Number Of Postoperative Complications Research Articles

Comparison of Single-Use Negative-Pressure Wound Therapy (sNPWT) and Standard Dressings Applied to the Same Patient During Bilateral Tissue Expander-to-Implant Exchanges.

Breast cancer is the most common cancer among women. The number of cases is increasing among young women, and consequently, breast reconstructions are performed more often. Postoperative complications, wound healing, and the quality of scars influence the final cosmetic outcomes. The aim of the study was to investigate the effect of using a negative-pressure therapy compared to a standard dressing on two postoperative wounds in the same woman, after bilateral tissue expander replacement surgery-when identical healing conditions occur. This study includes a single-center evaluation of the application of two different dressings during bilateral exchanges of tissue expanders with breast implants. The study included 22 patients with a history of breast cancer after bilateral mastectomy with two-stage reconstruction. During the second stage, a sNPWT was applied to one breast and a standard dressing to the other. A statistically significant difference in skin elasticity in favor of sNPWT was visible after 7 days, while the greatest difference was visible in the evaluation after 6 months (mean of 0.806 vs. 0.607). A difference in temperature measurements was shown 7 days after the procedure. However, after 30 days, these measurements were similar. There was also a reduced incidence of postoperative complications as well as seroma accumulation in the breasts with negative pressure. The results indicate faster healing, better scar quality, and improved skin elasticity in breasts with sNPWT compared to the standard dressing. The number of postoperative complications were also reduced, which is especially important in high-risk patients.

Neoadjuvant chemotherapy with FLOT scheme in surgical treatment of gastric cancer: short- and long-term outcomes. A retrospective cohort study

Aim. To compare the results of surgical treatment of patients with gastric adenocarcinoma and esophagogastric junction cancer (EGJC) who received neoadjuvant chemotherapy (NCT) FLOT with primary operated patients. Materials and methods. A retrospective cohort study included 177 patients who underwent radical surgical treatment at the Burdenko Faculty Surgery Clinic of Sechenov University for gastric cancer (GC) and/or EGJC Sievert Type II–III in the period from January 2018 to December 2022. The main group consisted of patients (n=28) who received NCT FLOT. Patients in both groups did not statistically significantly differ in average age (p=0.110), ASA status (p=0.541), ECOG status 0–3 (p=0.12), localization (p=0.063), depth of invasion (p=0.099) and histological structure of the tumor (p=0.787). In the main group, more patients with lesion of the regional lymph nodes were expected (p0.001). According to the most significant indicators [postoperative complications, the presence of a "positive" edge of resection (R1), recurrence and/or progression of GC], we performed a quasi-randomization by the matching procedure, taking into account the selection of the nearest neighbors. Results. In 92.9% of patients in the main group and in 94.9% of the control group, R0 resection (p=0.750) was achieved. The number of removed lymph nodes was statistically significantly higher in the main group (average 26 vs 21; p=0.010). There was no difference in intraoperative blood loss (p=0.294) and hospital stay (p=0.992). The average duration of surgery in the main group was 319 minutes, compared to 250 minutes in the control group (p0.001). In the early postoperative period, the total number of complications (CD I–IV) was higher in the main group (p=0.031), however, there was no difference in the number of small (CD I–II; p=0.094) and significant (CD III–V; p=0.142) complications. Postoperative mortality in the first 30 days after surgical treatment was 3.6 and 2.5% in the main and control groups, respectively (p=0.764). The overall 6-month survival rate in the control group was 95.9% vs 90.9% in the main group, and the 12-month survival rate was 88.8% vs 75.7%, respectively. The reccurence-free 6-month survival rate in the control group was 96%, in the main group – 100%; the reccurence-free 12-month survival rate in the control group was 92.1%, in the NCT group – 93.3%. Conclusion. NCT FLOT in the treatment of GC and EGJC Sievert Type II–III does not increase the level of intraoperative blood loss, the number of postoperative complications and the duration of hospitalization. The 6-month and one-year survival rates did not differ in the two groups. Considering that the majority of patients in the NCT group belonged to the cN+ category, with an initially less favorable treatment prognosis, it can be assumed that comparable survival results were achieved thanks to NCT.

Clinical findings and prognostic factors for immediate survival in 33 dogs undergoing surgery for biliary peritonitis.

To report demographics, clinical signs, physical examination, diagnostic test results, surgical findings, and prognostic factors for in-hospital postoperative mortality following biliary peritonitis surgery in dogs. Retrospective, multi-institutional cohort study. Thirty-three client-owned dogs. The medical records of dogs that underwent surgery for biliary peritonitis between 2015 and 2021 were reviewed. Dogs were included if they had a definitive diagnosis of biliary peritonitis and a surgery report. Information on demographics, clinical signs and duration, physical examination findings, laboratory and diagnostic imaging results, surgery, perioperative medical treatment, and complications for each patient was obtained. Statistical analyses were performed to identify risk factors that affected survival. Cholecystectomy was the procedure most frequently performed (31/33, 94%). The overall mortality rate was 36% (12/33). Survival was affected negatively by hyperbilirubinemia (p = .049), administration of vasopressors (p = .002), renal dysfunction (p = .008), and number of postoperative complications (p = .005). A mortality rate of 50% was observed in dogs with a total bilirubin level greater than 60.5 μmol/L. There was no difference in mortality rate between septic and nonseptic biliary effusions. New prognostic factors associated with in-hospital postoperative mortality in dogs treated surgically for biliary peritonitis were identified, while others that had been reported previously were confirmed. A preoperative bilirubin threshold value associated with a 50% mortality was identified. Additional information that could help to predict survival in dogs with biliary peritonitis has been provided. However, further research is warranted.

Introduction of uniportal VATS access when performing lobectomies

Aim. Analysis of surgical indices during monoport thoracoscopic lobectomies in Sakhalin Regional Clinical Oncological Dispensary at different stages of mastering the technique. Materials and methods. Case histories of 251 patients who underwent radical surgical treatment for lung cancer using monoport thoracoscopic access. Patients were divided into two groups: initial (109 patients) and advanced (142 patients). The average surgical time, number of complications and conversions were assessed. Results. Mastering the technique leads to a statistically significant reduction in surgical time. The difference in other parameters, such as the number of postoperative complications and the percentage of conversions at different stages, tends to decrease. Conclusion. Surgical indices improve as the team goes through the learning curve. The technique is adequate and reproducible for surgical treatment of patients with lung cancer.

Efficacy and Safety of a Self-Improved Continuous Bladder Irrigation Sensor Device in Patients after Transurethral Resection of the Prostate: A Prospective Study.

To explore the efficacy and safety of a self-improved continuous bladder irrigation (CBI) sensor device after transurethral resection of the prostate (TURP). A total of 160 patients with benign prostatic hyperplasia who received TURP from June 2021 to May 2022 were selected. According to the envelope randomization method, patients were divided into a control group (80 cases) and study group (80 cases). In the control group, the speed of bladder flushing fluid was adjusted according to the clinical experience of nurses. On the basis of the control group, the self-improved CBI sensor device was used in the study group to observe the postoperative comfort and complication rate in the two groups. The comfort of patients in the study group was significantly higher than that of patients in the control group (97.50% vs. 88.75%, P = .023), and the number of postoperative complications in the control group was significantly higher than that in the study group (8.75% vs. 1.25%, P = .021). Meanwhile, the average amount of irrigation fluid in the study group was obviously lower than that in the control group (26.4 L vs. 27.8 L, P = .011). In addition, patients in the study group had a significantly shorter hospital stay than the controls (3.3 days vs. 3.6 days, P = .005). Implementation of the new self-improved CBI sensor device for patients after TURP can improve their awareness regarding disease-related knowledge, alleviate their fear and anxiety, improve their compliance and comfort with treatment and nursing, and reduce the incidence of complications.

Robotic assisted simple prostatectomy mitigates perioperative morbidity compared to open simple prostatectomy - a single institution report

BackgroundAccording to the guidelines of the European Association of Urology, open simple prostatectomy should be offered to men with a prostate size exceeding 80 mL suffering from moderate to severe LUTS in the absence of a transurethral enucleation technique. However, open simple prostatectomy is associated with complications such as bleeding, blood transfusions and increased length of stay compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first cases of robotic assisted simple prostatectomy (RASP) to that of patients subjected to open simple prostatectomy (OSP) at our department.MethodsThe patients were identified by a search for the respective procedure codes. In the OSP group enucleation of the adenoma was performed through the prostatic capsule (Millin procedure), while access to the adenoma was gained through the bladder in the RASP group. Complications were scored according to the Clavien-Dindo classification system.Results27 patients who underwent OSP were retrospectively identified and compared to the first 26 patients who were subjected to RASP. The groups were similar with respect to age, body mass index and ASA score. Operative time was significantly shorter in the OSP group compared to the RASP group. Bleeding volume, drop in postoperative hemoglobin and the number of blood transfusions were all significantly higher in the OSP group compared to the RASP group. Average length of stay was 5.5 (2–18) days in the OSP group compared to 1.6 (1–5) days in the RASP group (p < 0.001). The number of postoperative complications, Clavien-Dindo ≥ 2, were significantly higher in the OSP group (11) compared to the RASP group (none, p < 0.001).ConclusionsThe introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.

Pediatric Obesity's Effect on Open and Laparoscopic Appendectomy Outcomes.

Background Pediatric obesity is a common comorbid condition that may complicate pediatric surgeries, such as appendectomy. Prior research on the consequences of obesity on pediatric appendectomy outcomes have been limited by small-sample sizes and pooled analyses that do not distinguish the effects of surgical approach. Associations between surgical approach, pediatric obesity, and postoperative appendectomy outcomes thus remain unclear. Objective To analyze postoperative appendectomy outcomes by accounting for pediatric obesity, appendectomy approach, and their interaction. This is a retrospective cohort population analysis. Nationwide data of pediatric inpatients from the United States were obtained. All pediatric patients who had an appendectomy were selected from the 2019 Kids' Inpatient Database. Materials and Methods Outcomes variables were the length of stay and postoperative complication rate. The primary exposure variables were pediatric obesity, surgical approach (laparoscopic [LA] vs. open appendectomy [OA]), and an interaction term between the two. Control variables were patient demographics, clinical complexity, and geographic location. Multiple regression was used to determine relationships between the outcome, exposure, and control variables. Results A total of 49,037 pediatric patients had an appendectomy, with the number of OA and LA being 4,517 and 44,420, respectively. LA patients had 5.8% ( p < 0.001) shorter length of stay than OA patients. For obese patients, length of stay was 31.8% ( p < 0.001) longer than for nonobese patients, but LA (compared with OA) reduced it by 19% ( p < 0.007). Obesity had no effect on the number of postoperative complications. Conclusion Obese patients had significantly longer length of stay than nonobese counterparts following OA (31.8%), but this difference was minimized for LA patients (15.81%). There was no association between complication rate, obesity, and surgical approach. Our findings will enable more accurate estimations of pediatric patients' postoperative courses and efficient allocation of limited hospital resources. Further research may wish to study the effects of other common pediatric comorbidities on other procedures.

The influence of postoperative morbidity on long-term quality of life outcomes following pelvic exenteration

IntroductionPelvic exenteration provides significant survival benefits for selected patients diagnosed with locally advanced rectal cancer. However, in-hospital postoperative morbidity such as abdominal abscess, sepsis, and anastomotic leak remain highly prevalent, which can have short/long-term impacts on patient quality of life (QoL). The aim of this study was to determine the influence of postoperative morbidity on QoL outcomes in patients following pelvic exenteration. MethodsThis prospective cohort study included patients who underwent pelvic exenteration at a tertiary teaching hospital in Sydney, between 2008 and 2023. QoL measures were collected at baseline, 6, 12, 18, 24, 36, 48, and 60 months using the short-form 36 (SF-36v2) survey. The predictors included variables relating to postoperative morbidity, including hospital and ICU length of stay (LOS), post-discharge mortality and the number of postoperative complications. Mixed-effects analyses were used to determine the influence of these postoperative outcomes on physical and mental QoL trajectories. ResultsThis study included 674 patients, with a median age of 61 years. Shorter hospital and ICU LOS, and fewer or no postoperative complications were associated with higher physical QoL scores across all time points. Conversely, postoperative morbidity did not exhibit a significant impact on mental QoL scores. Furthermore, there was a longitudinal improvement in mental QoL outcomes compared to baseline, independent of postoperative morbidity. ConclusionPostoperative morbidity significantly impacted physical QoL outcomes after pelvic exenteration, whereas mental QoL outcomes were not influenced. Interventions aimed at mitigating postoperative morbidity may hold the potential to enhance long-term QoL outcomes following pelvic exenteration.

Intraluminal administration of indocyanine green as a method of intraoperative diagnostic of staple line leak during sleeve gastrectomy in an experiment.

Background: Bariatric surgery is an actively developing branch of surgery. At the same time, thanks to the use of modern hardware methods for disconnecting and stitching tissue, the number of postoperative complications have significantly decreased. However, staple line failure is still quiet high and the cause of severe postoperative complications. Traditional methods for intraoperative diagnosis of leakage are provocative tests: tests with methylene blue and air. One of the promising methods of intraoperative control in surgery is the use of indocyanine green (ICG) test . Aims: The purpose of the study is to assess the diagnostic value of intraoperative using fluorescent imaging with indocyanine green (ICG) in case of staple line leak during sleeve gastrectomy (SG) by modeling in pig models various causes of staple line failure using morphological studies. Methods: The study was carried out on 20 pigs, each of which underwent SG. The animals were divided into few groups: a control group standard SG (n=4), a group of SG with mechanical failure of staple line(n=12), and a group of SG with local ischemia of staple line (n=4). To assess a staple line leak methylene blue and indocynin green was injected into the stomach. The appearance of the methylene blue or visualization of indocyanine green fluorescence was assessed on the staple line. In the ischemia group ICG was administered intravenously. On the 7th day after surgery, the histological material for morphology examination was collected. Results: In the group of SG with mechanical failure of staple line (n=11) positive ISG test was in 10 cases and positive methylene blue test was in 2 cases. In 90% of cases, ICG leakage corresponded to the localization of modeling ischemia zone, while methylene blue leakage was noted in only 20% of cases. Conclusions: The intraluminal administration of indocyanine green in cases of "mechanical" failure of staple line during sleeve gastrectomy is more informative compared to the standart methylene blue test. ICG angiography data fully corresponds to the localization of modeling ischemia zone.

Immediate and long-term results of closure of a functioning single-stem ileostomy

The aim of the work was to study and evaluate the immediate and long-term results after performing reconstructive and reconstructive operations to eliminate functioning ileostomes. Materials and methods: We operated on 30 patients with functioning single-stem ileostomes in 2019–2022. All interventions were performed as planned. The average age of patients at the time of reconstructive and reconstructive operations was in the range from 35 to 72 years. There were 18 men and 12 women. Results: When using in clinical practice the method of areflux small-colonic anastomosis developed by us in the early postoperative period, intestinal paresis and seromas of the postoperative wound were observed, which were resolved by conservative measures. No complications were observed in the long-term postoperative period. Conclusions: The developed valvular, areflux small-colonic anastomosis prevents reflux of the contents of the colon into the small intestine, thereby preventing the development of SIBR and the number of postoperative complications.

Trends in Indications, Intraoperative Findings and Outcome of Relaparotomy after Caesarean Section at a Tertiary Hospital in Eastern Zone Tanzania; Five Years’ Review

Background: The increased incidences of caesarean section rate is associated with a number of post-operative complications; one being re-laparotomy which is considered a maternal near-miss. The purpose of a re-laparotomy is to manage complications of the previous surgery such as unsecured hemostasis, manage intraabdominal infection, repairing of iatrogenic damaged organs like bowels, ureters and bladder, relieve intestinal obstruction and maintain intestinal continuity or to carry out delayed curative surgery. In general, second surgery increases not only the morbidity but also the risk of maternal mortality. Methods: The study was cross sectional, conducted at the Department of Obstetrics and Gynecology in MNH. It involved review of medical records of all women who necessitated re-laparotomy following Caesarean Section (CS) that was performed either at MNH or from referring health facilities during the study period. Results: There were 193 relaparotomy cases, 98% were referrals. Atonic uterus and sepsis (septic uterus, pelvic abscess and pus in peritoneal cavity) as intraoperative finding showed statistical significance in our study. Atonic uterus for those women who underwent relaparotomy due to post-partum hemorrhage (PPH) increase from 1(7.7%) in 2017 to 6(14%) in 2021 with an average increase of 2.31 % every year. Number of cases for sepsis (combination of septic uterus, pelvic abscess and pus in peritoneal cavity) was significant decreasing every year from 22(37.3%) in 2018 to 7(16.3%) 2021with an average decrease of 3.15% every year from 2017 to 2021. The number of cases who had hysterectomy as one of the post-operative outcomes was statistically significant decreasing from 44(74.6%) to 26(60.5%) over the study period with an average decrease of 5.89% every year from 2018 to 2021. Conclusion: The most frequent indication for relaparotomy after CS was a burst abdomen. For the women who had relaparotomy due to uncontrollable PPH, the main intraoperative .......

Clinical benefits of parenteral iron carboxymaltose in patients with colorectal cancer: a retrospective observational study

Background. The high incidence of anemia in colorectal cancer and its severe consequences for patients determine the need for timely diagnosis and correction of this condition. At the same time, it is extremely important to choose a method for correcting anemia, allowing to achieve maximum efficiency and safety. Aim. To evaluate perioperative methods for correcting iron deficiency anemia in patients with colorectal cancer based on a comparative analysis of the clinical results of intravenous administration of iron carboxymaltose and transfusion of blood components. Materials and methods. The results of treatment of 594 patients with colorectal cancer operated on in 2022 at the department of surgical treatment methods No. 3 (abdominal oncology No. 1) of the Volgograd Regional Clinical Oncology Dispensary were studied. Stratification of patients into groups was carried out using the method of pseudo-randomization by sex and age to eliminate confounding errors. After pseudo-randomization in a 1:1 ratio, the sample of patients with anemia was divided into 2 groups (main group – 124 patients, in whose treatment blood-saving techniques and parenteral administration of iron carboxymaltose were used, and control group – 124 patients, for treatment of anemia in which transfusions of blood components were used). In 98 (39.5%) cases hemicolectomies were performed, in 88 (35.5%) – anterior resections of the rectum, in 36 (14.5%) – resections of the sigmoid colon, in 18 (7.3%) – extirpations of the rectum, in 8 (3.2%) – resection of the transverse colon, 217 (87.5%) operations were performed through laparotomy access, 31 (12.5%) using minimally invasive technologies. Results. The frequency of postoperative complications of grade III–V according to Clavien–Dindo score in the main group (4.8%, 6/124) was statistically significantly lower compared to the control group (14.5%, 18/124) [χ2=6.643; p=0.01]. Postoperative mortality in the main group was 0.8% (1/124), in the control group – 5.6% (7/124) [χ2=4.65; p=0.032]. Conclusion. The use of blood-saving technologies with parenteral administration of iron carboxymaltose in patients with colorectal cancer leads to a reduction in the number of postoperative complications and the level of postoperative mortality.

Ten-Year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps

Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.

A New Approach in Management of Orbital Adherence Syndrome.

Orbital walls are one of the most common sites of midface fractures and account for ~40% of traumatic injuries in this region. These fractures are often associated with changes in the anatomy of the orbital cavity and frequently affect the orbital inferior wall, infraorbital groove and canal, and medial orbital wall, which leads to changes in its pattern and volume as well. Generally, the forces required for brake superior and lateral walls are greater than those required for thin medial and inferior walls. Disruption of any of these structures leads to the expansion of orbital volume that brings to the appearance of enophthalmos, diplopia, and impaired ocular mobility. The gold standard in the treatment of orbital wall fractures is surgical reconstruction, that includes fracture site exposure, freeing tissue prolapsed into the fracture site, and re-approximating the orbital wall support, usually with an orbital implant. It usually could be achieved by the usage of such as transconjunctival, subciliary, and coronal approaches and implementation of graft and reconstructive materials, including bones, cartilage, titanium, and resorbable mesh. Today, the gold standard in orbital floor reconstruction is the application of titanium mesh orbital plates. However, their implementation could be associated with a number of postoperative complications, such as mispositioning and orbital adherence syndrome. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. It usually appears as limited eye movement that appears 1 to 2 weeks after reconstructive procedure. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery. The aim of the current study is to present the outcomes of orbital reconstruction done by both orbital mesh and customized ​​smooth-surfaced titanium orbital implants.

The role and place of arthroscopy in the early diagnosis of monoarthrosis (literature review)

Background. Knee osteoarthritis is a progressive incurable disease that in severe cases leads to total joint replacement, which requires significant economic costs and medical and social adaptation, has a number of postoperative complications and adverse outcomes. Therefore, special attention has recently been paid to the prevention and treatment of the early stages of the disease. The purpose of the study was to conduct a systematic analysis of scientific literature on the prospects and possibilities of using arthroscopy in the early diagnosis of monoarthrosis. Material and methods. A literature search was conducted in the PubMed and MEDLINE databases for 2010–2024 using the following medical subject headings and keywords: “deforming osteoarthritis of the knee joint”, “osteoarthritis of the knee joint”, “unilateral deforming osteoarthritis of the knee joint”, “unilateral osteoarthritis of the knee joint”, “gonarthrosis”, “monoarthrosis”, “arthroscopy”, “diagnosis”, “treatment”. If necessary, literature sources beyond the search period were used in some cases. A general search revealed 48 references on the use of arthroscopy as a diagnostic and therapeutic method in the early stages of monoarthrosis. The primary exclusion concerned the literature in which arthroscopy was used for the diagnosis and treatment of late-stage knee osteoarthritis (n = 38). The secondary exclusion included literature sources that contained only background information (summary, figures, references) (n = 12). As a result, only relevant full-text articles in professional journals remained (n = 15). Results. The lack of correlation between clinical symptoms and radiological signs of knee osteoarthritis causes low availability of orthopaedic care: more than 30 % of newly diagnosed patients have a severe stage of the disease, and in some cases the pathology is detected only in connection with the manifestation of complications; the diagnosis of osteoarthritis due to a large percentage of painless development of the disease (40 %) is often established at terminal stages. All of this suggests the need for further research into the various factors that influence the frequency, prevalence, economic and social burden of knee osteoarthritis. Arthroscopy is potentially the gold standard for validating non-invasive assessment methods such as magnetic resonance imaging, as it provides high magnification and direct view of articular cartilage with non-destructive interactive assessment of its structure and functional properties. Arthroscopy allows for a more detailed description of the depth and extent of lesions, as well as the detection of subtle changes such as cartilage softening, fibrillations, and tangential peeling. Clinical symptoms and structural changes in the knee joint elements visualised during arthroscopy in patients with monoarthrosis are covered in a few studies, some of which were published 10 years ago. The results of modern arthroscopic studies can be an important contribution to the development of diagnostic and differential diagnostic criteria for the early stages of monoarthrosis. Conclusions. Based on information and analytical studies of modern scientific literature, it has been found that knee osteoarthritis is accompanied by persistent pain, significant limitation of the lower limb function, and reduced ability to work, which often leads to joint replacement. Diagnosis of osteoarthritis in the early stages is difficult due to the absence of pathognomonic clinical, radiological and laboratory parameters, and in case of monoarthrosis with synovitis, it is complicated by differentiation with specific arthritis of the knee joint. Arthroscopy allows performing the necessary scope of diagnostic and therapeutic measures with verification of the pathological process and determination of gonarthrosis stage.

Long-term Outcomes of Surgical Correction of Ischemic Mitral Regurgitation

Objective: To evaluate long-term outcomes of mitral valve annuloplasty using an autologous pericardial strip (“soft support ring” type) and a rigid support ring in combination with coronary artery bypass graft (CABG) in patients with ischemic mitral regurgitation.Materials and methods: We carried out retrospective and prospective analyses of the treatment outcomes in 90 patients with coronary heart disease (CHD) and ischemic mitral regurgitation. Ischemic mitral regurgitation (grade 2 or above) was an inclusion criterion for patients with CHD. Exclusion criteria were as follows: nonischemic mitral regurgitation, acute myocardial infarction, progressive angina pectoris, and repeated heart interventions. The patients were divided into 2 groups. Patients from group 1 underwent CABG with mitral regurgitation correction using a strip of glutaraldehyde-treated autologous pericardium (“soft support ring” type) according to our own method, whereas patients from group 2 underwent CABG with mitral regurgitation correction using a rigid support ring. The analysis revealed that the groups were comparable in all the studied parameters.Results: There was no statistically significant difference in the number of postoperative complications and hospital mortality between the groups. According to the analyzed data obtained at the time of discharge, all the patients had grade 0-1 mitral regurgitation, which shows a complete restoration of the mitral valve function after annuloplasty. In addition, there was a statistically significant decrease in the end-diastolic volume and an increase in ejection fraction, which is a sign of reverse left ventricular (LV) remodeling. The mean follow-up was 44±7.4 months. No deaths were reported during the follow-up. The results of the examination in the long-term period did not reveal negative dynamics in most patients compared with the findings in the early postoperative period. The LV size also did not change significantly, and the ejection fraction demonstrated an upward trend. One patient in each group had a recurrence of grade 3 mitral regurgitation.Conclusions: The immediate outcomes showed no recurrence of mitral regurgitation, a low number of intraoperative and postoperative complications, and pronounced reverse LV remodeling. We observed stable results in the long-term follow-up: only one patient in each group had a recurrence of mitral regurgitation. Reverse LV remodeling persisted throughout the follow-up. There were no significant differences between the groups in any parameter, which indicates that the developed annuloplasty method is not inferior to the traditional technique with a rigid support ring.

Predictive Role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in Patients With Peritonitis at the National Hospital Abuja.

A validated tool may facilitate assessing the severity of peritonitis among surgical patients. This study evaluates the predictive role of Acute Physiology and Chronic Health Evaluation II (APACHE II) in the surgical outcomes of patients managed for peritonitis in Abuja. This is a prospective study of consecutive adult patients managed for peritonitis by the general surgery unit of National Hospital Abuja (NHA) over a 19-month period (September 2020 through March 2022). Patient characteristics and treatment outcomes were recorded in a structured proforma and analyzed using SPSS Statistics version 25 (IBM Corp., Released 2017; IBM SPSS Statistics for Windows, Version 25.0; Armonk, NY: IBM Corp.). The accuracy, sensitivity, specificity, and threshold of APACHE II were derived from the receiver operating characteristic (ROC) curve analysis and its coordinates. There were 54 patients with peritonitis during the study period, with a male-to-female ratio of 2.6:1. This study's mortality and morbidity rates were 13.0% and 63.0%, respectively. The APACHE II score at admission was positively correlated with the likelihood of postoperative mortality, morbidity, number of postoperative complications, ICU admission, and length of hospital admission. The average APACHE II score of patients in this study was 7.1±5.2. APACHE II best-predicted mortality by the ROC curve at a threshold point of 9 (sensitivity of 85.7%, specificity of 70.2%, the accuracy of 86.8%, P-value 0.002). At a threshold score of 6, APACHE II was significantly associated with the occurrence of postoperative morbidity (sensitivity of 74.3%, specificity of 73.7%, accuracy of 75.2%, P-value = 0.043). This study confirms that the APACHE II score at admission can predict the outcome of surgery within the first 30 days post-surgery among adult patients who had peritonitis at NHA.

EFFECTIVENESS OF A BIOLOGICAL PROSTHESIS IN THE TREATMENT OF TRAUMATIC FEMORAL ARTERY INJURIES

HighlightsThe prevalence of vascular injuries during military engagements can reach 20%. In the thigh, vascular injuries are the second most frequent type of injury. Vascular replacement using a graft is required in case of a femoral artery injury with length of more than 10 cm. If autologous blood vessels are not available for replacement, specialists resort to using a synthetic prosthesis. Selection of an appropriate prosthesis remains a priority for vascular surgeons. Aim. To evaluate the outcome of vascular replacement using a biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries.Material and methods. The study involved 30 patients with femoral artery injuries. The analysis focused on the indicators of comprehensive examination and treatment of these patients, who were divided into 2 statistically homogeneous groups of 15 people each. In the first group, a biological prosthesis derived from bovine internal thoracic artery was used to replace the artery, and in the second group, a large subcutaneous vein was used. The results of treatment were evaluated by the number of postoperative complications, the durability of grafts and the quality of life of patients.Results. There were no fatal cases. In the first group, 6 (40%) patients suffered postoperative complications, and in the second group – in 5 (33.3%) patients. After 5 years, 12 (80%) grafts remained functioning in the first group, and 13 (86.7%) grafts in the second group. The physical component of the health of patients in the first group was equal to 60.6 ± 3.2, in the second group – 62.5 ± 3.4, and the psychological component of health 58.7 ± 2.8, and 59.5 ± 3.1, respectively. There was no statistical reliability between the indicators of the groups (p &gt; 0.05).Conclusion. Biological prosthesis derived from bovine internal thoracic arteries for the treatment of femoral artery injuries is quite effective.

A Cross-Sectional Analysis of Pediatric Necrotizing Soft Tissue Infection Cases and Racial Disparities From the 2016 to 2020 National Inpatient Sample

IntroductionThe incidence, treatment, and outcomes of necrotizing soft tissue infections (NSTIs) and associated racial disparities have been described in adults, but research in the pediatric population is limited. The purpose of this study is to provide a nationally representative characterization of pediatric NSTI and determine the presence of any racial disparities. MethodsThe National Inpatient Sample was analyzed from 2016 through 2020. Patients aged less than 20 y with a diagnosis of necrotizing fasciitis, Fournier’s gangrene, or gas gangrene (based on International Classification of Diseases, Tenth Revision, Clinical Modification codes) were included for analysis. ResultsA total of 355 patients were identified. Black and Hispanic patients accounted for the most admissions in 2016 and 2018, respectively (P = 0.024). Compared to White patients, more Black patients were insured by Medicaid (P = 0.037) and were in the first zip code–based income quartile (P = 0.005). The leading infection overall was necrotizing fasciitis and most patients (81.7%) underwent a surgical procedure by the first calendar day after admission. Although the proportion of Black patients undergoing subcutaneous tissue and fascia excisions was more than that of White patients (P = 0.005), there were no significant differences by race in the time to first procedure, the total number of procedures, or number of postoperative complications. Our amputation and mortality rates were low and unreportable, but there were no differences by race. ConclusionsNSTI is rare in the pediatric population and mortality is low. Black patients are disproportionately diagnosed, but these disparities do not extend to disease treatment or outcomes.

Safety assessment of preventive pressurized intraperitoneal aerosol chemotherapy in combined treatment of gastric cancer: preliminary results

Purpose of the study. Preventive pressurised intraperitoneal aerosol chemotherapy (PIPAC) safety assessment in the combined treatment of gastric cancer (GC).Patients and methods. The study included 48 patients with morphologically confirmed resectable GC and cardio esophageal transition, having at least one criterion that is a predictor of the development of peritoneal carcinomatosis, e. g. tumor spread to the serous layer (≥ T4a), diffuse tumor type, affected regional lymph nodes, large tumor, young age (up to 45 years), subtotally and totally affected stomach. 36 out of those patients received treatment according to the protocol. All patients received 4 cycles of neoadjuvant chemotherapy according to the FLOT scheme, radical surgical treatment in combination with a PIPAC session, 4 cycles of adjuvant chemotherapy according to the FLOT scheme. The safety assessment was carried out according to the classification of surgical complications according to Clavien-D indo and the international scale for toxicity scaling NCI–CTCAE v5.0.Results. Postoperative complications were diagnosed in 25 %, &gt;III grade complications were revealed in 11 % of cases according to the Clavien-D indo classification. The postoperative mortality rate was 0 %.Conclusion. Preventive PIPAC of locally advanced GC and CET in combined treatment is a reproducible and safe method, which is characterized by the absence of an increase in the number of postoperative complications and mortality rate.