Mean Volume Of Blood Loss Research Articles

Carbetocin Versus Misoprostol in Prevention of Postpartum Hemorrhage in High Risk Patients

Background: Postpartum hemorrhage (PPH) is a significant problem and a major cause of maternal mortality and morbidity, resulting in up to 28% of maternal deaths. It is a potentially life-threatening complication of both vaginal and cesarean delivery, the prevalence of PPH is approximately 6% of all deliveries. Objective: The aim of this study is to compare the effectiveness and safety of carbetocin and misoprostol for the prevention of atonic postpartum hemorrhage in high risk patients. Patients and Methods: this study is a prospective clinical study which was conducted at the Department of Obstetrics and Gynecology, Aswan University Hospital, in the period from September 2017 till September 2018. One hundred cases were involved in the study and divided into 2 equal groups. The study was approved by the medical ethics committee of Aswan University Hospital and a written informed consent is obtained from all patients. Results: Significant difference was found between the two studied groups as regard mean volume of blood loss. Carbetocin group showed the lowest volume of blood loss. As regard uterine tone after treatment, carbetocin group showed the highest tone compared to misoprostol groups. Significant difference was found between the two groups as regard need for additional uterotonics. The results demonstrated an increased use of additional oxytocics in the misoprostol group (32% of cases) VS (12% of cases) in carbetocin group. Conclusion: According to the results of this study, it's concluded that carbetocin is more effective in controlling the amount of blood loss during delivery and eventually help in the prevention of postpartum hemorrhage in high risk patients.

Salvage of failed dynamic hip screw fixation of intertrochanteric fractures.

Background and aimFailure of intertrochanteric fracture fixation can occur in patients with poor bone quality, extreme osteoporosis, or unstable fracture arrangement. Although hip replacement is a commonly successful process, it includes technical problems, such as implant removal, bone loss, low bone quality, nonunion of trochanter, and difficult surgical exposure. The goal of this study was to restore total hip replacement for failed intertrochanteric fractures to assess the outcomes.MethodsDuring April 2009 to October 2015, 203 patients (203 hips) underwent total hip arthroplasty through the direct lateral approach, as salvage of failed intertrochanteric fracture management by dynamic hip screw (DHS). The restoration process was done by a direct lateral approach (Hardinge) in all hips. The operation details, such as duration, blood transfusion volume, blood loss, and duration of hospital stay, were recorded. Modified Harris hip score (MHHS) was applied for assessment of clinical outcome before and after the operation, and during the follow-up.ResultsOverall, 112 patients were male (55.17%) and 91 patients (44.8%) were female and the mean of age was 72.58±10.60 years old. Average operation time was 93.96±10.72 minutes. The mean blood loss volume during the operation was 355.86±84.11 mL. The mean preoperative MHHS score was 39.55±6.74 (range: 30–50). The MHHS score improved to 90.55±2.24, 92.34±1.26, and 94.34±1.85 during the first, second, and final follow-up, respectively (P<0.0001). Infection was found in only two patients, who had undergone one stage revision and linear of the cup was exchanged. Total rate of complications during the follow-up was 4.92%.ConclusionThe current research was a large population study and indicated that sufficient functional outcome could be obtained by total hip replacement in geriatrics with failed intertrochanteric fractures. Therefore, well-performed hip replacement could be a suitable choice for restoring failed DHS in unsuccessfully managed intertrochanteric fractures in the elderly.

Computed tomography-guided simultaneous coil localization as a bridge to one-stage surgery for multiple lung nodules: a retrospective study

BackgroundVideo-assisted thoracoscopic surgery (VATS) has been widely used for diagnostic wedge resection of lung nodules. When VATS is performed for multiple lung nodules, preoperative localization for each target nodule is required. In this study, we evaluated the clinical effectiveness of computed tomography (CT)-guided simultaneous coil localization in one-stage VATS wedge resection for multiple lung nodules.MethodsBetween November 2015 to March 2018, 19 patients with multiple target nodules underwent CT-guided simultaneous coil localization and one-stage VATS resection at our center. Data on the technical success of simultaneous localization and wedge resection, complications, and pathological results were collected.ResultsA total of 43 nodules were localized. The localization was successfully achieved in 42 of 43 nodules (97.7%). The technique of simultaneous localization was successfully achieved in 18 of 19 patients (94.7%). Fifteen patients underwent unilateral lung localization and four patients underwent bilateral lung localization. Three patients (15.8%) experienced asymptomatic pneumothorax after localization. All patients successfully underwent one-stage wedge resection for all target nodules. The mean duration of one-stage VATS procedure was 171.8 ± 84.0 min. The mean volume of blood loss was 94.2 ± 58.0 mL. Three patients experienced pleural effusion after VATS. During a follow-up of 6–31 months (median 18 months), no patient developed new lung nodules or distant metastasis.ConclusionsPreoperative simultaneous coil implantation is a safe and simple method for localization of multiple lung nodules. Simultaneous coil localization could effectively guide a one-stage VATS diagnostic wedge resection procedure.

Сравнительный анализ результатов лапароскопической и ретроперитонеоскопической резекции почки в зависимости от вида временного и окончательного гемостаза

to carry out a comparative analysis of treatment results of patients with renal tumors who were undergone to nephron-sparing surgery, depending on the type of temporary and definite hemostasis. a total of 163 laparoscopic partial nephrectomies were performed by single surgeon from January 2015 to July 2018. The comparative analysis of treatment results of patients with renal tumors based on following parameters: tumor stage, features of the tumor site, the duration of surgery, the amount of blood loss, complications rate and grade as well as functional and oncological outcomes, depending on the type of temporary and definite hemostasis, was conducted. For preoperative planning the generally accepted nephrometric scale R.E.N.A.L. was used as well as 3D-reconstruction of the tumor. Of the 163 patients, 64 were women (39.3%). The mean age of patients was 56.7+/-11.1 (25-80 years). A clinical stage T1a, T1b, T2 and T3a was diagnosed in 77, 20, 2 and 64 cases, respectively. The average tumor size was 34.8+/-1.1 (11-78 mm). The mean operative time was 84.5+/-32.2 min (30-180). Laparoscopic transperitoneal access was used in 90 patients (55.21%), retroperitoneoscopic approach was chosen in 73 cases (44.79%). The tumor had exophytic growth in 110 cases (67.5%) and in 53 cases it was endophytic (32.5%), while in 59 cases it localized in renal sinus (36.2%). The operative time was significantly shorter in the Group of zero ischemia (72.2+/-29.02 [p<0.001]) and bipolar coagulation of the tumor bed (60.8+/-31.7 [p<0.001]). The mean volume of blood loss was 160.8+/-142.7 ml (30-900). A GFR calculated by the MDRD equation (mean level was 75.7 ml/min/1.73 m2) on the next day and 6 months after surgery showed a slight decrease in group of zero ischemia, compared to other groups: next day and 6 months after surgery it was 72.8+/-21.6 (p<0.001) and 72.01+/-16.6 (p=0.025), respectively. A simple enucleation was performed in 41 cases, while enucleoresection was done in 70 cases. A collection system was opened in 22 cases (13.5%+/-9.8). The suturing and clipping were performed in 20 and 2 patients, respectively. In 2 cases a stenting was performed. In 2 cases there was hemoglobin drop requiring blood transfusion (1.2%+/-3). An embolization due to refractory bleeding was required in 3 cases (1.8%+/-3.7). There was no conversion to open surgery or nephrectomy. Of the 163 tumors, a malignancy was diagnosed in 151 (92.6%+/-7.5) cases. There was no positive surgical margin and recurrence of the tumor. Laparoscopic partial nephrectomy can be successfully performed under zero ischemia. The intervention without clamping of renal blood vessels contributes to significant preservation of the renal function.

Combined glue embolization and excision for the treatment of venous malformations

BackgroundThe purpose of this study was to evaluate safety, technical success, and clinical outcomes of treatment for venous malformations using n-BCA glue embolization immediately prior to excision. Sixty three patients (22 male, 41 female; mean age 12 years (range 1–25)) who underwent 70 procedures for extremity and trunk venous malformations were reviewed. Indications for treatment included pain (100%), swelling (22%), and diminished range of motion (16%). Thirty seven patients (59%) had undergone prior stand-alone interventional or surgical treatment but were persistently symptomatic. Safety, technical and clinical success were retrospectively assessed.ResultsEmbolization was technically successful in 100% of patients. Mean lesion size was 3.0 × 2.9 × 5.7 cm. Three patients (5%) underwent planned, second stage procedures for lesions intentionally not treated at the first procedure. Four patients (6%) underwent an unplanned, second stage procedure for residual disease after the primary operation. Mean and median follow-up duration were 18 and 17 months, respectively (range 3 to 35 months). Symptomatic improvement was achieved in 58 patients (92%), of whom 41 (65%) reported complete elimination of pain. There were no recognized instances of nontarget embolization or other complications of the interventional procedure. One patient required additional surgery for wound dehiscence and one patient developed an abscess requiring incision and drainage. Minor surgical complications included surgical site skin infections (n = 5) and numbness (n = 1). Mean and median surgical blood loss volumes were 131 mL and 10 mL, respectively. One patient required perioperative blood transfusion.ConclusionsExtremity and truncal venous malformations can be safely and effectively treated in a single-stage fashion using glue embolization immediately preceding excision.

Propofol Versus Remifentanil: Which One Is More Effective in Reducing Blood Loss During Orthognathic Surgery? A Randomized Clinical Trial

Propofol and remifentanil are 2 useful drugs used in induced hypotensive anesthesia. The purpose of this study was to compare the effects of these drugs on intraoperative blood loss, transfusion requirements, and hemodynamic status during standardized orthognathic surgical procedures. In this double-blind randomized clinical trial, 50 consecutive healthy patients with Class III skeletal deformity were candidates for bimaxillary orthognathic surgery at Qaem Hospital, Mashhad University of Medical Sciences (Mashhad, Iran), from November 2016 until December 2017. These patients were randomly assigned to 2 equal-number groups to receive hypotensive anesthesia with propofol or remifentanil. Neither the surgeon nor the patients were aware of the study groups, whereas both the student and anesthesiologist were not blinded. Age and gender were recorded, and mean blood loss, mean arterial pressure, and mean heart rate, as well as duration of surgery and duration of general anesthesia, were monitored intraoperatively.The hypotensive anesthetic drugs were the primary predictor variables and the mean blood loss volume was the main outcome in this research. The independent t test and χ2 test were performed for data analysis using SPSS software (version 16; SPSS, Chicago, IL). In this study, 25 patients with a mean age of 22.25±3.31years were investigated in each group. The mean blood loss volume was 578.26±95.14mL and 366.67±64.92mL in the propofol and remifentanil groups, respectively. The independent-samples t test showed that mean blood loss was significantly lower in the remifentanil group than in the propofol group (P=.001). Furthermore, the mean arterial blood pressure was significantly lower in the remifentanil group than in the propofol group (85±20mm Hg vs 95±15mm Hg, P<.001). Hypotensive anesthesia with remifentanil, in comparison with propofol, significantly reduces mean blood loss during orthognathic surgery, which decreases the transfusion requirements and disadvantages of transfusion and blood loss.

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30 IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p = .06 and 0.24 respectively) and hematocrit values (p = .12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7 ± 90.6 versus 588.9 ± 96.3 mL respectively, p = .001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p = .002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.

Single oblique cage posterior lumbar interbody fusion with local bone graft as an alternative to double straight-ahead cages posterior lumbar interbody fusion with iliac crest graft

Background Posterior lumbar interbody fusion (PLIF) is a fusion technique with reliable and rapid fusion results. The traditional technique describes the use of two cages filled with bone graft and inserted in a straight-ahead direction within the prepared disc space. Bone graft used is usually harvested from the posterior iliac crest. This study evaluates the use of a single cage inserted diagonally through unilateral discectomy and filled with bone fragments obtained from the local decompression procedure. Patients and methods Fourteen patients underwent pedicle screw-rod supplemented PLIF and spinal canal decompression for symptomatic spinal canal stenosis, instability, or spondylolisthesis refractive to conservative treatment. PLIF was performed using a single PEEK cage filled with impacted graft from the locally excised bone. The PEEK cage was inserted into the prepared intervertebral disc space in an oblique (diagonal) manner to obtain near-symmetrical end-plate loading across the midline. Results The mean follow-up period was 15 months. The mean duration of surgery was 170 and 225 min for single-level and double-level fusions, respectively. The mean volume of blood loss was 850 and 1050 ml for single-level and double-level fusions, respectively. The mean duration for hospital stay was 5 days. Postoperative radiographs showed a mean increase in the disc height by 24.4% and a mean increase in lordosis angle by 4.3°. Pain and functional scores showed marked improvement. The mean Visual Analog Scale decreased from 7.8 to 2.2. The mean Oswestry Disability Index decreased from 82 to 28. The mean Economic Prolo Scale was 3.2 whereas the Functional Prolo Scale was 3.8. Interbody fusion was assessed using lateral radiographs. Loss of demarcation of the bony end-plates with consolidation of graft through the cage was the indication of successful fusion. At final follow-up, 10 patients showed solid fusion, three patients showed delayed fusion, and one patient showed loss of reduction of spondylolisthesis after a traumatic incident and required a revision surgery. Yet, patients with delayed union did show similar improvement to those with early union on the Visual Analog Scale and Oswestry Disability Index. Conclusion The use of single unilateral and obliquely inserted PEEK cage is an effective safe procedure for interbody fusion that gives comparable results to the traditional double-cage technique while shortens the operative time, lowers the blood volume loss, and also lowers the cost for implants used without endangering reliability of the technique.

Ender Nail versus Dynamic Compression Plating For Humeral Shaft Fractures

Aim: To compare ender nail with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates. Methods: 30 men and 20 women aged >18 years with fresh humeral shaft fractures without neurological deficits underwent either ender nail (n=30) or dynamic compression plating (n=20). Functional outcome of the upper limbs, pain, rates of union, and complications in the 2 groups were compared. Results: Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes, mean blood loss volumes were 20 and 232 ml, complication rates were 20% and 24%, non-union rates were 13% and 8%, and delayed union rates were 7% and 4%. Conclusion: Both techniques were equally appropriate for treating humeral shaft fractures.

Coil Localization-Guided Video-Assisted Thoracoscopic Surgery for Lung Nodules.

To determine the clinical efficacy of preoperative coil localization-guided video-assisted thoracoscopic surgery (VATS) for lung nodules. Between November 2015 and July 2017, 56 patients with lung nodules underwent coil localization-guided VATS procedure. The coil implantation was performed under the guidance of computed tomography (CT). The end tail of the coil remained above the visceral pleura. The target lung nodules were removed by VATS wedge resection. Data on the technical success of coil localization and wedge resection, procedure-related complications, and pathological results were collected and analyzed. Sixty-seven lung nodules in 56 patients (1.2 nodules/case) were localized. The technical success rate of coil localization was 89.6% (60/67). Sixty-three nodules were localized with one coil and four nodules with two coils. The mean time taken to perform CT-guided coil implantation was 15.7 ± 5.3 (range: 8-40) minutes. Six patients (9.0%) experienced pneumothorax after coil implantation. The technical success rate of wedge resection was 97.0% (65/67). Two nodules were removed directly by video-assisted lobectomy. Nine patients with multiple target lung nodules underwent single-stage resection. The mean total operating time was 147.2 ± 79.1 (range: 50-360) minutes. The mean volume of blood loss was 113.2 ± 113.0 (range: 10-700) mL. Postoperative complications included prolonged air leak (n = 2) and pleural effusion (n = 5). Preoperative coil localization is a safe and effective method to facilitate a high successful rate of VATS wedge-resection for lung nodules.

Perioperative Blood Loss During Total Hip Arthroplasty Among Patients With Ankylosing Spondylitis.

Intraoperative blood loss is frequently an overarching concern during total hip arthroplasty (THA) for patients who have ankylosing spondylitis with hip involvement. However, the factors that affect blood loss have not been identified. The goal of this study was to investigate these factors among patients with ankylosing spondylitis. Patients in the authors' department who had ankylosing spondylitis and underwent unilateral THA from 2011 to 2016 were studied retrospectively. Demographic characteristics, perioperative laboratory values, intraoperative data, transfusion rate, transfusion volume, and data on hemostatic use were collected and analyzed statistically. Multiple and univariate linear regression analyses were performed. As a result, 44 patients were eligible for inclusion in the study. Mean age was 31.7±10.6 years, and mean disease duration was 9.7±5.8 years. Mean body mass index was 21.30±3.01 kg/m2. Mean volume of blood loss during THA was 1735.19±756.04 mL. Multiple linear regression analysis showed that perioperative blood loss was positively associated with Ankylosing Spondylitis Disease Activity Score (ASDAS), fibrinogen concentration, and surgical time. Further evaluation with univariate linear regression analysis suggested that ASDAS, red blood cell transfusion, and change of hematocrit concentration from preoperatively to postoperatively were correlated with blood loss. Disease activity, allogeneic blood transfusion volume, and change of hematocrit concentration from preoperatively to postoperatively appeared to be positively associated with perioperative blood loss during THA for patients with ankylosing spondylitis. For these patients, disease activity and the potential for allogeneic transfusion should be considered carefully before surgery. [Orthopedics. 2017; 40(5):e904-e910.].

Transmanubrial osteomuscular sparing approach for resection of cervico-thoracic lesions.

To review our experience of transmanubrial osteomuscular sparing approach (TMA) for resection of various lesions involving the thoracic inlet and to prove the feasibility and safety of the approach. Retrospective review of 58 consecutive cases, from April 2007 to January 2016, with surgical resection of cervico-thoracic lesions via TMA. There were 22 neurogenic tumors, 21 bronchogenic tumors, and 15 other cases in the study. There was no intraoperative or postoperative mortality. Mean postoperative stay was 10.5 days (3-33 days). Mean operation time was 179.0 mins (57-328 mins) and the mean volume of blood loss for bronchogenic tumors was 900 mL, which was similar to non-bronchogenic tumors (474 mL, P=0.103). Moreover, patients with malignant tumors had more intraoperative blood loss than patients with benign diseases did (847 versus 194 mL, P=0.001). R0 resection was achieved in 28 of 33 (84.8%) malignant cases. Tumor size was related to incomplete resection (8.19 vs. 5.72 cm, P=0.023) in malignancy. Five (8.6%) cases were complicated with chylothorax and all occurred in patients with left incision. All of 21 cases (100%) with brachial plexus compression symptom were relieved after surgery and 3 of 4 (75%) cases with Horner's syndrome were ameliorated postoperatively. TMA can be carried out safely in treating various cervico-thoracic lesions with good resection rate. Left side procedure should be cautious of thoracic duct injury.

Clinical characteristics of critically ill cancer patients who are undergoing isolated limb perfusion

The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.

Stopping versus continuing acetylsalicylic acid before coronary artery bypass surgery: A systematic review and meta-analysis of 14 randomized controlled trials with 4499 patients.

This study aimed to evaluate the efficacy and safety of continuing versus stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE, CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino Americana em Ciências da Saúde (LILACS), Google Scholar and reference lists of relevant articles were searched for randomized controlled trials that reported efficacy outcomes of myocardial infarction and mortality, and safety outcomes of blood loss, packed red blood cell transfusion and surgical re-exploration were compared between groups. Fourteen studies fulfilled our eligibility criteria and included a total of 4499 patients (2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled analysis, continuing aspirin therapy did not reduce the risk of myocardial infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P = 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P = 0.323). Preoperative ASA increased postoperative chest tube drainage (mean difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell transfusion (mean difference 142 ml, 95% CI 55-228; P = 0.001) but did not increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI 0.910-1.905; P = 0.145). This meta-analysis found no statistically significant difference regarding the risk of operative mortality and myocardial infarction between the 'continuing ASA' and 'stopping ASA' strategies. On the other hand, the mean volume of blood loss and packed red blood cell transfusion was higher in the 'continuing ASA' group, but this finding did not translate into higher risk of reoperation for bleeding.

Safety of laparoscopic distal gastrectomy for gastric cancer when performed by trainee surgeons with little experience in performing open gastrectomy.

This study aimed to evaluate the surgical outcomes and clinical safety of laparoscopic distal gastrectomy (LDG) when performed by trainee surgeons with little prior experience in performing open gastrectomy, under the guidance of trainer surgeons. From January 2008 until March 2015, 17 trainee surgeons and 5 trainer surgeons performed LDGs to treat 371 patients with clinical stage T1-T3 gastric cancer. Of these patients, 140 and 231 underwent LDG performed by trainee surgeons and trainer surgeons, respectively. We retrospectively analyzed the surgical outcomes of the two groups. Trainee surgeons required significantly longer operation times than the trainer surgeons, with respective mean operation times of 262 and 223min (p<0.001). However, the mean blood loss volumes, average numbers of retrieved lymph nodes, postoperative complications, and postoperative hospital stay lengths did not differ significantly between LDGs performed by trainee surgeons and trainer surgeons. The study findings suggest that, under the guidance of trainer surgeons, trainee surgeons with little experience with open gastrectomy and even without prior experience with LDG can perform radical surgeries safely.

Risk factors for acute surgical site infections after lumbar surgery: a retrospective study

BackgroundCurrently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery.MethodsWe retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital’s spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses.ResultsTwenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients’ mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p < 0.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p < 0.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery.ConclusionsIn order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

Short-term outcomes of laparoscopic D2 gastrectomy with complete mesogastrium excision (D2+CME) for advanced gastric cancer.

43 Background: D2 lymphadenectomy has been widely accepted as a standard procedure of surgical treatment for local advanced gastric cancer [1,2]. However, neither the dissection boundary nor the extent of the excision for perigastric soft tissues has been described [3-7]. Our previous researches demonstrate the existence of disseminated cancer cells in the mesogastrium [8, 9] and present an understandable mesogastrium model for gastrectomy [10]. Hence, the D2 lymphadenectomy plus complete mesogastrium excision (D2+CME) is firstly proposed in this study, aiming to assess the safety, feasibility and corresponding short-term surgical outcomes. Methods: All of these patients underwent laparoscopy assisted D2+CME radical gastrectomy with a curative R0 resection, and all the operation was performed by Prof. Jianping Gong, chief of GI surgery of Tongji Hospital, Huazhong University of Science and Technology. All participants provided informed written consent to participate in the study. This study was approved by the Tongji Hospital Ethics Committee. The standard surgical procedures in the video are described as follows. Reconstruction of the alimentary tract was done by extracorporeal anastomosis. Standard recovery protocols were followed in postoperative treatments. Results: 68 patients between September 2014 and March 2016 have been recruited with informed consent and underwent laparoscopic D2+CME by a single surgeon. The mean number of retrieved regional lymph nodes was 33.62±11.40 (ranges 14-55). The mean volume of blood loss was 12.44±22.89 ml (ranges 5-100). The mean laparoscopic surgery time was 127.82±17.63 mins (ranges 110-165). The mean hospitalization time was 16.5±3.3 days (ranges 8-28). No operative complication was observed during the hospitalization. Conclusions: The anatomical boundary of mesogastrium is well described and dissected within D2+CME surgical process. It proves to be safely feasible and repeatable with less blood lost, qualified lymph nodes, retrieval results, and other improved short-term surgical outcomes in advanced gastric cancer. Meanwhile, potential disseminated cancer cells fall into the mesogastrium can be eradicated by D2+CME. Clinical trial information: NCT01978444.

Simplifying Laparoscopic Surgery for Left Side Colon and Rectal Cancer Using Linear Stapler for Vascular Ligation: A Prospective Cohort Study

Introduction: Systematic lymphadenectomy and ligation of the feeding artery is extremely important when performing radical resection in colorectal cancer. However, vascular surgery via laparoscopy requires advanced skills and techniques; thus, this procedure needs to be simplified while maintaining quality of the surgery to make it a preferred technique for the surgeons. Methods: There were 49 patients who underwent laparoscopic sigmoidectomy or anterior resection till T2 level for sigmoid colon cancer and recto-sigmoid colon cancer. We analyzed short-term and long-term outcomes between stapling ligation and clipping ligation techniques used in these surgeries. Results: The mean volume of blood loss in the stapling ligation group was 12.8 ± 12.3 ml, which was significantly lower than 41.9 ± 71.2 ml of mean volume of blood loss in the clipping ligation group. There was no significant difference in the mean duration of surgery, the mean number of harvested lymph nodes, morbidity, recurrence, and 5-year relapse free survival rates between the 2 groups. Conclusions: This study demonstrates a surgical technique using staplers for vascular treatment of tumor-feeding arteries as a new technical improvement in laparoscopic colectomy for the treatment of early-stage colon cancer. We found that the described procedure was technically safe, simple, convenient, and oncologically valid.

Computer-assisted skip pedicle screw fixation for adolescent idiopathic scoliosis.

A retrospective single-center and single-surgeon study. This study investigated the clinical and radiological results of skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS). At present, the generally used technique for pedicle screw fixation for the surgical correction of AIS entails inserting a pedicle screw into every segment on the corrective side and into every or every other segment on the supportive side. To reduce operation time, blood loss, and cost, we developed skip pedicle screw fixation to achieve correction of AIS using fewer pedicle screws. We evaluated 62 consecutive patients who had undergone computer-assisted skip pedicle screw fixation from August 2005 to June 2014. All patients were followed up for at least two years. We investigated the clinical results of skip pedicle screw fixation for AIS. The mean number of fused vertebrae was 10.3±2.0, the mean surgical time was 242±78min, and the mean blood loss volume was 1060±688ml. The mean Cobb angle of main thoracic (MT) curve two years after surgery improved significantly compared with that before surgery (p<0.01). The mean correction rate of MT curve immediately after surgery was 62.4±12.4% and correction loss of MT curve at two years after surgery was 1.9±5.8°. The SRS-22 subtotal score two years after surgery improved significantly compared to that before surgery (p<0.01). Although no patients experienced major complications, eight (12.9%) encountered minor complications (two [3.2%] had massive blood loss [>3000ml], three [4.8%] had a broken screw, one [1.6%] had a set-screw that dropped out, one [1.6%] experienced deep vein thrombosis, one [1.6%] experienced acute renal failure, and one [1.6%] experienced intercostal neuralgia). Revision surgery was not performed. Subjects with AIS who underwent skip pedicle screw fixation had significantly improved clinical and radiological parameters at two years after surgery, indicating that skip pedicle screw fixation could be used to successfully treat AIS. Level 4.

Laparoscopic repair with hysteroscopy of cesarean scar diverticulum.

The aim of this study was to investigate the clinical data of laparoscopic repair with hysteroscopy of cesarean scar diverticulum (CSD). We retrospectively evaluated 49 patients with CSD in our hospital who had undergone laparoscopic repair with hysteroscopy from January 2014 to June 2015. All patients had a history of cesarean section deliveries and prolonged postmenstrual spotting (duration 16.1 ± 3.4 days). The diagnosis of CSD was established by using 2-D transvaginal ultrasound. All patients underwent the surgical repair successfully, without evident complications. The mean operation time was 90.4 ± 9.1min, the mean volume of blood loss was 31.2 ± 14.3mL, and the mean length of hospital stay was 4.1 ± 0.3days. All patients were followed for 6 months after the operation; the mean duration of menstruation was 7.5 ± 2.5days shorter on average than the pre-surgical menstrual days, and the difference was statistically significant (P=0.001). According to the clinical symptoms assessment, 89.8% (44/49) of the surgeries were effective, while according to the anatomic assessment, 95.9% (47/49) were effective. Laparoscopic repair with hysteroscopy of CSD was confirmed to be a safe, effective, and minimally invasive treatment, and should be widely used to treat patients with CSD.