Mean Postoperative Day Research Articles

Eliminating Use of Home Oral Antibiotics in Pediatric Complicated Appendicitis

BackgroundPostoperative oral antibiotic management at discharge for perforated appendicitis varies by institution. A prior study at our institution led to a decrease in antibiotic therapy in patients without leukocytosis. A subsequent protocol change eliminated the white blood cell count check and oral antibiotics if discharge criteria were met by postoperative day seven. We hypothesized this change could be made without an increase in abscess or readmission rates. MethodsWe conducted a retrospective review of patients with perforated appendicitis over two 1-year periods after institutional review board approval (262061). In the pre-protocol group, a white blood cell count was checked at discharge and patients with leukocytosis were prescribed oral antibiotics to complete a total of 7 d. In the post-protocol group, no white blood cell count was checked and patients were discharged home without antibiotics. ResultsThere were a total of 174 patients with complicated appendicitis in the two 1-year periods with 129 (74%) patients with perforated appendicitis discharged before postoperative day seven. The pre-protocol group included 71 children, and post-protocol included 58 children. There were no differences between mean postoperative days to discharge (2.57 versus 3, P = 0.0896), postoperative abscess rate (12.7% versus 12.1%, P = 1.0000), or readmission rate (12.7% versus 17.2%, P = 0.6184). None of the patients in the post-protocol group were discharged home with oral antibiotics compared with 22.5% in the pre-protocol group (P < 0.001). ConclusionsFor pediatric patients with perforated appendicitis discharged before postoperative day seven, stopping antibiotics at the time of discharge significantly decreased our home antibiotic use without an increase in postoperative morbidity.

Pericardiectomy for constrictive pericarditis in a resource constraint setting.

IntroductionConstrictive pericarditis is the endpoint of the natural history of acute pericarditis of different aetiologies where a chronic inflammatory process results in a thickened, fibrotic and inelastic pericardium with consequent impairment of diastolic function and systemic congestion.AimTo evaluate the clinical features, diagnosis, surgical management and outcome of patients with constrictive pericarditis as managed in a local setting of a tertiary hospital in Ghana.Material and methodsA retrospective review of the medical records of patients who had undergone pericardiectomy for constrictive pericarditis at a teaching hospital.ResultsTen patients underwent pericardiectomy for the period of study. There were 8 (80%) males and 2 (20%) females. The mean age was 20.4 ±17.2 years. Six of the patients 6 (60%) were in NYHA class III. Preoperative diagnostics included chest X-ray, echocardiography, and computed tomography scan. The surgical approach for the pericardiectomy was median sternotomy. The mean operative time was 159.9 ±43.0 min. The mean postoperative days spent before being discharged was 6.9 ±2.3 days. Nine (90%) of the patients were in NYHA class I after a mean follow-up of 19.3 ±16.7 months. One patient died 6 weeks after surgery with heart failure and one patient was lost to follow-up.ConclusionsSurgical pericardiectomy via median sternotomy is still the standard modality of treatment for constrictive pericarditis with excellent results even in resource constraint settings.

Timing and Success of Postoperative Voiding Trial After Colpocleisis With and Without Concomitant Midurethral Sling

The aim of this study was to compare failure rates of first voiding trial (VT) within 7 days and on postoperative day (POD) 1 after colpocleisis with versus without concomitant midurethral sling (MUS). Predictors of POD 1 VT failure were also examined. This was a retrospective cohort study of women undergoing colpocleisis from January 2012 to October 2019 comparing VT outcomes with versus without MUS. Primary outcome was first VT failure within 7 days; outcomes of VTs performed on POD 1 were also assessed. Association between MUS and VT failure and predictors of POD 1 VT failure were assessed via logistic regression. Of 119 women, 45.4% had concomitant MUS. First VT was performed on mean POD 3.1 ± 2.2 in the MUS group versus POD 1.8 ± 1.8 in the no MUS group (P < 0.01). The MUS group was less likely to undergo POD 1 VT (50% vs 83%, P < 0.01). Failure of the first VT did not differ (22.2% with MUS vs 32.8% without MUS, P = 0.20); no association between VT failure and MUS was noted (adjusted odds ratio [aOR], 0.6; 95% confidence interval [CI], 0.18-2.1). There were 68.1% (81/119) of participants who underwent POD 1 VT, MUS was performed in 33.3% (27/81). The POD 1 failure did not differ between those with 33.3% versus 40.7% without MUS (P = 0.52). Midurethral sling was not associated with POD 1 VT failure (aOR, 0.93; 95% CI, 0.27-3.23). In women undergoing POD 1 VT, preoperative postvoid residual was associated with VT failure (aOR, 1.39; 95% CI, 1.01-1.92). In women undergoing colpocleisis, MUS was not associated with VT failure within 7 days or on POD 1. Increased preoperative postvoid residual was associated with POD 1 VT failure.

To study the effect of limbal relaxing incision on pre existing astigmatism in SICS cataract surgery

Aim: To assess pre-existing astigmatism and to evaluate the effect of limbal relaxing incision on pre-existing astigmatism post-operatively in patients undergoing SICS cataract surgery. Materials and Methods: The study was conducted in the Department of Ophthalmology at Nehru Hospital attached to B.R.D. Medical College, Gorakhpur from period of July 2016 to June 2017. Study Design: This study is a comparative observational study. All the surgeries were performed by one surgeon. Study Group: patients meeting the inclusion criteria i.e. 1-3 D astigmatism as per keratometric readings. Results: A total of 90 patients were included in the study. Mean age 58.19 ± 7 years(range 30-70yrs). Mean pre-operative astigmatism of 1.44 ± 0.39D was found in these patients. Data analyzed demonstrated statistically significant reduction in the mean post-operative day 30 astigmatism in the LRI group to 0.54 ± 0.34 D (range: 0 to 2.5) from 1.31 ± 0.38 D (range: 1 to 3 D) preoperatively as compared to control group to 1.19 ± 0.56 D (range: 0 to 2.5) from 1.57 ± 0.37 D (range: 1 to 3 D) preoperatively, p-value 0.0001. There were no intraoperative complications or postoperative subjective complaints in our patients. Conclusion: Limbal relaxing incisions performed during SICS cataract surgery appear to be effective as well as safe procedure to reduce pre-existing corneal astigmatism. Keywords: LRI, SICS, Cataract, Astigmatism.

Canadian Postoperative Dependency Protocols Following Lower Limb Microvascular Reconstruction: A National Survey and Literature Review

Microsurgical free tissue transfer for lower limb reconstruction presents unique challenges in the postoperative period where dependency promotes interstitial fluid diffusion and reduced tissue perfusion. Management of flap edema, venous congestion, and ischaemic conditioning is critical for flap survival. Little evidence exists to guide postoperative protocols in the initiation and progression of lower extremity dangle, monitoring, and anticoagulation. We aim to describe current trends for postoperative dependency protocols by surveying Canadian microsurgeons. Plastic surgeons performing lower limb microvascular reconstruction at Fellow of The Royal College of Surgeons of Canada approved teaching institutions were administered a 17-question anonymous electronic survey. A literature review was conducted to identify protocols and consensus opinions in other jurisdictions. All respondents (n = 16) monitored flaps clinically, with conventional Doppler used by 13 respondents. Anticoagulation was employed by 15 of 16 respondents, and 9 of 16 used 2 or more agents. The most common agents were aspirin, followed by low-molecular-weight heparin. Significant variability existed in dangling protocols. Dependency was initiated at postoperative day (POD) 3 to 10 (mean POD: 6 ± 1.64 standard deviation), with intervals ranging from 5 to 20 minutes and frequencies ranging from 1 to 6 times per day. Nearly half allowed both increasing duration and frequency of dependency. Flap success rates were above 90%, and the median length of stay was 10 to 12 days. While flap success rates across the country are similar, no consensus exists for postoperative dependency protocols amongst Canadian microsurgeons. Prospective randomised controlled trials are warranted to evaluate early aggressive dependency protocols to reduce length of stay and cost.

Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life.

Xen implantation in patients with primary open-angle glaucoma: comparison of two different techniques.

To compare retrospectively two different techniques of Xen implantation, which are transconjunctival (ab-externo) and standard (ab-interno) techniques. Forty-three eyes of 43 patients with primary open-angle glaucoma (POAG) who had Xen implantation operation via transconjunctival (ab-externo) technique comprised Group 1. Of the 43 patients, 20 (46.5%) were males and 23 (53.5%) were females. Their mean age was 61.76 ± 8.81 (41-74) years. Forty-four eyes of 44 patients with POAG who had Xen implantation operation via standard (ab-interno) technique comprised Group 2. Of the 44 patients, 21 (47.7%) were males and 23 (52.3%) were females. The mean age of this group was 63.80 ± 9.78 (38-75) years. Regarding age and sex, there were no significant differences between the groups (p > 0.05). The mean postoperative 1st day, 1st week, 1st month, 3rd month, 6th month, and 12th month IOPs were significantly lower than the mean preoperative IOP in both groups (p < 0.05). The mean number of anti-glaucomatous agents used postoperatively was significantly lower than the mean preoperative number for both groups (p < 0.05). There was a significantly smaller need for needling in the transconjunctival group (p < 0.05). Xen implantation is a safe and effective method of reducing IOP and anti-glaucomatous dependence. Potential postoperative complications can be resolved easily. There were no significant differences between the standard method and the transconjunctival method in respect of IOP and re-use of anti-glaucomatous agents. However, there was a significantly smaller need for needling in the transconjunctival group. We recommend further studies to investigate long-term results.

Feasibility investigation of uniportal video-assisted thoracoscopic anatomical lung resection for pulmonary sequestration

BackgroundUniportal video-assisted thoracic surgery (UVATS) technique has been increasingly used for many thoracic diseases. Whether UVATS has equivalent or better perioperative outcomes for pulmonary sequestration (PS) patients remains controversial. Our study aimed to evaluate the feasibility of UVATS in anatomical lung resection for pulmonary sequestration.MethodsA total of 24 patients with PS including fifteen males and nine females with the mean age of 40 (range, 18–65) years old, who had received completely UVATS anatomical lung resection for PS in Nanjing Chest Hospital between January 2016 and December 2018 were retrospectively reviewed. Related clinical data were retrieved from hospital records and analyzed.ResultsAll 24 patients had been treated with the UAVTS approach successfully without aberrant artery ruptured or massive hemorrhage, and no patients died during the perioperative period. Overall mean surgery time was 102 mins (range, 55–150 min), the mean blood loss was 94 ml (range, 10-300 ml), the mean days of chest tube maintained were 4 days (range,1-10 days), and the mean postoperative hospitalization days was 6 days (range,2-11 days). All patients were cured, without cough, fever, hemoptysis, and so on, associated with PS, occurring during the average follow-up of 17 months (range, 3-35 months).ConclusionsOur preliminary results revealed that anatomical lung resection by UVATS is a safe and feasible mini-invasive technique for PS patients, which might be associated with less postoperative pain, reduced paresthesia, better cosmetic results, and faster recovery.

Comparison of bipolar cautery dissection and harmonic scalpel tonsillectomy in terms of postoperative bleeding and pain in children

Aim: To compare postoperative bleeding and pain in children after tonsillectomy with bipolar diathermy versus tonsillectomy with harmonic scalpel tonsillectomy.Materias and Methods: Group A, 25 patients were treated by tonsillectomy with bipolar diathermy and group B, 25 patients underwent tonsillectomy with harmonic scalpel. Results: Postoperative bleeding occurred in one patient in each group. The mean pain postoperative first day was 8.51±1.31 in the bipolar tonsillectomy group (BTG) and 6.02±0.84 in the harmonic scalpel group (HSG), 3th day 6.84±1.42 in the BTG and 4.98±1.03 in the HSG and at the postoperative 5th day were examined, it was 5.39±0.73 in the BTG and 3.95±0.74 in the HSG and this differences were significant statistically (p&amp;lt;0.05).Conclusion: Harmonic scalpel tonsillectomy technique is significantly less painful in postoperative early period compared to bipolar cautery technique.

Report on 153 sequential three-incision robotic-assisted pulmonary resections by a single surgeon: technical details and learning curve.

BackgroundThere are several techniques for robotic-assisted pulmonary resection, depending on the number and position of ports and utility incisions. We developed a technique for three-incision robotic-assisted pulmonary resection, and here we reported our initial results.MethodsThree-incision pulmonary resection with the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was attempted in 153 patients. Robotic instruments were used for individual dissection of the hilar structures through two thoracoscopic ports and a 3-cm utility incision without rib spreading. Data on patient characteristics and perioperative results were prospectively collected.ResultsBetween December 2016 and December 2018, a single surgeon performed three-incision robotic-assisted pulmonary resection on 153 consecutive patients in the Thoracic Surgery Department of the Second Xiangya Hospital. There was no emergent conversion to thoracotomy. Median operative time was 146.84 minutes (range, 40–320 minutes), and the median estimated blood loss was 62.70 mL (range, 5–200 mL). The mean postoperative days before chest tubes were removed was 3.91 (range, 2–18), and the mean postoperative days before patients were discharged was 5.34 (range, 2–20). The median number of lymph node stations dissected was 5 (range, 1–9). The mean number of nodes resected was 12 (range, 1–35), and postoperative complications were observed in 12 patients (7.84%).ConclusionsThree-incision robotic-assisted pulmonary resection is practicable, safe, and ideal for novices experienced in video-assisted thoracic surgery (VATS) surgery. It also appears to be oncologically acceptable for lung cancer; however, more studies on a large population are necessary to confirm these conclusions.

Does Intra-articular Tranexamic Acid Decrease Blood Loss in Total Hip Arthroplasty?

ABSTRACT Background Blood is the nurturing liquid that delivers oxygen to the cells of the body and removes carbon dioxide and waste from the body. Blood is considered as liquid gold. Total hip replacement causes blood loss and in turn needs blood transfusion. The aim of the study is to find the role of intra-articular tranexamic acid (TXA) in control of blood loss in total hip replacement surgeries. Materials and methods A prospective study of 50 patients who underwent total hip replacement surgery. The study group and control group patients were selected through the card method. In the study group after the skin closure, 2 g of TXA was injected through the drain tube and drain tube was clamped for 1 hour and then released. Blood loss during the first and second postoperative periods from suction drain was calculated. Results Four hundred and fifty-five milliliters was the mean first postoperative day blood collected in the drain tube in the control group while study group had 283 mL. Similarly, the second day mean postoperative day drain was 89 mL in control group and 25 mL in study group. The mean first and second postoperative day blood loss was statistically significant between the groups. Discussion There was a considerable reduction of transfusions in postoperative period; hence, there was a reduced hospitalization cost and less risk of transmitted infections and transfusion reactions. There is a negligible risk of thrombosis in patients who had intravenous TXA not the intra-articular TXA. Conclusion Intra-articular TXA is an effective tool in controlling blood loss and reducing blood transfusions in hip replacement surgeries. How to cite this article Ram GG, Vijayaraghavan PV. Does Intra-articular Tranexamic Acid Decrease Blood Loss in Total Hip Arthroplasty? J Orth Joint Surg 2020;2(2):49–51.

Myomectomy during cesarean section: is it a redundant or a feasible procedure?

Aim: The aim of this study was to evaluate the postoperative course of myomectomies performed during cesarean deliveries at a tertiary hospital and determine the safety of this procedure. Materials and Methods: The clinical characteristics and postoperative outcome of 64 patients who underwent cesarean myomectomy and 75 patients who underwent cesarean delivery only were compared retrospectively. The operative times and complete blood count (CBC) parameters obtained preoperatively and on the first and second postoperative days were recorded. The clinical course of each pregnancy and postoperative complications, such as bleeding necessitating blood transfusions, fever and uterine atony were recorded. Results: No difference was detected in the mean preoperative and postoperative days 1 and 2 CBC parameters between the two groups. The change between preoperative and postoperative day 1 mean CBC parameters was not significantly different between the two groups, however the mean change in the CBC parameters between preoperative day 1 and postoperative day 2 was statistically significantly higher in the myomectomy group (p = 0.034) when compared with the non-myomectomy group. The mean operative time in the cesarean myomectomy group was significantly longer than the non-myomectomy group (p = 0.004). Conclusions: A higher amount of blood loss is encountered in those who underwent cesarean myomectomy than those who underwent cesarean delivery only, however, because the incidence of severe hemorrhage is not significantly different between the two groups, hence the authors conclude that cesarean myomectomy is a safe and feasible procedure, for subserosal as well as for intramural ones.

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery

The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (≥37 weeks). Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of -1.90 g/dL (95% CI, -2.14 to -1.66) and -1.78 g/dL (95% CI, -2.03 to -1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, -0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1. ClinicalTrials.gov Identifier: NCT03150641.

Robotic-assisted kidney transplant: a single center experience with median follow-up of 2.8years.

The main aim of the paper is to report a single-centre experience with RAKT, focusing on surgical, perioperative and functional outcomes at a median follow-up of 2.8years. Data of 26 RAKT patients was prospectively collected from December 2014 to February 2019 with follow-up of up to 55months. All donors were done laparoscopically. We followed Vattikuti-Medanta technique with modification of using pfannenstiel incision instead of Gelpoint and patient positioned in steep Trendelenburg position (30°) with leg split position. Hypothermia was maintained using a "modified graft hypothermia jacket". The engrafted kidney is oriented with the vessels being tagged with Prolene sutures. The mean BMI was 26.1 ± 4.7. The mean warm, cold and total ischemia times were 4.8 ± 1.1, 113.8 ± 20.9 and 118.7 ± 21.2min, respectively. Mean rewarming time was 62.5 ± 10min. The mean post-operative day (POD) 1, 3, 7, 30, 6months, 1 year and most recent creatinine was 3.4, 2.4, 1.8, 1.4,1.2, 1.2 and 1.69mg/dl. There was no case of delayed graft dysfunction (DGF) with graft survival of 1.8-55months. The mean GFR at POD 1, 1month and 1year was 24, 53.16 and 64.6. We had two intraoperative complications-one topsy turvy graft placement with anastomosis of donor ureter to native ureter and other had to be converted to open technique after anastomosis to control graft surface bleeding. Three postoperative complications-one patient has graft pyelonephritis which was managed conservatively with antibiotics. Two patients had lymphocele. One patient was managed with just aspiration while the other required laparoscopic de-roofing of the lymphocele. The mean hospital stay was 13.5 ± 3days. RAKT is feasible and safe only if performed by surgeons with appropriate background in robotic surgery and kidney transplantation after proper surgical training at experienced centres in the mid-term follow-up. Further studies need to confirm the long-term safety of RAKT.

Shift in the timing of microvascular free tissue transfer failures in head and neck reconstruction.

Analyze the cause and significance of a shift in the timing of free flap failures in head and neck reconstruction. Retrospective multi-institutional review of prospectively collected databases at tertiary care centers. Included consecutive patients undergoing free flap reconstructions of head and neck defects between 2007 and 2017. Selected variables: demographics, defect location, donor site, free flap failure cause, social and radiation therapy history. Overall free flap failure rate was 4.6% (n = 133). Distribution of donor tissue by flap failure: radial forearm (32%, n = 43), osteocutaneous radial forearm (6%, n = 8), anterior lateral thigh (23%, n = 31), fibula (23%, n = 30), rectus abdominis (4%, n = 5), latissimus (11%, n = 14), scapula (1.5%, n = 2). Forty percent of flap failures occurred in the initial 72 hours following reconstruction (n = 53). The mean postoperative day for flap failure attributed to venous congestion was 4.7 days (95% confidence interval [CI], 2.6-6.7) versus 6.8 days (CI 5.3-8.3) for arterial insufficiency and 16.6 days (CI 11.7-21.5) for infection (P < .001). The majority of flap failures were attributed to compromise of the arterial or venous system (84%, n = 112). Factors found to affect the timing of free flap failure included surgical indication (P = .032), defect location (P = .006), cause of the flap failure (P < .001), and use of an osteocutaneous flap (P = .002). This study is the largest to date on late free flap failures with findings suggesting a paradigm shift in the timing of flap failures. Surgical indication, defect site, cause of flap failure, and use of osteocutaneous free flap were found to impact timing of free flap failures. 4 Laryngoscope, 130:347-353, 2020.

Extraocular and Intraocular Infections Following Strabismus Surgery: A Review.

An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].

Comparıson of SMILE and FS-LASIK procedures ın terms of dry eye dısease

Purpose: To compare SMILE (Small Incision Lenticule Extraction) and FS-LASİK (Femtosecond Laser In Situ Keratomileusis) procedures in terms of dry eye disease. Material and Methods: One hundred and six eyes of 53 patients with myopia and/or myopic astigmatism who had undergone SMILE procedure were compared with 106 eyes of 53 patients with myopia and/or myopic astigmatism who had undergone FS-LASIK procedure in terms of dry eye disease. Results: The mean postoperative 1st day, 1st week, 1st month OSDI (Ocular Surface Disease Index) scores of the second group were significantly higher than those of the first group (p values, 0.000, 0.000 and 0.000 respectively). The mean postperative 1st day, 1st week, 1st month, 3rd month and 6th month TBUT (Tear break-up time) values of the second group were significantly lower than those of the first group (p values, 0.000, 0.000, 0.000, 0.003 and 0.003 respectively). The mean postperative 1st day, 1st week, 1st month, 3rd month and 6th month ST1 (Schirmer Test 1) values of the second group were significantly lower than those of the first group (p values, 0.000, 0.000, 0.000, 0.003 and 0.002 respectively). The mean postoperative 1st day, 1st week, 1st month, 3rd month and 6th month staining values of the second group were significantly higher than those of the first group (p values, 0.007, 0.001, 0.000, 0.042 and 0.041 respectively). However, all postoperative dry eye tests of both groups returned to preoperative values after postoperative 3rd month. Conclusion: The signs and symptoms of dry eye disease are fewer and last shorter in SMILE procedure, when compared with FS-LASIK procedure. But dry eye disease is transient after both procedures.

A study of reduced port laparoscopic cholecystectomy

Background: The objective was to study various technical feasibility and safety, benefit of three port cholecystectomy over four port cholecystectomy.Methods: Total 25 patients have taken part in study with valid consent, in B.J. Medical College, Ahmedabad. All patient study regarding operative time, conversion rate, inta-operative complication, immediate postoperative complication, postoperative pain, requirement of postoperative analgesic, hospital stay, feasibility and safety.Results: Out of 25 patient mean ages 39.5 ranging from 25 to 60. Female 88%, male 12% are in this study. 72% patient have multiple stone, 28% have single stone. 96% and 4% patient has distended and contracted GB respectively. 92% patient have normal GB wall and 8% have thickened GB wall. 8%, 68% and 20% patient were discharge on 3rd, 2nd and 1st postoperative day respectively. Mean postoperative day was 4 ranging from 1 to 10. Conversion rate to open procedure is 12% in this study.Conclusions: Three port cholecystectomy is safe procedure in expert hand. It has less requirement of analgesic with less hospital stay with good cosmetic result.

Predictors of Readmission After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

BackgroundRisk factors for hospital readmission after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are poorly understood. MethodsThe American College of Surgeons–National Surgical Quality Improvement Program databases from 2011 to 2016 were used to identify all patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative variables were examined using logistic regression to identify factors associated with 30-d postoperative readmission. ResultsAmong 618 patients who underwent CRS-HIPEC, 96 (15.5%) required hospital readmission within 30 d of surgery. The incidence of readmission decreased over the study period (18.3% in 2011 to 4.8% in 2016). Among the 59 patients who were readmitted and had complete data available, readmission occurred on mean postoperative day 18.5 ± 5.5; the most common reasons for readmission were digestive complications (39.0%), postoperative infections (25.4%), uncontrolled pain (8.5%), and venous thromboembolism (5.1%). On multivariate logistic regression analysis, increasing age (OR 1.02, 95% CI 1.00-1.05), number of operative procedures (OR 1.12, 95% CI 1.00-1.25), perioperative complication (OR 7.06, 95% CI 3.96-12.59), need for reoperation (OR 10.21, 95% CI 3.50-29.83), and length of stay (OR 0.93, 0.90-0.97) were associated with hospital readmission. ConclusionsIn this population-based analysis of patients undergoing CRS-HIPEC, older age, perioperative complications, need for reoperation, and extent of cytoreduction were associated with hospital readmission. The American College of Surgeons–National Surgical Quality Improvement Program database is a powerful research tool that can be used to identify opportunities to improve the perioperative care of surgical patients.

Hybrid assistive limb (HAL) treatment for patients with severe thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) in postoperative acute phase

The purpose of this study was to clarify the safety and feasibility of rehabilitation using the robot suit hybrid assistive limb (HAL) for severe thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). Eight patients (mean age, 60.9 years) in the postoperative acute or subacute phases who presented with severe gait disturbance before surgery and underwent posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament (T-OPLL) were included in this study. Treatment using HAL (about 60 min per session, 2–3 times a week, 10 sessions in total) was started on mean postoperative day 27.5. Gait speed, step length, and cadence for each session were measured with the 10-m walking test. The American Spinal Injury Association (ASIA) motor score (lower extremities) and Walking Index for Spinal Cord Injury (WISCI) II were also evaluated at baseline and after 10 sessions. In addition, the Japanese Orthopaedic Association (JOA) score was calculated over time after surgery. Ten sessions of HAL treatment were completed in all patients. No serious adverse events related to the locomotor treatment with HAL were noted. Gait speed, step length, and cadence improved over time. Compared with baseline values, WISCI-II and ASIA motor score (lower extremities) after 10 sessions improved. The JOA score improved over time after surgery. Treatment using HAL can be performed in the early postoperative period without severe adverse events in patients with T-OPLL and severe gait disturbance.