Mean Operation Time In Group Research Articles

Comparison between Endoloop-Assisted Endoscopic Resection and Endoscopic Submucosal Dissection for Large Pedunculated Polyps

Abstract Background Endoscopic resection of large pedunculated colorectal polyps with a thick stalk is technically difficult. Endoloop-assisted endoscopic resection and endoscopic submucosal dissection have been confirmed to be effective and safe, respectively. Here, we compared the efficacy and safety of these two different methods. Methods In total, 124 patients with large pedunculated polyps treated by endoloop-assisted endoscopic resection (group B) or endoscopic mucosal resection (group A) were enrolled in the study. Results There were two cases of immediate postpolypectomy bleeding and one case of delayed postpolypectomy bleeding in group A, while there were four cases of immediate postpolypectomy bleeding and 0 case of delayed postpolypectomy bleeding in group B. There was no significant difference in postpolypectomy bleeding between the two groups (p = 0.68 and 1.0). The mean operation time in group A was 29.31 ± 5.64 minutes, which was significantly longer than that in group B (p < 0.001). The mean hospitalization time in group A was 7.14 ± 1.1 days, but in group B it was 5.98 ± 1.18 days (p < 0.001). In addition, the number of clips used in group A was 5.58 ± 1.3, which was also more than that in group B (p < 0.001). Conclusions Endoloop-assisted endoscopic resection is effective and safe for the removal of large pedunculated polyps, while endoscopic submucosal dissection may be an alternative option for difficult areas with poor visibility or polyps with large or lobulated head.

Comparison of autologous venous grafts and three types of extracellular matrix grafts in Peyronie's disease surgery.

Peyronie's disease (PD) is known as a wound-healing disorder for which surgery remains the gold-standard treatment, but studies comparing graft materials are limited in the literature. The aim of this study was to evaluate the mid- and long-term results of patients who underwent surgery for PD with grafting procedures performed by a single experienced surgeon according to graft materials. Patients who underwent corporoplasty between 2014 and 2020 with grafting procedures performed by a single experienced surgeon were retrospectively reviewed. A total of 115 patients were divided into 4 groups according to the grafting material used: autologous saphenous venous grafts, Group 1 (n = 36); porcine pericardial extracellular matrix grafts (EMGs; XenoGuard, MBP Medical Biomaterial Products GmbH, Neustadt-Glewe, Germany), Group 2 (n = 40); porcine intestinal submucosal EMGs (BioDesign, Cook Medical, Bloomington, IN, USA), Group 3 (n = 36); and bovine pericardial EMGs (Tutopatch, Tutogen Medical, Inc., Alachua, FL, USA), Group 4 (n = 43). The mean operation time for Group 1 was longer than that of the other groups (p < 0.001). When comparing the groups in pairs, it was observed that the duration of postoperative loss of sensation (LOS) was significantly shorter in Group 3 (12.3 ± 5.3 days) and Group 4 (15.1 ± 3.1 days) (p < 0.05). There was a statistically significant difference between Groups 1 and 4 in penile length loss when the groups were compared in pairs (p = 0.017). There was a statistically significant difference between patients with penile curvatures of 0° to 59° and patients with curvatures of ≥60° in terms of duration of postoperative LOS (14.4 ± 5 vs. 16.4 ± 5.8 days, respectively; p = 0.028) and penile length loss (2.6 ± 5 vs. 5.7 ± 6.8 mm, respectively; p = 0.002). The findings suggest that EMGs should be preferred to autologous venous grafts due to reduced postoperative erectile dysfunction, shorter operation time, and shorter recovery time for LOS.

Comparative Study Between Autologous Platelet-rich Fibrin Membrane and Local Flaps as Intervening Layer in Management of Distal Hypospadias

Background/PurposeThe most frequent complication following hypospadias correction is fistula formation. Recently, fibrin glue has been employed as a 2nd layer covering the urethroplasty resulting in a reduction in the incidence of fistulas. Platelet-rich fibrin (PRF) is an autologous growth factor-rich source. Although the authors recommend the use of additional layers in hypospadias correction, there remains a controversy. In a trial to address this issue, our research was conducted to compare the accessibility of urethroplasty coverage using PRF to traditional local flaps, aiming to prevent fistula formation in hypospadias repair. Patients and methodsThis is a prospective single-blinded randomized controlled study that involved 60 hypospadias cases admitted to Mansoura University Children Hospital's Pediatric Surgery department between March 2021 and March 2023. These 60 cases were randomly divided into 2 equal groups: (group A platelet-rich fibrin coverage membrane & group B local dartos flap as an additional layer). Both groups were compared regarding the rate of complications. All cases were evaluated regarding age at repair, type of hypospadias, urethral plate width, length of urethroplasty, and size of the 2nd layer. The blood loss and operative time were documented and post-operatively; the cases were assessed for the repair intactness, shape, and size of the neo-meatus, existence of any post-operative problems such as urethral fistula, urethral stricture, meatal stenosis, failure of the repair, or diverticulum. Statistical analysis was carried out following data collection. ResultsThe median length of the 2nd layer in group A was 20 mm (range 15–23 mm) and in group B was 22.5 mm (range 19.5–25 mm) and the difference between the two groups was statistically significant (p = 0.012∗), while its median width in group A was 10 mm (range 10–11 mm) and in group B was 15 mm (range 10–18 mm) and also there was statistically significant difference (p = 0.001∗). The mean operative time in group A was 95.73 ± 11.9 min and in group B was 102.33 ± 10.32 min and there was a statistically significant difference (P < 0.001). The length of hospital stay in group A was 5.47 ± 1.11 days and in group B was 5.47 ± 0.89 days. The urethral fistula was detected in 4 cases of group A (13.3%) and 3 cases of group B (10%). The failure of repair was similar, one case of each group (3.3%). The meatal stenosis was reported in only one case of group A (3.4%) and 7 cases of group B (24.1%) (P = 0.02∗) and the difference was statistically significant. There were no reports of urethral strictures among the cases in either group over the follow-up period (mean 9 months, range 5–17 months). ConclusionPRF patch may be employed as a coverage layer over the urethroplasty in repair of the distal hypospadias, especially in cases without accessible vascular flap with comparable outcome to traditional local flaps. Type of studyA prospective single blinded randomized controlled trial (computer-generated numbers method). Level of evidenceLevel 2.

Laparoscopic vs Open Orchiopexy for Palpable Undescended Testis in Children

Abstract Background Cryptorchidism is the absence of one or both testes in the scrotum and is generally synonymous with undescended testis. Undescended testis is the most common genital disorder identified at birth. Undescended testes occur in 1–3% of full-term and up to 45% of preterm male neonates. Approximately 80% of undescended testes are clinically palpable and 20% are non-palpable. Aim of the Work To compare between laparoscopic and open orchiopexy evaluating final testicular position, success rate, and complications. Patients and Methods A prospective comparative study was made in Urology department, Ain Shams University Hospital for Twelve months starting from 1st of June 2021 to 1st of May 2022 on 50 children (aged from 1-18 years) with UDT and were included in the study and divided in to 2 groups 25 for each study group. Results In the present study the mean age in group I was 8.1± 0.99 y and in group II was 9.28± 0.91 y with no significant difference. The mean operative time in group I was 63.6 ± 5.56 min, and in group II was 58.44. ± 5.28 min with no statistically significant difference. There was in group I all the studied cases had no testicular atrophy, no testicular ascent, no need for redo-orchiopexy and a hernial sac was detected in all cases. In group II all the studied cases had no testicular atrophy, 92% had negative testicular ascent and 96% had a hernial sac. As regard to complications, only 2 patients presented with wound infection in group I and in group II there were a case with wound infection, a case with hydrocele and 2 cases with scrotal haematoma with no significant difference. Conclusion For the treatment of inguinal cryptorchidism, laparoscopic orchiopexy is a safer and less invasive option than open groin surgery. In children with palpable undescended testis, laparoscopic orchiopexy is linked with improved testicular position and a better success rate as open orchiopexy.

Can e-TEP be a Better Option than TEP for Inguinal Hernia Repair?

Background: An organ or fatty tissue, like the colon, might abnormally emerge through the wall of the cavity in which it normally resides, for making a hernia. Among different hernias inguinal hernia repair is the most frequently done procedures by surgeons in Bangladesh and worldwide. Now-a-days Laparoscopic repair is performed in this country and accepted by the people. Laparoscopic TEP and e-TEP are excellent procedure for repair of inguinal hernia. In this Centre, we performed both procedures. In Technical aspects e-TEP is better approachable than TEP. Objective: In this article we present how to overcome the difficulties of TEP technique by doing the enhanced view totally extra peritoneal technique for repair of inguinal hernia. Methods: It is a non-randomized comparative study. The study consists of patients with laparoscopic hernioplasty for the period of one year (From July 2018 to July 2019). Total 20 cases were included in the study (10 cases of Laparoscopic e-TEP and 10 cases of Laparoscopic TEP). Data were collected by follow up visit, questionnaire and by phone call. Results: The study consists of 20 patients among whom 10 were placed in group A (e-TEP group) and 10 cases were placed in group B (TEP group). Mean operating time in group A was 108.5 min while in group B was 114 min. Pain scoring in group A was 75% and giving score 1-2 (mild pain). All are male. Mean age for e-TEP was 26.5 years and for TEP was 35.6 years. Conclusion: Laparoscopic e-TEP provides wide area than TEP for repair of inguinal hernia. It is a surgeon friendly procedure for repairing hernia. It is easier to learn e-TEP than TEP. JAFMC Bangladesh, Vol 19, No 2 (December) 2023: 21-23

Evaluation of the feasibility of endoscopic tympanoplasty in two-person three-hand operation

Objective:To study the difference of postoperative efficacy between two-person three-hand ear endoscopy and microscopic tympanoplasty in patients with chronic suppurative otitis media, and to explore the advantages and disadvantages of two-person three-hand ear endoscopy. Methods:A retrospective study was conducted on 100 patients who underwent tympanoplasty in the Department of Otolaryngology and Head and Neck Surgery of Hunan People's Hospital from April 2019 to March 2023, and they were divided into 2 groups with 50 cases each according to random number table method. Among them, 50 cases underwent endoscopic tympanoplasty in two-person three-hand（group A） and 50 cases underwent routine microscopic tympanoplasty（group B）. The operation and postoperative conditions of the two groups were followed up. Results:In group A, the mean operation time was（65.78±18.21） min, the mean intraoperative blood loss was（12.94±4.46） mL, the postoperative pain score was（1.82±0.60） points, and the mean postoperative hospital stay was（2.76±0.72） d. The mean operation time of group B was（89.45±20.38） min, the mean intraoperative blood loss was（22.78±5.74） mL, the postoperative pain score was（2.98±0.85） points, and the mean postoperative hospital stay was（3.82±0.75） d, which with statistical significance between the two groups（P<0.05）. Hearing in both groups was significantly improved 6 months after surgery, and the difference was statistically significant before and after surgery（P<0.05）, but there was no significant difference between the two groups before surgery and 6 months after surgery（P>0.05）. There were 2 cases in group A（4%） and 1 case in group B（2%） complicated with tympanic cord injury during operation, and the difference was not statistically significant（P>0.05）. There were 47 cases of A group（94%） of one-time healing of tympanic membrane after operation, 48 cases（96%） of group B, and the difference was not statistically significant（P>0.05）. Conclusion:There is no significant difference in cure rate and hearing improvement between two-person three-hand ear endoscopic tympanoplasty and conventional microscope surgery, and the operation time is significantly shortened, the amount of blood loss is less, and the postoperative recovery is faster. It has the advantages of clear operating field, two-person three-hand operation, minimally invasive, and can reach the range of middle ear tympanic sinus and mastoid apex, and the surgical complications are seldom, which is worth promoting.

Laparoscopic Versus Open Surgical Management of Hydrocele of the Canal of Nuck: A Retrospective Analysis of 20 Cases.

Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling.The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery. The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed. The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score amongpatients of Group A at all intervals (p-value< 0.001, p-value = 0.005, p-value = 0.005, p-value< 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison. The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.

Evaluation of intra-operative trans-urethral endoscopic management of possible open transvesical prostatectomy complications

ObjectiveTo evaluate the benefits of using transurethral cystoscope and resectoscope for managing possible complications that may occur during open transvesical prostatectomy operation.BackgroundOpen transvesical or retropubic prostatectomy remains, in less technologically developed countries, the standard option for treatment of complicated large benign prostatic hyperplasia. Complications rate with open prostatectomy procedures, especially post-operative bleeding and urinary incontinence, represent a real challenge facing urologists. Hopefully, recent advances in endourology section helped greatly in management of complicated benign prostatic hyperplasia and also offered a tool to deal with possible open prostatectomy complications.Patients and methodsIn a prospective study, fifty (50) male patients with complicated large benign prostatic enlargement associated with large single or multiple bladder stones with stone burden ≥ 3cm3 planned to undergo transvesical prostatectomy divided randomly into two groups. Group (A) included 25 patients who underwent standard T.V.P. and group (B) included 25 patients in whom diagnostic urethro-cystoscopy and a mono-polar resectoscope were used pre- and post-prostatic adenoma enucleation. Patients had follow-up evaluation visits at 1, 3 and 6 months postoperatively to evaluate IPSS, post-void urine estimation, Qmax., and quality of life.ResultsA total of 50 patients were divided equally into two groups. Group (A) included 25 patients who underwent standard transvesical prostatectomy, while group (B) included 25 patients who underwent initial diagnostic urethro-cystoscopy, then bilateral ureteric catheter insertion, followed by prostatic apical demarcation using a monopolar resectoscope. Finally, transurethral hemostasis of the prostatic bed is done after standard transvesical adenoma enucleation. Mean operative time in group (A): 48.3 ± 12.4 min. while in group (B): 68.9 ± 14.1 min (p < 0.001), Hemoglobin deficit in group (A): 2.8 ± 1.1 g/dl. while in group (B): 1.1 ± 0.39 g/dl. (p < 0.001). Enucleated prostate volume in group (A): 89.2 ± 16.1g, while in group (B): 91.2 ± 17.2g (p = 0.673). Post-operative IPSS, Post-void residual urine and Qmax showed insignificant differences between the two groups.ConclusionTrans-urethral endoscopically assisted transvesical prostatectomy provides more safety and fewer morbidities and complications rate compared to standard T.V.P.

Safety analysis of immediate breast reconstruction with a deep inferior epigastric perforator (DIEP) flap in the post-COVID-19 era: a comparison between pre- and post-pandemic cohorts.

The demand for immediate breast reconstruction with a deep inferior epigastric perforator (DIEP) flap is recovering as coronavirus disease 2019 (COVID-19) transitions from a pandemic to an endemic. This study sought to evaluate the safety of resuming DIEP flap reconstruction in the post-COVID-19 era. Consecutive breast cancer patients who underwent immediate breast reconstruction with a DIEP flap at the Comprehensive Breast Health Center, Ruijin Hospital were retrospectively included in the study. The patients were divided into a post-pandemic group (Group A) and a pre-pandemic group (Group B). The clinicopathological factors, surgical procedures, and rates of post-operative complications were compared between the two groups using the Mann-Whitney U test and Chi-squared test. A total of 167 patients were included in the study, of whom 119 (71.3%) were in Group A and 48 (28.7%) were in Group B. The two groups had similar clinicopathological features, including age (P=0.988), body mass index (P=0.504), and tumor, node, metastasis (TNM) stage (P=0.932). The Group A patients were more likely to receive single perforator DIEP flap transplantation than the Group B patients (n=28, 22.8% vs. n=3, 5.8%, P=0.007). There was a numerical decrease in the mean operating time of Group A patients compared to Group B patients (9.82 vs. 10.12 hours, P=0.172). The mean length of stay after the surgery was significantly shorter after the pandemic than before the pandemic (11.2 vs. 14.3 days, P<0.001). The complication rates between the two groups were similar. This study provides evidence that resuming DIEP reconstruction is safe in the post-COVID-19 era.

Introducing a novice surgeon to an experienced robotic gynaecological oncology team: An observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery

ObjectiveTo evaluate the effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team treating cervical cancer patients. MethodsPatients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019 were retrospectively included. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all 226 patients over three groups: early learning phase of 61 procedures without structured training (group 1), experienced phase of 104 procedures (group 2), and the 61 procedures during introduction of a novice with structured training (group 3). Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to assess the learning curve effect. Patient outcomes between the groups were compared. ResultsBased on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 (p < 0.001) and similar to group 2 (p = 0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. ConclusionsIntroducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.

Laparoscopic assisted dismembered pyeloplasty versus open pyeloplasty in UPJO with poorly function kidney in pediatrics

BackgroundThe management of UPJO with poor function kidney, less than 10%, has been the subject of debate for more than a decade. Some authors have recommended nephrectomy, while others favor renal salvage (pyeloplasty). We report our experience with laparoscopic assisted pyeloplasty in pediatric patients with poorly functioning kidneys in comparison with an open approach.Materials and methodsA retrospective study was conducted to review 65 patients who were diagnosed with hydronephrosis and had impaired renal function due to UPJO. The study was conducted in the pediatric surgery departments of Al-Azhar University Hospital and Fattouma Bourguiba University Hospital of Monastir over a period of 20 years. Limited to pediatric patients with UPJO with ≥ Grade III hydronephrosis, antero-posterior pelvic diameter ≥ 20 mm, as well as a renal function equal to or less than 10%, was corrected by laparoscopic assisted or open pyeloplasty.ResultsThere were 40 cases in group A who underwent laparoscopic assisted pyeloplasty, and 25 cases in group B who underwent open pyeloplasty. There were no complications or difficulties during the operation. The mean operative time in group A was 90 ± 12 min, while in group B, it was 120 ± 11 min. The renal assessment parameters significantly improved in both groups. In group A, the mean split renal function was 7.9 ± 1.3% and increased to 22.2 ± 6.3%. In group B, the mean split renal function was 8.1 ± 1.1% and increased to 24.2 ± 5.1%. However, the differences between both groups in terms of pre-operative and post-operative renal functions were statistically insignificant.ConclusionLaparoscopic assisted pyeloplasty is an effective treatment for patients with poorly functioning kidneys, especially those with less than 10% function. While this surgical procedure requires shorter operative times, it yields functional outcomes that are comparable to open approach.

Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

ObjectiveThe traditional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, intraoperative repair of the PQ muscle often fails due to tissue injury and unstable muscle repair. This study compared the outcomes of different methods of sparing the PQ muscle combined with the volar plate in treating distal radius fractures.MethodsA total of 95 patients with distal radius fractures sparing the PQ muscle were enrolled with the brachioradialis (BR) splitting approach (group A, 33 people), the volar plating insertion PQ muscle approach (group B, 35 people) and traditional Henry approach without sparing PQ muscle (group C, 27 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the three groups. The visual analog scale (VAS) of postoperative wrist pain was compared between three groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy.ResultsA total of 95 patients with distal radius fractures were followed up for more than one year after surgery. All fractures obtained good union, with no vascular injury, nerve injury or wound infection. Outcomes at three days, one month and three months all showed no significant differences in postoperative imaging indexes among three groups and no significant differences in various indexes among three groups during the same period. The mean operative time in group C was significantly lower than that in groups A and B. There was significant difference in the mean operation time between group A and group B. The amount of mean operative blood loss or mean bone union time in groups A and B was significantly lower than those in group C. No significant difference was shown in mean operative blood loss or mean bone union time between group A and group B. No significant differences in limb function scores, VAS scores and the mean range of motion existed among three groups at the 12-month postoperative follow-up. However, outcomes assessed one week, one month and three months after surgery demonstrated significant differences in the VAS scores and the mean range of motion among three groups, and the group B had lower VAS score and greater the mean range of motion. According to Dienst score, the excellent rate in groups A, B and C was 91.0% (30/33), 94.2% (33/35) and 85.2% (23/27), respectively, at 12 months after surgery. Tendon irritation occurred in 2 cases and joint stiffness in 1 case in group A. In group B, there were 2 cases traumatic arthritis and 2 cases delayed carpal tunnel syndrome and 1 case tendon irritation. In group C, tendon irritation and delayed carpal tunnel syndrome occurred, respectively, in 3 cases.ConclusionOur results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. The volar plating insertion PQ muscle approach could reduce early postoperative pain, promote early activity and return to normal life, while the BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. At 12 months of follow-up, no significant advantage was seen in sparing the PQ muscle. Therefore, surgeons should be aware of their individual characteristics and choose patients carefully.

The effect of tonsilla fossa cooling with gauze soaked in ice-cold after tonsillectomy in monopolar electrodissection

Purpose: Tonsillectomy was one of the most popular surgical procedures in otorhinolaryngology. Postoperative pain was troublesome and optimal management seems to be still insufficient. Only a few studies appropriately investigated the effect of non-pharmacological treatments and this is the purpose of our study. Aim: the effect of tonsilla fossa cooling with gauze soaked in ice-cold after tonsillectomy. Materials and Methods: Sixty two patients were scheduled for bilateral tonsillectomy in monopolar electrodissection from 2021 June to 2022 June. Results: the reason for hospitalization was sore throat for group I and group II (83.9% and 45.2%, respectively). For group I, sore throat was the most common symptom (87.1%) while dysphagia was the most common symptom for group II (67.7%). The mean operative time for group I was 39.03 ± 15.46 and 50.65 ± 14.36 for group II (p &lt; 0.05). Pain scores have significantly been lower for group I as compared to group II at all time (p &lt; 0.05). Conclusion: Tonsilla fossa cooling with gauze soaked in ice-cold after tonsillectomy was a useful method in reducing postoperative pain without any main adverse effects Key words: tonsillectomy, monopolar electrodissection, tonsilla fossa cooling, postoperative pain.

A Comparative Study between Onlay versus Sublay Mesh Repair in Treatment of Midline Incisional Hernia

Abstract Background Incisional hernia is a common complication following laparotomy and is the most common indication for reoperation. However, the optimal approach for its repair is still a matter of debate. Aim of Study The aim of this study was to compare between onlay and sublay mesh repairs in treatment of midline incisional hernia regarding the operative technique and postoperative complications. Patients and Methods This randomized controlled prospective comparative study was conducted in general surgery department Ain-Shams University Hospital and Damanhour Medical National Institute in the period between November 2019 and April 2020. It included 40 patients with Midline incisional hernia who were randomly divided into two equal groups: A (treated with sublay repair) and B (treated with onblay repair). Results The mean operative time in group A was 104.2 minutes and in group B was 82.9 minutes. The mean time of drain removal in group A was 4.3 days while in group B was 13.6x days. Seroma formation after drain removal was not recorded in any patients of group A while it occurred in 4 patients in group B (20%). The other postoperative complications were comparable in both groups. During 6 months of follow up, hernia recurrence didn’t occurs in any patient in group A nor group B. Conclusion Sublay mesh repair of incisional hernia is a good alternative to onlay repair. It is applicable to all sites of incisional hernia with a low recurrence rate and acceptable complication rates.

Laparoscopic common bile duct exploration with primary closure could be safely performed among elderly patients with choledocholithiasis

BackgroundFor patients with choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is preferred over open surgery. Whether primary closure of the common bile duct (CBD) should be performed upon completion of choledochotomy remains unclear, and the corresponding indications for primary closure of the common bile duct have yet to be fully identified. This study was performed to evaluate the safety and feasibility of primary closure of CBD among elderly patients (≥ 70 years) after LCBDE.MethodsPatients with choledocholithiasis who had undergone LCBDE with primary closure of the CBD between July 2014 and December 2020 were retrospectively reviewed. Included patients were assigned into two groups (Group A: ≥70 years and Group B: <70 years) according to age. Group A was compared with Group B in terms of preoperative characteristics, intraoperative results and postoperative outcomes.ResultsThe mean operative time for Group A was 176.59 min (± 68.950), while the mean operative time for Group B was 167.64 min (± 69.635) (P = 0.324). The mean hospital stay after surgery for Group A was 8.43 days (± 4.440), while that for Group B was 8.30 days (± 5.203) (P = 0.849). Three patients in Group A experienced bile leakage, while bile leakage occurred in 10 patients in Group B (3.8% vs. 4.5%, P = 0.781). Group A was not significantly different from Group B in terms of postoperative complications and 30-day mortality except pneumonia (P = 0.016), acute cardiovascular event (P = 0.005) and ICU observation (P = 0.037). After a median follow-up time of 60 months, 2 patients in Group A and 2 patients in Group B experienced stone recurrence (2.5% vs. 0.9%, P = 0.612). One patient in Group A experienced stenosis of the CBD, while stenosis of the CBD occurred in 5 patients in Group B (1.3% vs. 2.2%, P = 0.937).ConclusionsPrimary closure of CBD upon completion of LCBDE could be safely performed among patients ≥ 70 years.

Role Of CO2 Laser & Microdebrider In The Treatment Of Juvenile Onset Recurrent Respiratory Papillomatosi.

To compare the efficacy of two main treatment modalities of microdebrider and carbon dioxide laser excision for juvenile onset recurrent respiratory papillomatosis. The retrospective study was conducted in May 2021 at the Combined Military Hospital, Kharian, Pakistan, and comprised data from July 1, 2007, to January 31, 2020, of patients of either gender aged 2-12 years who were treated for juvenile onset recurrent respiratory papillomatosis either with microdebrider excision in group A or carbon dioxide laser excision in group B. Extent and severity of disease was documented as per the Derkay-Coltrera grading system. Data was analysed using SPSS 20. Of the 39 patients, 23(59%) were girls and 16(41%) were boys. The overall mean age at the time of procedure was 6.62±2.06 years. Group A had 22(56.4%) subjects; 15(68.2%) girls and 7(31.8%) boys, while group B had 17(43.6%) cases; 8(47%) girls and 9(53%) boys. The mean operative time for group A was 40.91±11.50 minutes and for group B it was 60.59±19.51 minutes. Postoperative breathing and oedema status was better for group A (p<0.05), while there was no significant difference regarding postoperative pain, residual disease and repeat surgeries (p>0.05). Microdebrider was found to be superior to carbon dioxide laser excision in the treatment of juvenile onset recurrent respiratory papillomatosis.

Anterior Cervical Discectomy and Fusion by Using Bone Graft and Plate Versus Using Zero Size Peek Cage Filled with Bone Graft and Inbuilt Screws

Objective: The purpose of this study was to compare the clinical and radiological results of employing local bone graft with a PEEK cage vs bone graft and plate in ACDF. Study Design: Retrospective study Place and Duration: Department of Neurosurgery, Gomal Medical College DI Khan in the period from June, 2022 to November, 2022. Methods: There were 80 cases of both genders were included for anterior cervical discectomy and fusion. Detailed demographic information on enrolled cases was recorded after receiving informed written consent. Patients were divided in two groups. Group I received ACDF by using bone graft and plate in 40 cases while in 40 cases of group II ACDF was performed by using zero size peek cage filled with bone graft and inbuilt screws. Outcomes among both groups were compared. SPSS 22.0 was used to analyze all data. Results: Among 80 cases, there were 46 (57.5%) males and 34 (42.5%) females. Mean age of the patients was 43±18 years. Perioperative mean pain score was 7.5±6.20, mean NDI was 62.4±2.8, mean SF-36 was 29.8±3.15 in group I and in group II mean pain score was 6.9±5.20, NDI was 64.8±3.10 and SF-36 was 30.5±4.13. Significantly reduction in pain score, NDI and increase in SF-36 among both groups were found while in group II outcomes were better than group I. Mean operative time in group I was higher as compared to group II with p value &lt;0.004. There was no any significantly difference in blood loss among both groups. With a p value of 0.003, group II had higher disc space height and segmental interbody angle at the operative segment than group I. Perioperative complication rates in group I was higher with p value &lt;0.05. Conclusion: In this study, we found that patients undergoing ACDF with local bone graft and a PEEK cage had significantly shorter operating times, fewer perioperative problems, and better radiological outcomes than patients undergoing ACDF with bone graft and plate. A PEEK cage-encased local bone graft seems to be a secure substitute for an ACDF's bone transplant. Keywords: Cervical spine, Anterior cervical discectomy and fusion, bone graft, Local bone graft

Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR).

Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes. A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded. Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001). RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

Comparative study of laparoscopic versus open surgery in cases of liver hydatid cysts

Background: Hydatidosis is a zoonotic infection, and treatment is mandatory to avoid complications. The infection can be asymptomatic or severe, causing extensive organ damage and even death of the patient. Aims and Objectives: The main aim of this study is to find out the merits and demerits of laparoscopy over that of open surgery in the treatment of hydatid cysts of liver. Materials and Methods: This prospective observational study was done on 50 patients who had liver hydatid disease admitted in the Department of Surgery, Shyam Shah Medical College Rewa (M.P.). Patients were divided into two groups consisting of 25 cases in each. Group A: managed by laparoscopic surgery and Group B: managed by open surgery. Results: The mean operative time in Group A was 99.6 min, while in Group B, it was 140.4 min. Group A patients were mobilized early and resumed duty very fast then Group B. The mean duration of stay in hospital was 8.64 days (range: 4–20 days) in Group A and 11.84 days (range: 4–12 days) in Group B. Wound infection seen in 9 patients in Group B and 0% in Group A. General complication rate was 32% in Group B and 8% in Group A. No recurrence noticed in either group during follow-up. Conclusion: Overall laparoscopic management of liver hydatid cyst is cost-effective in terms of early mobilization, early discharge, and early resumption of work along with cosmetic benefit.

A Randomized Controlled Study of Robot-Assisted versus 3D Laparoscopic Radical Prostatectomy in Patients with Carcinoma Prostate.

A prospective randomized comparative study was performed from 1st January 2020 to 30th June 2021. All patients included were diagnosed with localized/locally advanced ca prostate. 60 patients fulfilling the inclusion and exclusion criteria were randomized into 2 groups. Groups A and B included patients who underwent robot-assisted radical prostatectomy and 3D laparoscopic transperitoneal radical prostatectomy, respectively. Various demographic, intraoperative, postoperative, and follow-up parameters were collected. Outcomes were evaluated in the form of the trifecta (continence, potency, and BCR-free status) and pentafecta rates (trifecta with no perioperative complications and negative surgical margins) in between the two groups. The mean operative time in Group A was 137.83 mins ± 17.27 compared to 148.20 mins ± 26.16 in Group B. Trifecta rates in Group A and Group B were 43.3%, 63.3%, and 76.6% and 40%, 53.3%, and 70% at 1, 3, and 6 months. Pentafecta rates in Group A and Group B were 36.6%, 53.3%, and 70% and 33.3%, 40%, and 53.3% at 1, 3, and 6 months. Complication rates were 10% in Group A and 13.3% in Group B, respectively. Only one patient in our study (Group B) had a positive surgical margin. We conclude from our comparative study, that both robot-assisted and 3D laparoscopic transperitoneal radical prostatectomy are feasible and efficacious treatment modalities for achieving acceptable trifecta and pentafecta rates in managing ca prostate with earlier continence and shorter urethrovesical anastomosis time in the robotic arm.