Surgical Management Of Complications Research Articles

Straddle injuries to the bulbar urethra: What is the best choice for immediate management?

Cystostomy, endoscopic realignment, and emergency anastomosis are three methods used to treat bulbous urethral injury (BUI). The aim of the study is to determine the optimal management. A retrospective study was performed on 328 male patients with blunt straddle injury to the perineum. In total, 304 patients were included in the analysis due to strict criteria. Among these 304 patients, 197 had partial urethral disruption diagnosed, and 107 had complete urethral disruption. Group placement of the patients was based on the extent of injury. Each group was further divided into two subgroups based on the immediate management. Propensity score matching was used to correct for differences in baseline characteristics. In the partial disruption group, the propensity score-matched subgroups set comprised of 164 patients. Of the 82 patients treated with endoscopic realignment, 34 (41.5%) patients required no urethral surgery, in contrast to 12 (14.6%) patients with cystostomy (p < 0.05). No significant difference was found in the other respects (p > 0.05). In the complete disruption group, the propensity score-matched subgroups set comprised of 104 patients. The success rate of emergency anastomosis was 90.4% (47 patients), and urethral stricture occurred in five patients (96%), while urethral stricture developed in all 52 patients in the cystostomy subgroup. With regard to surgical management of complications, the choice of management methods significantly differed between the two subgroups (all, p < 0.05). The time to natural urination and duration of hospital stay were significantly shorter in the emergency anastomosis subgroup (29.1 ± 5.4 days vs. 57.1 ± 6.4 days; 7.2 ± 3.1 days vs. 12.5 ± 2.3 days; each p < 0.05). Endoscopic realignment is associated with a lower stricture rate than cystostomy as immediate management for partial disruption. Emergency anastomosis provides better clinical outcomes for patients with complete disruption. Therapeutic Level IV.

Koch's abdomen- management of surgical complications and outcomes at a remote hill area tertiary care center

Background: Abdominal tuberculosis needs surgical intervention in a subset of patients; both in emergency and elective settings, requiring surgeons to be familiar with its varied and non-specific modes of presentation and their diagnosis and management.Methods: Patients of abdominal tuberculosis, having undergone surgical management at our Institute, VCSGGMS&amp;RI-UT, between April 2015 to March 2019, numbering eighty (n= 80), were included in this concurrent observational study.Results: Middle age-group patients (20-50 years; 56.3%) with a male majority (73.8%) predominated. Reinfection/ relapse of tuberculosis infection might occur despite BCG immunisation (46.3%) and course of ATT (16.3%); complications like bowel obstruction (28; 35%), perforation etc. need laparotomy to effect relief, with stomy formation required (51.3%) frequently; inadequate recovery warranting a secondary/re-look laparotomy (15; 18.8%). Prolene suture for abdominal wound closure is advantageous with a lesser rate of complications and incisional hernia. Septicemia, multi-organ dysfunction, wound infection should be aggressively managed to prevent adverse outcomes, including death (10; 12.5%).Conclusions: Adequate, intensive and timely surgical intervention/laparotomy, with nutritional support, stomy care and concurrent ATT can result in prompt relief and speedy recovery of patients with abdominal tuberculosis.

Comparative fMRI and MEG localization of cortical sensorimotor function: Bimodal mapping supports motor area reorganization in glioma patients.

IntroductionPreoperative functional mapping in the vicinity of brain lesion is of high importance for avoiding complications in surgical management. However, space-occupying lesions may lead to functional reorganization or decreased BOLD activity.MethodsTherefore in 13 patients with cerebral gliomas or brain arterio-venous malformations/ hemangioma fMRI- and MEG-based cortical localizations of motor and somatosensory cortical activation pattern were compared in order to investigate their congruency.ResultsLocalization of cortical sensorimotor areas with fMRI and MEG showed good congruency with a mean spatial distance of around 10 mm, with differences depending on the localization method. The smallest mean differences for the centroids were found for MEF with MNE 8 mm and SEF with sLORETA 8 mm. Primary motor area (M1) reorganization was found in 5 of 12 patients in fMRI and confirmed with MEG data. In these 5 patients with M1-reorganization the distance between the border of the fMRI-based cortical M1-localization and the tumor border on T1w MR images varied between 0–4 mm, which was significant (P = 0.025) different to the distance in glioma patients without M1-reorganization (5–26 mm).ConclusionOur multimodal preoperative mapping approach combining fMRI and MEG reveals a high degree of spatial congruence and provided high evidence for the presence of motor cortex reorganization.

Thoracic disc herniation, avoidance, and management of the surgical complications.

Thoracic disc herniations are a relatively rare occurrence compared to disc herniations in the cervical or lumbar spine. Surgical management of these thoracic herniations can be technically difficult with a wide array of reported complications. In this study, we aim to describe the most common complications that can occur during or after surgical management of thoracic disc herniations. Furthermore, we describe tips and tricks for avoidance and, if necessary, management of surgical complications. Common complications addressed in this review include vertebral column instability, neurologic injury, cerebrospinal fluid leak/pleural fistula, thoracic viscera injury, wrong level surgery, incomplete disk resection, and intercostal neuralgia.

Study on outcome and complications of surgical management of proximal humerus fractures using locking compression plate

Study on outcome and complications of surgical management of proximal humerus fractures using locking compression plate

Abdominal signs of von recklinghausenrsquo;s disease a rare case report and revue of literature

Von recklinghausen&#039;s disease is a dominant genetic disease whose incidence is 1 in 4000 of all cases are spontaneous mutations, it belongs to phacomatoses and is part of neurocristopathy. The disease manifestations are extremely variable. The abdominal manifestations during this disease is well described in the literature, but of relatively rare occurrence. We report in this article the case of a patient aged 2 years, recently admitted to the pediatric surgery department for a retro-vesical pelvic mass discovered on the abdomino-pelvic ultrasound performed in the etiological assessment of chronic diarrhea in von recklinghausen disease. The patient underwent a surgery with favorable post-operative follow up, histopathological evaluation of the piece returned to a bladder wall ganglioneuroma associated with diffuse neurofibroma. Association of neurofibromatosis 1 and ganglioneuroma is rarely reported in the literature. The follow-up of patients with nf1 is clinical and radiological in the quest for complications that could involve the patient&#039;s prognosis, hence the urgency of the surgical management of complications of benign or malignant tumor.

The evidence-based approach for surgical complications in the treatment of lumbar disc herniation.

The purpose of this article is to review the evidence-based approach for surgical complications following disc herniation. A search of the primary English literature was conducted for research examining the outcomes and complications of surgical discectomy. Special regard was given to high-quality prospective randomized studies. The most commonly reported complications of surgical treatment of disc herniation are included in this review. Medical complications, and surgical complications including infection, durotomy, neurological injury, symptomatic re-herniation, and revision surgery are defined and systematically reviewed in detail for incidence, evaluation, and management. This article provides the clinician and surgeon with a review of the evidence-based evaluation and management of surgical complications following disc herniation, offering best practice guidelines for informed discussions with patients in shared decision-making.

Clinical Presentation of Thyroglossal Cyst and its Management Study of Two Hundred Cases

Objectives – To find out clinical presentation, management &amp; Complication of surgery of Thyroglossal cyst.Methods – It was a cross sectional study done in the Department of Otolaryngology and Head-Neck Surgery, BSMMU, DMCH &amp; RMCH, from January 2009 to June 2015. 200 Patients undergoing Sistrunk’s operation for cytologically proven Thyroglossal cyst were included in this study. Patients were reviewed after sugary and any complication that occurred were recorded. Results – Within 200 patients, most (34%) were in 1st decade, mean age19.17 years, male-female ratio 1.2 : 1, in 92.5% cases cyst in midline, Complication of surgical management in 8.5% cases and recurrence is 1.5% cases after Sistrunk’s operation.Conclusions – Thyroglossal cysts commonly present as midline neck swelling within 2nd decade of life and can be successfully treated with Sistrunk’s operation with minimal recurrence.TAJ 2012; 25: 26-29

Endoscopic Management of Gastrointestinal Complications

AbstractDespite improvements in preoperative patient optimization, refinements in surgical methodology and technology, and the implementation of enhanced recovery protocols, complications following gastrointestinal (GI) surgery remain a fact of life. As the rates of GI surgical procedures increase worldwide, so will the volume of complications. The surgical management of complications is often not ideal, as some (such as acute staple line bleeding or the development of an anastomotic stricture) are luminal-based processes that are difficult to approach from an extraluminal (i.e., surgical) perspective. Endoscopy has largely replaced surgery for the management of such postoperative problems. Leak, the most feared complications of GI surgery, can result from intestinal resection, anastomosis formation, or from iatrogenic injury. With advancements in both diagnostic and therapeutic endoscopy, novel endoluminal and transluminal management options for leak continue to evolve. In centers where these interventions are readily available, they are becoming a first-line treatment option. This article will review the endoscopic management of GI complications with a particular focus on the management of postoperative strictures and of full-thickness GI tract defects (perforations, acute leaks, and chronic fistulae).

Infection of Prosthetic Patches after Femoral Endarterectomy: An Unreported Complication

The femoral prosthetic patch is a surgical procedure frequently used to treat atherosclerotic lesions involving femoral artery bifurcation. Even though it is an easy to perform procedure, surgical management of complications, first of all graft infection, may be challenging, with a high morbidity and mortality risk for patients. We report our experience on surgical treatment of femoral patch infections. Between April 2012 and April 2018, 26 patients (26 limbs) were referred to the emergency department at our institution for the treatment of femoral prosthetic patch infections. None of the patients had been previously treated at our institution. All patients underwent a wide debridement of the infection site. Blood flow was restored through a vein interposition graft anastomosed at least 4-5 cm from the site of infection. End points of the study were death-related events, major or minor limb loss (major loss for above or below the knee amputation and minor for foot or toe), vein interposition graft failures, recurrent graft infections, or surgical wound healing. A total of 26 patients (21 male and 5 female patients) underwent surgical treatment. The mean age of patients was 69years. The majority of our patients (54%) had been previously treated with an isolated femoral artery prosthetic patch. Three (11%) patients had been treated with a bilateral prosthetic femoral patch, but only one side was infected. After debridement of the infection site, we used the great saphenous vein to revascularize the lower limb in 22 (85%) cases, whereas the cephalic vein was used in only 4 cases (15%). The 5-year survival rate was 81% (standard error [SE]=0.12). The 5-year primary patency rate was 70% (SE=0.14). During follow-up, 4 graft occlusions occurred, and in 2 cases, a major amputation was required. The limb salvage rate at 5 years was 81% (SE=0.13). An infection can complicate the femoral prosthetic patch carrying a high rate of morbidity, mortality, and limb loss. Surgical indication for a primary procedure must be restricted to critical limb ischemia, and it must be associated to a multilevel correction of the atherosclerotic disease.

Tips and tricks for endoscopic negative pressure therapy. German version

Endoscopic negative-pressure therapy (ENPT) is becoming avaluable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

Tips and tricks for endoscopic negative pressure therapy.

Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.

Diagnosis, assessment, and management of surgical complications following esophagectomy.

Despite improvements in operative strategies for esophageal resection, anastomotic leaks, fistula, postoperative pulmonary complications, and chylothorax can occur. Our review seeks to identify potential risk factors, modalities for early diagnosis, and novel interventions that may ameliorate the potential adverse effects of these surgical complications following esophagectomy.

Update on the Treatment of Uveitis in Patients with Juvenile Idiopathic Arthritis: A Review.

Chronic uveitis is a common extra-articular manifestation of juvenile idiopathic arthritis. The classic clinical picture is one of chronic anterior uveitis, which usually remains asymptomatic until ocular complications arise. The risk of uveitis is increased in girls with an early onset of oligoarthritis and positive antinuclear antibodies. Even though the inflammation in patients with juvenile idiopathic arthritis is initially limited in the anterior part of the eye, chronic active inflammation may eventually cause significant damage to the posterior pole. Complications may include band keratopathy, cataract, secondary glaucoma, posterior synechiae, cystoid macular edema, and hypotony. The cooperation of ophthalmologists with rheumatologists may help define the best treatment plan. The ophthalmic therapeutic regimen includes topical corticosteroids and mydriatics, while in severe cases immunosuppressive and biological agents are introduced. Surgical management of complications might be needed.

Conceptual Study on Management of Surgical Complications of Prameha w.s.r to Diabetes and Its Management by Acharya Sushruta

Prameha is characterized by copious flow of cloudy or turbid urine and as a sequel pidakas will be formed which are again with all the tridosha vitiation. 1 The disease prameha may be correlated to diabetes depending upon the similar characteristics of these two entities. Diabetes mellitus is recognized as a syndrome characterized by chronic hyperglycemia due to relative deficiency of insulin or resistance or both. The common surgical complications are – macro vascular changes, micro vascular changes, diabetic neuropathy, and infection in glucose-laden tissue. Most common are carbuncles, diabetic foot, necrotizing fasciitis, and atherosclerosis. Acharya Sushruta has described 10 prameha pidakas which are considered to be the complications of diabetes. Understanding the pathology and breaking the pathology by time would help to prevent the establishment of such complications and thus reducing the morbidity and mortality. Application of concepts of Ayurveda such as – Following pathya ahara vihara periodically, usage of shodhana therapies . Raktamokshana in order to improve the blood circulation as well as removal of impurities through blood. Lekhana basti s can be adopted in the prevention and management of vascular related complications, which would decrease the risk of gangrene formation as well as cardiac complications. In case of established cases of diabetic ulcers – use of topical application of Shodhana Dravyas like Gomutra Arka, Guggulu Tiktaka Ghrita , and Ropana Dravyas . The Shodhana therapies would help the diagnosed cases to eliminate the toxins and thus prevent and manage the complications like atherosclerosis and other complications. Local foot care, ulcer care, improvement of blood circulation would prevent gangrene formation and thus reduce the chances of amputation.

Surgical rescue: The next pillar of acute care surgery.

The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications. Epidemiological study, level III; therapeutic/care management study, level IV.

Chapter 31 - Neurologic complications of cardiac and vascular surgery

This chapter will provide an overview of the major neurologic complications of common cardiac and vascular surgeries, such as coronary artery bypass grafting and carotid endarterectomy. Neurologic complications after cardiac and vascular surgeries can cause significant morbidity and mortality, which can negate the beneficial effects of the intervention. Some of the complications to be discussed include ischemic and hemorrhagic stroke, seizures, delirium, cognitive dysfunction, cerebral hyperperfusion syndrome, cranial nerve injuries, and peripheral neuropathies. The severity of these complications can range from mild to lethal. The etiology of complications can include a variety of mechanisms, which can differ based on the type of cardiac or vascular surgery that is performed. Our knowledge about neuropathology, prevention, and management of surgical complications is growing and will be discussed in this chapter. It is imperative for clinicians to be familiar with these complications in order to narrow the differential diagnosis, start early management, anticipate the natural history, and improve outcomes.

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

AIMTo study the early postoperative intensive care unit (ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).METHODSOur study is a retrospective, observational study performed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.RESULTSOf the 170 patients who underwent CRS and HIPEC therapy, 51 (30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d (range 1-60 d) and mean APACHE II score was 15 (range 7-23). Thirty-one/fifty-one (62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L (range 1-14 L). Thirteen patients (25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8 (15%) developing anastomotic leaks and 5 (10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4% (2/51) and 90 d mortality of 16% (8/51). One year survival was 56.4% (28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.CONCLUSIONOverall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.

Surgical management of adult spinal deformity: Indications, surgical outcomes, and health-related quality of life

Due to the aging population, as well as advancements in surgical and anesthetic technique, the rate of surgical intervention for adult scoliosis has increased. The consequences of spinal deformity regarding pain, disability, health-related quality of life, and mental health, as well as the risks and complications of surgical management can be substantial and wide reaching. Significant attention has been directed in describing which patients benefit from operative treatment and validating methods in assessing the postoperative outcomes (pain, function, self-image, mental health, and general health). In this context, the purpose of this article is to discuss the indications, outcomes, and the quality-of-life changes following surgical intervention for adult degenerative scoliosis.

Incidence and surgical treatment of synthetic mesh-related infectious complications after laparoscopic ventral rectopexy

Prosthetic-related infection and erosion occurring after a laparoscopic ventral rectopexy (LVR) are rare complications, and their importance is often underestimated. The aim of this study was to compare the incidence rate and surgical management of these complications in LVR patients with polyester (PE) or polypropylene (PP) prostheses. From January 2004 to June 2012, 149 patients underwent LVR with PE and 176 underwent LVR with PP. Surgical management and rate of infectious and erosive prosthesis-related complications, depending on the type of prosthesis, were described and compared. Functional results after complications were assessed. Five patients from the PE prosthesis group (3.3%), compared with two patients from the PP prosthesis group (1.1%), experienced prosthesis-related infection or erosion (p=0.16). The rate of erosion alone was 3.3% in patients with a PE prosthesis, and 0.55% in patients with a PP prosthesis (p=0.06). The average time until clinical diagnosis of a prosthesis-related complication was identical for both groups: 31months (range 3-62months). All patients underwent surgical removal of the prosthesis: For the five patients from the PE group, complete removal was performed by laparoscopy associated with a transanal procedure. For the two patients in the PP mesh group, laparoscopy was ineffective in removing the mesh which was partially removed through a subsequent transanal procedure. None of the patients had a protective stoma, and in all patients the complication had resolved 12months after removal. Only one patient had worsening functional symptoms (fecal incontinence) after prosthesis removal. When a prosthesis-related infection or erosion occurs, treatment consists in the surgical removal of the prosthesis by laparoscopy/and/or a transanal procedure. Functional symptoms do not routinely recur after prosthesis removal.