Prepectoral surgery was performed in 156 cases and subpectoral was performed in 76. (3) Results: Preoperative chemotherapy was associated with more frequent minor late complications (p < 0.001), but not major ones (p = 0.101), while postoperative chemotherapy was related to more frequent serious (p = 0.005) postoperative complications. Postoperative radiotherapy was associated with a higher rate of minor complications (31.03%) than no-radiotherapy (12.21%; p < 0.001). Multivariate logistic regression found complications to be significantly associated with an expander (OR = 4.43), skin-reducing mastectomy (OR = 9.97), therapeutic mastectomy vs. risk-reducing mastectomy (OR = 4.08), and postoperative chemotherapy (OR = 12.89). Patients in whom prepectoral surgeries were performed demonstrated significantly shorter median hospitalization time (p < 0.001) and lower minor complication rates (5.77% vs. 26.32% p < 0.001), but similar major late complication rates (p = 0.915). (4) Conclusions: Implant-based breast reconstruction with the use of long-term, dual-stage resorbable, synthetic mesh is a safe and effective method of breast restoration, associated with low morbidity and good cosmesis. Nevertheless, prospective, multicenter, and long-term outcome data studies are needed to further evaluate the benefits of such treatments.

The effectiveness of enterprise stent use on the treatment of intracranial atherosclerosis disease.

To examine the clinical outcome of Enterprise stent in patients with severe and symptomatic intracranial atherosclerosis. Twenty-five patients who underwent Enterprise stenting between January 2012 and March 2019 were included in this study. Exclusion criteria were previous intracranial stenting and inadequate follow-up. Technical success rates of the procedures were recorded. Clinical outcome was evaluated with pre- and post-treatment modified Rankin Scale scores. The patients were monitored for 18months clinically and for 14.3months radiologically. The mean age of the 15 males and 10 females was 61.6 ± 8.19. Of these 25 patients, 6 (24%) were in the anterior system and 19 (76%) were in posterior system. The mean degree of pre-treatment stenosis was 86.4% ± 7 with the mean lesion length of 12.5 ± 7.5mm. The residual stenosis rate was 23.8% ± 8.81. Technical success rate was 100%. There were two major complications within the first 30 days (8%). Late major complications (after 30days) occurred in one case (4%). Stent restenosis was detected in two patients (8%). No intracranial bleeding or mortality was observed. In this single-center study, we achieved high technical success and tolerable complication rates. Enterprise stent may be a good treatment alternative for severe intracranial stenosis especially in patients resistant to medical treatment when correct patient selection is made. However, further randomized controlled studies, including more cases should be carried out.

Seven-year trajectories of body weight, quality of life and comorbidities following Roux-en-Y gastric bypass and sleeve gastrectomy

Background/objectivesThere is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities.We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB.Subjects/methodsPatients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015.Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril’s ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates.ResultsOf 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m2) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5–7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up.ConclusionIn routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.

Surgical intervention and outcome for treatment of myocardial bridging refractory to medication.

Myocardial bridging (MB) is a common and usually benign inborn coronary abnormality that may lead to anginal symptoms, acute coronary syndrome, arrhythmias, and rarely sudden cardiac death. MB are most commonly localized in the middle segment of the left anterior descending coronary artery (LAD). The treatment of LAD-MB is still challenging. Our objective was to assess the short- and long-term results of surgical procedures in patients with LAD-MB who had chest pain refractory to medical therapy. Between March 2005 and January 2020, 26 patients (19 males and 7 females; mean 55.8 ± 12.4 years) with MB underwent surgery. All MB was located in the mid-segment of the LAD with a mean length of 4.2 ± 1.7 cm. Coronary angiography before surgery demonstrated LAD-MB with systolic compression more than or equal to 70% in all patients. Twenty-five patients underwent myotomy and one patient underwent coronary artery bypass grafting (CABG). All patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Follow-up time was 3-173 months (mean 55.7 months). Follow-up of coronary angiography or computed tomography scan performed in 16 patients demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and are currently in NYHA Class I. The symptomatic LAD-MB patients who are refractory to medication should actively undergo the surgical intervention such as myotomy and CABG to eliminate the clinical symptoms and achieve satisfactory results by follow-up findings. Myotomy is a preferred procedure because of its safety and satisfactory results.

A proof-of-concept randomized phase 2 non-inferiority trial on simple versus modified radical hysterectomy in IA2-IB1 cervical cancer ≤2cm (LESSER)

Objectives: To evaluate the safety and efficacy of simple hysterectomy in early stage cervical cancer. Methods: The LESSER (LESs Surgical radicality for EaRly stage cervical cancer) study was a proof of concept randomized phase 2 non-inferiority trial evaluating the safety and efficacy of simple hysterectomy compared to modified radical hysterectomy in patients with stages IA2-IB1 cervical cancer and tumors of ≤2cm in size. Primary end-point was 3y-DFS rates and secondary endpoints were 3y-OS (3-year overall survival), surgical morbidity, indication of adjuvant therapy, and QoL (EORTC QLQ-C30). The study was registered at ClinicalTrials. gov (NCT02613286). Results: A total of 40 patients were randomized 1:1 from May 2015 to April 2018 in 3 oncological centers from Northeast Brazil. All cases had pelvic systematic lymph node dissection. Overall, 10% of patients underwent MIS procedures, 80% of tumors were SCC and 7.5% had lymph node metastasis, whereas inaccuracies for clinical tumor size estimation, LVSI and stromal invasion > 1 cm were found in 20%, 22.5% and 30% of cases, respectively. Clinical and pathological characteristics were well balanced between treatment arms, but the length of surgery and the time for bladder catheterization removal were higher after radical hysterectomy (p=0.003 and p=0.043, respectively). There was no postoperative mortality and rates of any grade postoperative complication were not statistically different between arms (15% and 20%; p=1.00). No major differences in the QoL over time were also observed. A quarter of patients received adjuvant therapy, with no significant difference between groups (30% vs. 20%, p=0.48). There was one death at 25 months of follow-up due to pelvic recurrence in the simple hysterectomy arm. A pathological review of this case found tumor embolus in the lymphovascular space of left parametrium that was missed at the time of former anatomopathological analysis. Another patient died of lung metastasis from a second primary thyroid cancer at 54.4 months of follow-up in the radical hysterectomy arm. A major late complication was also recorded after 3 months from radical surgery in a patient with distal urethral stenosis that was treated with segmental resection and psoas-hitch ureteroneocystostomy. Survival outcomes with a minimum of 3y follow-up will be mature for presentation during the SGO 2021 Annual Meeting on Women's Cancer. Conclusions: Simple hysterectomy is a promising substitute for modified radical hysterectomy in stage IA2-IB1 cervical cancer ≤2cm. To evaluate the safety and efficacy of simple hysterectomy in early stage cervical cancer. The LESSER (LESs Surgical radicality for EaRly stage cervical cancer) study was a proof of concept randomized phase 2 non-inferiority trial evaluating the safety and efficacy of simple hysterectomy compared to modified radical hysterectomy in patients with stages IA2-IB1 cervical cancer and tumors of ≤2cm in size. Primary end-point was 3y-DFS rates and secondary endpoints were 3y-OS (3-year overall survival), surgical morbidity, indication of adjuvant therapy, and QoL (EORTC QLQ-C30). The study was registered at ClinicalTrials. gov (NCT02613286). A total of 40 patients were randomized 1:1 from May 2015 to April 2018 in 3 oncological centers from Northeast Brazil. All cases had pelvic systematic lymph node dissection. Overall, 10% of patients underwent MIS procedures, 80% of tumors were SCC and 7.5% had lymph node metastasis, whereas inaccuracies for clinical tumor size estimation, LVSI and stromal invasion > 1 cm were found in 20%, 22.5% and 30% of cases, respectively. Clinical and pathological characteristics were well balanced between treatment arms, but the length of surgery and the time for bladder catheterization removal were higher after radical hysterectomy (p=0.003 and p=0.043, respectively). There was no postoperative mortality and rates of any grade postoperative complication were not statistically different between arms (15% and 20%; p=1.00). No major differences in the QoL over time were also observed. A quarter of patients received adjuvant therapy, with no significant difference between groups (30% vs. 20%, p=0.48). There was one death at 25 months of follow-up due to pelvic recurrence in the simple hysterectomy arm. A pathological review of this case found tumor embolus in the lymphovascular space of left parametrium that was missed at the time of former anatomopathological analysis. Another patient died of lung metastasis from a second primary thyroid cancer at 54.4 months of follow-up in the radical hysterectomy arm. A major late complication was also recorded after 3 months from radical surgery in a patient with distal urethral stenosis that was treated with segmental resection and psoas-hitch ureteroneocystostomy. Survival outcomes with a minimum of 3y follow-up will be mature for presentation during the SGO 2021 Annual Meeting on Women's Cancer. Simple hysterectomy is a promising substitute for modified radical hysterectomy in stage IA2-IB1 cervical cancer ≤2cm.