Need For Additional Surgery Research Articles

Effect of High Body Mass Index on Survivorship After Lateral Meniscal Allograft Transplantation: A Propensity Score Matching Analysis

Background: Preoperative body mass index (BMI) is one of the correctable factors before surgery. Few studies have investigated the effect of BMI on the survivorship of lateral meniscal allograft transplantation (MAT). Hypothesis: Patients with a high BMI have inferior survivorship after lateral MAT when compared with those with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Overall, 306 consecutive patients who underwent lateral MAT were retrospectively reviewed. According to the classification criteria of the World Health Organization, patients were split into 2 groups: normal weight (BMI <25.0) and overweight (BMI ≥25.0). There were 104 patients (34.0%) allocated into the overweight group. Given the demographic heterogeneity between the groups, propensity score matching was performed. Before and after propensity score matching, the anatomic and clinical survival rates of the 2 groups were compared by Kaplan-Meier survival analysis. Anatomic failure was defined as a tear covering >50% of the allograft or unstable peripheral rim on follow-up magnetic resonance imaging and second-look arthroscopy. Clinical failure was defined as a Lysholm score <65 or need for additional surgery, such as revision MAT. Results: For all patients, the mean ± SD follow-up period was 6.9 ± 4.2 years. The mean BMI of the overweight and normal weight groups was 27.8 ± 2.6 and 22.0 ± 1.9, respectively. The mean Lysholm scores at the last follow-up were not significantly different between the groups. However, the anatomic survival rate in the overweight group (77.9%) was significantly lower than that in the normal weight group (90.1%) (P < .001). The clinical survival rate (82.7%) in the overweight group was significantly lower than that in the normal weight group (95.0%) (P < .001). After propensity score matching for patient characteristics, which left 87 patients per group, the anatomic and clinical survival rates were significantly lower in the overweight group. Conclusion: Preoperative high BMI was associated with inferior anatomic and clinical survival rates. The results of the current study suggest that weight loss before lateral MAT may be required in overweight patients for the improvement of anatomic and clinical survival rates.

'Microincisional trabeculectomy for glaucoma".

To evaluate the short-term clinical outcomes of microincisional trabeculectomy (MIT), a new technique of ab-interno trabeculectomy. Consecutive patients with open-angle glaucoma identified from the hospital database that underwent MIT with or without cataract surgery between September 2021 to June 2022 at a tertiary eye centre in East India, were screened. Those with a follow-up of < 6 months or with incomplete data were excluded. MIT was done ab-interno using microscissors and microforceps in 2-4 clock hours of the nasal angle via a temporal incision. The intraocular pressure (IOP) reduction at 6 months, and reduction in the number of medications after surgery were analysed. Surgical success (IOP>6 and <22 mm Hg), complications, angle features on anterior segment optical coherence tomography (ASOCT), and the need for additional surgeries were analysed. We included thirty-two eyes of 32 patients with open-angle glaucoma (including n = 9 eyes that underwent concurrent cataract surgery) with a preoperative mean IOP of 22 ±11.1 mm Hg and visual field index of 47±37.9%. All eyes achieved >30% IOP reduction, with a final IOP of 14±6.9 mm Hg at 6 months. Surgical success in 31 of 32 eyes with complete success seen in 28 eyes with none of the eyes requiring >1 medication for IOP control. Hyphema was seen in 4 eyes, while transient IOP spikes at 1 day-1 month were seen in 5 eyes, none of which required any additional interventions. One eye with persistent raised IOP at 1 month required incisional trabeculectomy for uncontrolled IOP with 2 medications. MIT, a new technique of ab-interno trabeculectomy, is effective in terms of IOP control and reduction in the number of medications while having fewer complications. Long-term studies comparing the efficacy of MIT with incisional trabeculectomy, or other procedures are warranted in the future.

Extracting electromyographic signals from multi-channel LFPs using independent component analysis without direct muscular recording

Electromyography (EMG) has been commonly used for the precise identification of animal behavior. However, it is often not recorded together with invivo electrophysiology due to the need for additional surgeries and setups and the high risk of mechanical wire disconnection. While independent component analysis (ICA) has been used to reduce noise from field potential data, there has been no attempt to proactively use the removed "noise," of which EMG signals are thought to be one of the major sources. Here, we demonstrate that EMG signals can be reconstructed without direct EMG recording using the "noise" ICA component from local field potentials. The extracted component is highly correlated with directly measured EMG, termed IC-EMG. IC-EMG is useful for measuring an animal's sleep/wake, freezing response, and non-rapid eye movement (NREM)/REM sleep states consistently with actual EMG. Our method has advantages in precise and long-termbehavioral measurement in wide-ranging invivo electrophysiology experiments.

Outcomes of Corneal Transplant in Childhood Glaucoma.

Childhood glaucoma produces alterations of the postnatal development and function of various ocular structures, including the cornea. Childhood glaucoma patients present lower corneal transplant survival rates. Our series shows clinical outcomes of corneal transplant in childhood glaucoma, with 29. To investigate the surgical outcome of different types of keratoplasty in eyes with childhood glaucoma. A retrospective review was made of the medical records from 17 eyes of 15 patients who were diagnosed with childhood glaucoma and received a corneal transplant between January 2010 and July 2020. Patient demographics, intraocular pressure (IOP), previous ocular surgery, comorbidities, corneal transplant surgery and follow-up outcome were collected. The primary efficacy end point was graft survival (in months) until failure, the latter being considered as irreversible loss of corneal transparency. Secondary efficacy points were need for an increase in topical hypotensive therapy and need for additional surgery. Seventeen eyes of fifteen patients were included, eleven eyes (ten patients) with primary congenital glaucoma (PCG) and six with other types of childhood glaucoma. Corneal transplant was performed at the mean age of 23.76±14.86 years. At the time of the transplant, the number of topical medications was 1.35±1.27, IOP was 15.00±8.34mmHg and patients had received up to seven glaucoma surgeries. Descemet Stripping Automated Endothelial Keratoplasty was performed in thirteen eyes (76%) and penetrating keratoplasty in four (24%). After surgery, seven (41%) eyes required increased topical treatment and two (12%) glaucoma surgery. Twelve eyes (71%) developed graft failure at 24 months, the mean time of survival being 13.88±8.25 months. Management of corneal decompensation in childhood glaucoma poses a challenge. In this series of childhood glaucoma with corneal transplants, survival rate was 29% at 24 months.

Comparison of Value per Operative Time between Primary and Revision Surgery for Adult Spinal Deformity: A Propensity Score-Matched Analysis.

Retrospective cohort study. To compare the relative value units (RVUs) per minute of operative time between primary and revision surgery for adult spinal deformity (ASD). Surgery for ASD is technically demanding and has high risks of complications and revision rates. This common need for additional surgery can increase the overall cost of care for ASD. RVU is used to calculate reimbursement from Medicare and to determine physician payments nationally. In calculating RVUs, the physician's work, the expenses of the physician's practice, and professional liability insurance. Cost effectiveness of surgeries for ASD have been evaluated, except for RVUs per minute compared between primary and revision surgery. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥18 years who underwent surgery for spinal deformity between 2011 and 2019 were identified and included. To ensure a homogenous patient cohort, those who underwent anterior-only and concurrent anterior-posterior fusions were excluded. Propensity score matching analysis was performed, and Mann-Whitney U test, Pearson chi-square test, or Fisher's exact test were used to compare matched cohorts as appropriate. A total of 326 patients who underwent revision surgery were matched with 206 primary surgery patients via propensity score matching. Demographic characteristics, comorbidities, preoperative laboratory values, and readmission and reoperation rates were not significantly different between groups. The revision surgery group had significantly higher mean RVUs per minute than that of the primary surgery group (0.331 vs. 0.249, p <0.001), as well as rates of morbidity and blood transfusion. Compared to primary surgery, revision surgery for ASD is associated with significantly higher RVUs per minute and total RVUs and higher rates of 30-day morbidity and blood transfusions. Readmission and reoperation rates are similar between surgeries.

573 The Impact of Burn Injuries on Indigenous Populations

Abstract Introduction Racial and ethnic minorities experience disparities in prevention and treatment of burn injury. However, research on burn injuries in Indigenous populations is limited. This review summarizes literature on burn injuries in Indigenous populations that require consideration due to systemic racism, intergenerational trauma, and health disparities to inform new research. Methods A search was conducted in CINAHL, Ovid MEDLINE, PSYCinfo, and SocINDEX. for “burn OR scars OR scald OR deformity OR disfigurement” and “Aboriginal OR Indigenous OR First Nation OR American Indian OR Maori OR Native OR Torres Strait Islander OR Amerindian OR Inuit OR Metis OR Pacific Islander”. Search criteria were set by the authors with librarian assistance. Inclusion 1) peer-reviewed studies of burns in Indigenous persons 2) in English. Exclusion 1) no data specific to Indigenous burns 2) not peer-reviewed 3) not in full text 4) protocol publications. Selection was performed by a member of the research team and reviewed by the co-authors. Results The search identified 1,091 studies with 51 for review. Fifteen were excluded. Three were editorials or letters. Five were not full text. One was a protocol only, and one did not reference Indigenous persons. Two reported accident rates in Indigenous populations but not burns data. Two excluded articles did not report burns data in the Indigenous population. One was excluded as the conclusions were not supported by the data. Included publications were published between 1987 and 2021 with 24 between 2011 - 2021. Indigenous populations have a rate of burn injury up to two times of the general population in the US, Canada, New Zealand, and Australia. Indigenous people suffered more injuries from flame and inhalation. Burns in Indigenous people are of greater total body surface area and deeper. Indigenous persons had longer lengths of stay, more complications, and need for additional surgeries. The Indigenous population in the US is associated with more hypertrophic scarring. Indigenous patients in Australia struggle with a lack of culturally safe communication and support for aftercare. Conclusions Current literature is limited specific to burns in Indigenous populations. Racial disparities exist in burn injury incidence and outcomes for Indigenous persons. Indigenous populations suffer burn injuries, have more complications, and longer lengths of stay in hospital. Current care practices lack cultural safety considerations. Applicability of Research to Practice Qualitative research in this area will help providers better understand the experiences of Indigenous burn patients to develop more culturally competent care. We are currently developing a study using qualitative hermeneutic methodology to learn about the experiences of Indigenous burn survivors’ injuries, recovery, and social reintegration.

SPECTROPHOTOMETRIC DETERMINATION OF THE TANNIDITY OF LIGNOSULFONATES IN THE PRODUCTION OF REAGENT SYSTEMS FOR OILFIELD CHEMISTRY

The article is devoted to the issue of quantitative determination of the main qualitative indicator of lignosulfonates - a product of processing of vegetable wood raw materials. For a number of reasons of various nature, the quality of lignosulfonates has declined sharply over the past decades. The consequence was the need for additional operations to modify the lignosulfonate matrix in the technological cycles of obtaining reagent systems for oilfield chemistry, in the case of supplies of lignosulfonate with a low tannidity index. The tannidity index characterizes the inhibitory or tanning ability of reagent systems based on lignosulfonate and is quantitatively determined by the content of OH-phenolic functional groups in the composition of the lignosulfonate macromolecule (20-30 monomer units). The paper presents a comparative study of the results of determining the tannidity index of lignosulfonates of various methods of obtaining by adsorption on collagen and spectrophotometric method with ammonium molybdate. The results of the determinations were processed by the method of mathematical statistics and it was found that the variances of the results of experimental studies are homogeneous and belong to one general population according to the Fisher criterion. Based on the results of the work carried out, it can be considered mathematically justified to replace the long-term collagen method with a spectrophotometric express method for determining tannidity with ammonium molybdate at a wavelength of 400 nm and calculating the quantitative content of OH-phenolic groups. The determination of the values of the confidence intervals of the analytical methods under study shows a relatively high accuracy of the spectrophotometric method compared to the collagen method, which is characterized by overestimated results. Recommendations were issued on the inclusion of a spectrophotometric method for determining the tannidity of the process of obtaining reagent systems as an input control operation of raw materials. For citation: Teptereva G.A., Rolnik L.Z., Pugachev N.V., Zhuravleva A.A., Lukmanova I.F. Spectrophotometric determination of the tannidity of lignosulfonates in the production of reagent systems for oilfield chemistry. ChemChemTech [Izv. Vyssh. Uchebn. Zaved. Khim. Khim. Tekhnol.]. 2023. V. 66. N 6. P. 23-30. DOI: 10.6060/ivkkt.20236606.6797.

Outcomes of patients undergoing single-level arthroplasty versus anterior lumbar interbody fusion.

Compared to vertebral body fusion, artificial discs are thought to lessen the risks of adjacent segment disease and the need for additional surgery by maintaining spinal mobility as they mimic the intervertebral disc structure. No studies have compared the rates of postoperative complications and the requirement for secondary surgery at adjacent segments among patients who have undergone anterior lumbar interbody fusions (ALIF) versus those undergoing lumbar arthroplasty. An all-payer claims database identified 11,367 individuals who underwent single-level ALIF and lumbar arthroplasty for degenerative disc disease (DDD) between January 2010 and October 2020. Rates of complications following surgery, the need for additional lumbar surgeries, length of stay (LOS), and postoperative opioid utilization were assessed in matched cohorts based on logistic regression models. Kaplan-Meyer plots were created to model the probability of additional surgery. Following 1:1 exact matching, 846 records of patients who had undergone ALIF or lumbar arthroplasty were analyzed. All-cause readmission within 30-30days following surgery was significantly higher in patients undergoing ALIF versus arthroplasty (2.6% vs. 0.71%, p = 0.02). LOS was significantly lower among the patients who had undergone ALIF (1.043 ± 0.21 vs. 2.17 ± 1.7, p < .001). ALIF and lumbar arthroplasty procedures are equally safe and effective in treating DDD. Our findings do not support that single-level fusions may biomechanically necessitate revisional surgeries.

Evaluation of the widths of the mucosal strips in pathological examination of specimens of endoscopic submucosal dissection for early gastric cancer.

Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer in Japan. Pathological evaluation of ESD specimens is considered essential to determine if additional gastrectomy is necessary. Usually, specimens resected by ESD are sliced into 2-3mm wide sections, and each section is examined for depth of tumor and lymphovascular invasion. Nevertheless, in most cases of additional gastrectomy, lymph node metastasis is not present. Given that there are few-studies on how clinical-decisions based on the pathologic-evaluation-method, in particular the specimen cut-width, influence patient outcomes, we retrospectively evaluated whether reducing the number of cuts to one-half or one-third would result in underestimation of the real need for additional surgery. The effect of the actual cut-width on recommended treatment (referral to operation) and patient-outcomes was also assessed. Pathological records of 498 lesions from 439 patients were reviewed and re-evaluated. All pathological descriptions are based on the gastric cancer classification system of the Japanese Gastric Cancer Association, 15th edition. In 5.8% and 8.5% of the total specimens, underdiagnosis of tumor-depth and lymphovascular invasion occurred when the number of sections was reduced to one-half and one-third, respectively. Significantly more submucosal invasions were found in the group in which the cut-with was between 3 and 4mm than in the group in which the cut width was less than 3mm. Evaluation of the appropriate cut-width is important and should be discussed from the standpoint of labor costs and lost opportunities to search for molecular markers in ESD materials.

Modified-dropless protocol (nil intraocular) for micro-incision vitrectomy surgery (MIVS): a retrospective pilot study

BackgroundPerioperative infection and inflammation prophylaxis after ocular surgery has evolved over the years along with improvements in surgical equipment and a growing interest in alternatives to the standard topical eye drops. The purpose of this study is to evaluate the outcomes of a novel, modified-dropless protocol for 23-gauge (23-G), 25-gauge (25-G) and 27-gauge (27-G) micro-incision vitrectomy surgery (MIVS) that omits any intraocular injections of antibiotics or steroids.MethodsThis Institutional Review Board-approved, single-surgeon retrospective study reviewed MIVS post-surgical outcomes in patients who received a modified-dropless protocol from February 2020 to March 2021. A total of 158 charts were reviewed, of which 150 eyes met the eligibility criteria. After each case, patients were administered a 0.5 cc subconjunctival injection of a 1:1 Cefazolin (50 mg/cc):Dexamethasone (10 mg/cc) in the inferior fornix and 0.5 cc of posterior Sub-Tenon’s Kenalog (STK). No intravitreal injections were administered, and no pre- or postoperative antibiotic or steroid eye drops were prescribed. For patients allergic to penicillin, separate subconjunctival injections of 0.25 cc each of Vancomycin (10 mg/cc) and Dexamethasone (10 mg/cc) were administered. The primary safety parameter was postoperative cases of endophthalmitis. Secondary endpoints consisted of Best-Corrected Distance Visual Acuity (BCVA), intraocular pressure (IOP), and postoperative complications (retinal detachments, inflammation, need for additional surgery) within three months of surgery. Statistical analysis was performed using chi-square (χ²) tests for categorical values, and a Student’s t-test to compare continuous outcomes.ResultsThe majority of surgeries (96%) were performed with the 27G MIVS platform. There were no cases of postoperative endophthalmitis. Mean logMAR BCVA improved from 0.71 (± 0.67) to 0.61 (± 0.60) post-operatively (p = 0.02). Excluding patients who had silicone oil tamponade, postoperative BCVA improved from 0.67 (± 0.66) to 0.54 (± 0.55) (p = 0.003). Mean IOP increased from 14.6 (± 3.8) to 15.3 (± 4.1) (p = 0.05). Ten patients required further medication therapy for an increase in IOP, one had inflammatory signs, and 14 required a second surgical intervention mostly due to recurrences of initial surgical indication.ConclusionA modified-dropless postoperative protocol involving subconjunctival and posterior sub-Tenon’s injections only may be a safe and convenient alternative to topical eye drops for patients undergoing MIVS, but additional and larger studies are needed.

A Contemporary Analysis of Closed Claims Related to Wrong-Site Surgery

Wrong-site surgeries are considered "never events" and continue to occur despite the implementation of the Universal Protocol by The Joint Commission in 2003. The authors reviewed closed claims data on wrong-site surgery between 2013 and 2020 from a medical malpractice company. The claims were classified by allegations made by claimants, the responsible services, the types of procedures, the injuries, and contributing factors. Researchers performed a descriptive analysis of the available variables and reviewed the clinical summary of each case. Between 2013 and 2020, there were 68 wrong-site closed claims cases. The mean age of the patients was 55.7 (standard deviation 16.21) years, and 51.5% were female. The services most frequently responsible for these were Orthopedic (35.3%), Neurosurgery (22.1%), and Urology (8.8%). The most common types of procedures were spine and intervertebral disc surgery (22.1%), arthroscopy (14.7%), and surgery on muscles/tendons (11.8%). The severity of claims was higher in the inpatient setting compared to the ambulatory setting. The most common alleged injuries included the need for additional surgery (45.6%), pain (33.8%), mobility dysfunction (10.3%), worsened injury (8.8%), death (7.4%), and total loss (7.4%). The top contributing factors to wrong-site surgery were failure to follow policy/protocol (83.8%) and failure to review the medical records (41.2%). The mean closed claim value was $136,452.84, and 60.3% of cases were settled. The risk of wrong-site surgeries is increased with spine surgeries, likely due to unique technical challenges. Further research is required to identify effective methods of prevention of these events.

Nonsteroidal Anti-inflammatory Drugs in the Acute Post-operative Period Are Associated With an Increased Incidence of Pseudarthrosis, Hardware Failure, and Revision Surgery Following Single-level Spinal Fusion.

Retrospective study. Research has shown that the use of NSAIDs and COX-2 inhibitors increases the risk of pseudoarthrosis following spinal fusion surgery. Pseudoarthrosis can lead to complications such as chronic pain and the need for additional surgeries. The purpose of this study was to examine the relationship between NSAID and COX-2 inhibitor use and pseudarthrosis, hardware complications, and revision surgeries in patients undergoing posterior spinal instrumentation and fusion. We queried the PearlDiver database using CPT and ICD-10 codes to identify patients between the ages of 50 and 85 who underwent posterior spinal instrumentation between 2016 and 2019 and experienced pseudarthrosis, hardware failure, or revision surgery. Information regarding age, Charlson Comorbidity Index, tobacco use, osteoporosis, and obesity were extracted from the database along with COX-2 or NSAID use during the first 6-week post-surgery period. Logistic regression was used to identify associations while adjusting for confounders. There were 178,758 patients included in the cohort; 9,586 experienced pseudarthrosis (5.36%), 2828 (1.58%) experienced hardware failure, and 10,457 (5.85%) patients underwent revision fusion surgery. Of these patients 23,602 (13.2%) filled NSAID and 5278 (2.95%) filled COX-2 prescriptions. A significantly higher proportion of patients using NSAIDs experienced pseudarthrosis, hardware failure, and revision surgery compared to patients not taking NSAIDs. COX-2 inhibitors were also associated with a significantly higher rate of pseudarthrosis, hardware failure, and revision surgery. Postoperative ketorolac use was not associated with these complications. Regression models demonstrated that both NSAIDs and COX-2 inhibitors were associated with statistically higher pseudarthrosis, hardware failure, and revision surgery rates. Both NSAID and COX-2 inhibitor use in the early post-surgical period may be associated with increased rates of pseudarthrosis, hardware failure, and revision surgery in patients undergoing posterior spinal instrumentation and fusion.

MP07-03 OBESITY IMPACTS ROBOTIC SACROCOLPOPEXY OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP07-03 OBESITY IMPACTS ROBOTIC SACROCOLPOPEXY OUTCOMES Jessie Chen, Paige Kuhlmann, Alana Christie, Ramy Goueli, Philippe Zimmern, and Maude Carmel Jessie ChenJessie Chen More articles by this author , Paige KuhlmannPaige Kuhlmann More articles by this author , Alana ChristieAlana Christie More articles by this author , Ramy GoueliRamy Goueli More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Maude CarmelMaude Carmel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Obesity is a known risk factor for pelvic organ prolapse (POP) and its prevalence has been increasing worldwide. Many obese women with POP seek treatment, and robotic sacrocolpopexy (RSC) is a gold standard for apical POP. We sought to investigate the impact of obesity on complication rates and clinical outcomes in women undergoing RSC at our institution. METHODS: IRB approval was obtained for this study. We reviewed the charts of all women who underwent RSC at our institution between December 2013 and September 2022 and compared women without obesity, those with class 1 obesity (BMI ≥30 and <35), and those with class 2 obesity or greater (BMI≥35). Patient characteristics included age, ASA score, and surgery performed. Outcomes assessed included operating time, estimated blood loss (EBL), length of stay (LOS), intra-operative complications, and readmission rates. Additional clinical characteristics evaluated included history of prolapse surgery, pre-operative POP-Q stage, and follow up time. Outcomes evaluated were POP recurrence beyond the hymen, sensation of bulge, further surgery for POP, and overall failure rate (composite of the last three outcomes mentioned). RESULTS: 166 non-obese and 60 obese women were included in our study. 39 patients had BMI ≥30 and <35; 21 had BMI ≥35. Obese patients were significantly younger than non-obese patients (p<0.0001). Patients with BMI≥35 were more likely to undergo a simultaneous SUI procedure (p=0.042). There were no significant differences in ASA score, type of RSC, or likelihood of having a concomitant rectopexy or other major procedure. There were no significant differences in LOS, intra-operative complications, EBL, operating time, or readmission rates between groups. There were no significant differences in length of follow up. Among patients with ≥6 months of follow up, none experienced recurrence of apical prolapse. Those with BMI≥35 were more likely to experience failure in the anterior or posterior compartment (p=0.0029) and need for additional surgery for POP (p=0.033). CONCLUSIONS: Obesity was not associated with higher EBL, operating time, intra-operative complications, or readmission rates. However, BMI≥35 was associated with higher failure rates and need for further surgery for POP. Source of Funding: Internal funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e85 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessie Chen More articles by this author Paige Kuhlmann More articles by this author Alana Christie More articles by this author Ramy Goueli More articles by this author Philippe Zimmern More articles by this author Maude Carmel More articles by this author Expand All Advertisement PDF downloadLoading ...

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistula with Surgical Correlation

Objective: This study's goal was evaluate the part magnetic resonance imaging plays in the identification and classification in perianal fistulas to contrast those results with those from surgery. Study Design: Cross Sectional Place &amp; Duration: Study carried out between the periods of January 2022 to Aug 2022 Material &amp; methods: This study was tested on 50 patients in the hospital. Patients who had undergone MRI pelvis with or without contrast study were counted in the current study. Patients who undergone surgery prior or had recurrent perianal illness were not included in the study. Short T1 inversion recovery, T2 weighted (T2W) sagittal, axial, and coronal MRI sequences (STIR), T1W axial, and coronal sequences, and T1W post contrast axial &amp; coronal sequences were all evaluated. Results Reflected: while evaluation by MRI, among 50 patients, 45 which is 90% were man and 5 which is 10% were female gender. In 45 (90%) of the 50 patients overall, postoperative results confirmed perianal fistula. A total of 5(10%) patients had perianal sinus only. The primary tract was found to have a sensitivity and specificity of 97.73% and 83.33%, respectively, whereas the abscess had a sensitivity and specificity of 88.89% and 95.12%. High sensitivity was also acknowledged for accurately locating the internal opening (95.45%), detecting the horseshoeing (90.91%), correctly identifying the secondary ramification (92.86%) with specificity (94.44%). Conclusion: It is found that MRI demonstrated superior performance in evaluating perianal fistula with critical parameters (primary tract and its grading, internal opening, secondary ramification, abscess, horseshoeing). Pre-operative perianal fistula assessment should be correct to prevent problems and recurrence, which will decrease the need for additional surgeries. Practical Implication: As a result of this study, unnecessary radiation and diagnostic time could be avoided in the preoperative assessment of PAF in ano using MRI. It would also help decrease complications and unnecessary surgeries. Keywords: Magnetic Resonance Imaging and Perianal Fistula, perianal sinus, horseshoeing

Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study.

The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort. We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications. A total of 267 patients were included in the study (130 females; mean age, 51.46 ± 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p=0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 ± 10.9 vs. 11.3 ± 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications. PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications. 4 Laryngoscope, 133:2910-2919, 2023.

The Need for Additional Surgery after Passive versus Active Approaches to Syndromic Craniosynostosis: A Meta-analysis

PubMed and Embase were searched in June 2022 to identify all articles reporting primary reoperation or Whitaker outcomes for syndromic patients undergoing cranial vault expanding surgery or suturectomy. A meta-analysis of proportions was performed comparing UORs, and a trim-and-fill adjustment method was used to validate sensitivity and assess publication bias. A total of 721 articles were screened. Five EACS articles (83 patients) and 22 active approach articles (478 patients) met inclusion criteria. Average UORs for EACS and active approaches were 26% (14%-38%) and 20% (13%-28%), respectively (P = 0.18). Reoperation occurred earlier in EACS patients (13.7 months postprimary surgery versus 37.1 months for active approaches, P = 0.003). Relapse presentations and reason for reoperation were also reviewed. Subjectively, EACS UORs were higher in all syndromes except Apert, and Saethre-Chotzen patients had the highest UOR for both approaches. There was no statistically significant increase in UORs among syndromic patients treated with EACS compared with traditional approaches, although EACS patients required revision significantly sooner. Uncertainties regarding the long-term efficacy of EACS in children with syndromic craniosynostosis should be revisited as more data become available.

POST-EVACUATION OF SILICONE OIL COMPLICATIONS IN RHEGMATOGENOUS RETINAL DETACHMENT PATIENTS WHO UNDERWENT PARS PLANA VITRECTOMY AT TERTIARY HOSPITAL IN BALI, INDONESIA

Introduction: Pars plana vitrectomy with silicone oil injection has become a standard procedure to treat retinal detachment with complex cases. Considerations related to the use of silicone oil are the need for additional surgical procedures to remove silicone oil after the retinal condition is declared stable or because emulsification of silicone oil has occurred.&#x0D; Methods: An analytical observational study with a cross-sectional approach. Data were collected retrospectively by collecting medical records of patients who underwent silicone oil evacuation in 2021.&#x0D; Result: The research subjects were 23 people, where 52.2% of the subjects were women with a median age of 51 years. Most of the subjects (65.2%) had no complications, with the most complications occurring were secondary glaucoma (13%) and redetached retina (13%). There was no statistically significant difference between visual acuity before and after the evacuation of silicone oil with a P value of 0.202 and there was no statistically significant difference between IOP before and after evacuation of silicone oil with a P value of 0.132.&#x0D; Conclusion: Evacuation of silicone oil is a follow-up action after PPV with SO tamponade. Complications which may arise are detach dan glaucoma. There was no significant difference in visual acuity and IOP before and after SO evacuation.

Longitudinal analysis of persistent stress urinary incontinence after radical prostatectomy and time to definitive surgical treatment: Data from CaPSURE.

347 Background: Persistent urinary incontinence (UI) after radical prostatectomy (RP) can have significant impact on quality of life, return to work and need for additional surgery. We aim to characterize the long-term cumulative incidence of incontinence procedure and report changes in urinary function (UF), urinary bother (UB), and work status from time of RP to 1 year postop. Methods: Participants treated by primary RP (1990-2020) for prostate cancer enrolled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry of 43 US urologic practices. UI was defined as self-reported use of &gt;1 pad per day at 1 year after RP. UI procedure was tracked with CPT codes for urinary sling and artificial urinary sphincter (AUS). Participants reported work status (full-time paid, part-time paid, unpaid) and urinary scores (0-100) using UCLA Prostate Cancer Index. Associations of incontinence with changes in urinary scores (t-test) were assessed. Lifetable estimates and Cox proportional hazards regression were used to evaluate the risk of undergoing a UI surgical procedure, with model adjustment for pre-treatment age and urinary dysfunction, surgical characteristics, and post-surgical radiation. Results: Of 5742 men treated with primary RP, 641 (11%) reported UI as defined above at 1 year post-RP. Mean age was 61 years. A larger proportion of individuals with UI underwent open RP (93% vs 7%) and non-nerve sparing (62% vs 38%). At 1 year post RP, score decline in UF (-42.6 vs -11.7) and UB (-25.5 vs -2.7) were significantly worse in the incontinent group (all p&lt;0.01). Cumulative incidence of incontinence procedures was 1.4% at 10 years with median time to UI-redirected procedure of 36 months (IQR 12, 74) after RP. Incontinence procedures comprised 52.4% AUS, 15.8% sling, 6.3% both, and 25.4% unspecified. UI (HR 10.6,95%CI 6.3-17.9), older age (per decade, HR 2.0, 95% CI1.3-3.0), history of voiding dysfunction (HR 6.1,95% CI 2.9-12.8) and receipt of radiation (adjuvant or salvage) (HR 2.4, 95% CI1.2-4.8)) were associated with undergoing incontinence procedure. Conclusions: UI at 1 year after RP may occur in up to 11% of surgical recipients. However, the rate of intervention remained low with 1.4% of the total cohort undergoing an incontinence procedure within 10 years. Incontinence affected urinary quality of life. Median time to UI procedure was 36 months. This information suggests that a significant number of men may have long – term, untreated incontinence and even those who undergo procedures to manage it may not have it in a timely fashion.

Percutaneous Axillary Artery Puncture: An Efficient Approach for Upper Extremity Access

The aim was to analyze the anatomic feasibility of the percutaneous axillary access (PAXA) using cadaverous models and then to analyze the complications associated with PAXA during Fenestrated or Branched Endovascular Aneurysm Repair (F/BEVAR) procedures. Cadaverous models were used to analyze axillary pedicle after a PAXA on an initial anatomical investigation. A subclavian approach was performed after puncture to assess the injuries caused by the needle. Then, in an observational study, patients who underwent F/BEVAR using a PAXA between July 2019 and July 2021 were included. PAXA-related events and complications were monitored. Eleven dissections were performed on cadavers. The axillary vein was injured twice (18.2%); the puncture site on the axillary artery was found on the arterial proximal part, behind the clavicle. Fifty-three patients underwent a F/BEVAR using a PAXA. The mean (SD) age of patients was 74.5 (9.7) years. Most indications for endovascular repair were para-renal aneurysms (66%). Two Proglide® closure devices served to close arterial access in all procedures. Adjunct balloon inflation was used in 19 (35.8%) patients. There were 5 (9.4%) PAXA-related events included preoperative blush in 2 (3.8%) patients, axillary artery dissection in 2 (3.8%), and 1 (1.9%) axillary artery stenosis. Five patients (9.4%) had a postoperative axillary hematoma without need for additional surgical procedure. No PAXA-related complication was found after discharge (mean [SD] 11.7 [7.4] months following surgery). Percutaneous axillary artery access was an efficient upper extremity access and associated with a low rate of PAXA-related events.

Comparison of statins with steroids and botulinum toxin A in the prevention of benign strictures after esophageal endoscopic submucosal dissection: a retrospective cohort study.

Preventing benign strictures following esophageal endoscopic submucosal dissection (ESD) remains difficult, and finding a safe, effective, and simple management method is vital. We previously reported that rosuvastatin significantly reduced the incidence and severity of strictures in a rabbit model of esophageal stricture. Accordingly, in this study, we compared the effects of statins, steroids, and botulinum toxin A (BTX-A) on stricture prevention after ESD involving more than three-fourths of the luminal circumference. Of the 1019 ESD cases treated between January 2015 and December 2020, 246 met the inclusion criteria, with 21 cases excluded due to loss to follow-up, tumor recurrence, death, or need for additional surgery, radiotherapy, and/or chemotherapy. Of the 225 included cases, 145 received no intervention, while the remaining 80 were treated: 16 with oral steroids, 20 with topical triamcinolone acetonide (TA) injection, 21 with topical BTX-A injection, and 23 with statins. The occurrence stricture rate in the statins group (17.4%, 4/23) was significantly lower than in the non-intervention (75.2%, 109/145, P = 0.000), oral steroids (56.3%, 9/16, P = 0.011) and TA injection (50%, 10/20, P = 0.023) groups, but comparable to in the BTX-A injection (38.1%, 8/21, P = 0.124) group. The dysphagia score was lower in the statin than non-intervention group (P = 0.000). Although there was no significant difference in the number of required dilations between groups, the maximum number of dilations in the statins group was only six. Statins may be a potential treatment to prevent esophageal strictures after extensive ESD; however, clinical trials should be conducted to validate this.