Number Of Postoperative Complications Research Articles

Comparison of revisional surgeries after OAGB vs RYGB: Results from Multicenter Polish Revision Obesity Surgery Study (PROSS)

Introduction: The Roux-en-Y gastric bypass (RYGB) is a leading bariatric surgery globally. The One Anastomosis Gastric Bypass (OAGB), a modification of RYGB, ranks as the third most common bariatric procedure in Poland. While clinical trials show OAGB outcomes are comparable to RYGB regarding weight loss, remission of comorbidities, and hormonal impact, there's limited data on long-term outcomes and complications.Materials and Methods: A retrospective study analyzed patients undergoing revisional bariatric surgeries from January 2010 to January 2020 across 12 Polish centers. Inclusion criteria included patients aged 18 and above who underwent prior OAGB or RYGB. Those with incomplete primary surgery data and follow-up post-revision were excluded. Data gathered covered parameters like anthropometrics, comorbidities, and perioperative details. Patients were categorized based on their initial surgery: OAGB or RYGB. Primary endpoints covered reasons for and types of revisional surgeries, and weight changes; secondary endpoints included postoperative complications and length of hospital stay (LOS).Results: 27 patients participated, with a mean age of 38.187 years. Differences between OAGB (13 patients) and RYGB (14 patients) groups included median initial body weight (100kg vs 126 kg, p<0.016), number of postoperative complications (9 vs 3, p=0.021), median LOS (3 vs 4.5 days, p=0.03). GERD was the primary reason for OAGB revisions (69.2%), whereas insufficient weight loss led RYGB revisions (42.9%). Conclusions: RYGB patients commonly needed revisions due to weight issues, whereas reoperations in the OAGB patients were conducted due to postoperative complications. Postoperative complications and LOS were similar between groups.The importance of research for the development of the field: The results of research may have an influence on clinical surgeons' decisions regarding operation technique choice.

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 > 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 %, >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.

Introduction of a Post-Anaesthesia Care Unit in a Teaching Hospital Is Associated with a Reduced Length of Hospital Stay in Noncardiac Surgery: A Single-Centre Interrupted Time Series Analysis.

A post-anaesthesia care unit (PACU) may improve postoperative care compared with intermediate care units (IMCU) due to its dedication to operative care and an individualized duration of postoperative stay. The effects of transition from IMCU to PACU for postoperative care following intermediate to high-risk noncardiac surgery on length of hospital stay, intensive care unit (ICU) utilization, and postoperative complications were investigated. This single-centre interrupted time series analysis included patients undergoing eleven different noncardiac surgical procedures associated with frequent postoperative admissions to an IMCU or PACU between January 2018 and March 2019 (IMCU episode) and between October 2019 and December 2020 (PACU episode). Primary outcome was hospital length of stay, secondary outcomes included postoperative complications and ICU admissions. In total, 3300 patients were included. The hospital length of stay was lower following PACU admission compared to IMCU admission (IMCU 7.2 days [4.2-12.0] vs. PACU 6.0 days [3.6-9.1]; p < 0.001). Segmented regression analysis demonstrated that the introduction of the PACU was associated with a decrease in hospital length of stay (GMR 0.77 [95% CI 0.66-0.91]; p = 0.002). No differences between episodes were detected in the number of postoperative complications or postoperative ICU admissions. The introduction of a PACU for postoperative care of patients undergoing intermediate to high-risk noncardiac surgery was associated with a reduction in the length of stay at the hospital, without increasing postoperative complications.

Choice of hybrid interventions for iliac-femoral arterial lesions

To compare the short-term and long-term outcomes of hybrid interventions after various infrainguinal reconstructions (restoration of blood flow through superficial femoral artery and pulsatile blood flow through deep femoral artery) in patients with iliac-femoral arterial disease. A retrospective analysis included patients after hybrid iliac-femoral interventions between 2014 and 2018. These interventions included stenting of iliac arteries and various open infrainguinal reconstructions. The first group (n=41) consisted of patients who underwent reconstruction of superficial femoral artery, the second group (n=88) - restoration of pulsatile blood flow in deep femoral artery. We analyzed the Rutherford score, perioperative complications, primary patency rates and limb salvage rates after 12 months in both groups. Significant improvement (Rutherford score +3) was achieved in 28 (70%) and 14 (15.9%) patients, respectively (p<0.05). There were no significant between-group differences in the number of postoperative complications. Surgery time was longer in the first group (median 160 and 130 min, respectively, p<0.05). However, intraoperative blood loss was similar. Primary patency rates after 12 months were 82.4% and 95.1%, respectively (p=0.054). Limb salvage rates after 12 months were 94.7% and 100%, respectively (p<0.05). This study highlights the potential advantages of restoring pulsatile blood flow through the deep femoral artery in hybrid interventions. Higher primary patency and limb salvage rates in the second group indicate better long-term outcomes after restoration of blood flow through the deep femoral artery. Further prospective studies are needed to confirm these results and determine the underlying mechanisms of differences.

Treatment of a Patient With Closed Liver Injury Using Interventional Methods:&#x0D; a Case Study

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Study of Mannheim peritonitis index for predicting morbidity and mortality in patients of hollow viscous perforation: In a tertiary care hospital of Eastern India

Background: Peritonitis is the inflammation of peritoneum, the serosal membrane that lines the abdominal cavity and organs inside. The hollow viscous perforation (HVP) is one of the most common surgical emergencies encountered by surgeons on a daily basis. Mannheim Peritonitis Index (MPI) is a simple and effective method in predicting the morbidity of patients with HVP. Aims and Objectives: This study attempts to evaluate the prognostic value of MPI scoring system in patients with peritonitis due to HVP. Materials and Methods: This is a clinical, prospective, and observational study. There were 50 patients with HVP (stomach, duodenum, ileum, and appendix) admitted in Srirama Chandra Bhanja Medical College and Hospital from March 2021 to October 2022 included in the study. Necessary data were collected; MPI score was calculated for each patient and analyzed. Results: The number of post-operative complications, duration of intensive care unit, and hospital stay proportionately increased with the MPI score. Out of the eight variables used in this scoring system, duration of pain, intraperitoneal fluid and organ failure on admission carried more significance in predicting the morbidity in the post-operative period than the other variables. Conclusion: MPI is a simple and effective method in predicting the morbidity of patients with HVP and to assess it as a clinical tool in stratifying these patients according to individual surgical risk.

RECONSTRUCTIVE SURGERY OF POST-RESECTION DEFECTS OF THE UPPER JAW

Post-resection defects of the upper jaw are one of the most difficult problems in surgery. They can occur after removal of tumors, trauma or infection, and can cause various functional and aesthetic problems in patients. Surgical reconstruction of the maxilla may require the use of bone grafts and/or implants, which may be ineffective or cause a number of complications in the absence of a reconstructive approach.The aim of the study was to assess the efficacy and safety of surgical reconstruction of the upper jaw using modified individual plates and bone autografts.Materials and methods. The study was conducted among 35 patients with post-resection defects of the upper jaw. All patients underwent surgical reconstruction using modified individual plates and revascularizable autografts, according to the division into 2 groups. Evaluation of the effectiveness of the reconstruction was carried out based on clinical data in the early and late postoperative periods.Results. The use of revascularized flaps makes it possible to achieve an optimal long-term result with the absence of a large volume of foreign bodies in the recipient bed.Conclusions. Reconstructive surgery using metal structures is fraught with a number of postoperative complications that require corrective manipulations and (or) a fundamentally different approach for repeated interventions. Currently, the gold alternative standard is the use of revascularized flaps, which allowed 16 patients to achieve a long-term stable result with the restoration of the continuity of the upper jaw, followed by prosthetics.

Prevention strategies for reducing the incidence of postoperative pancreatic fistulas in patients following pancreatoduodenectomy

Objective — to design and implement a preventive approach aimed at reducing the incidence of postoperative pancreatic fistulas and other complications following pancreatoduodenectomy in patients diagnosed with cancer of the pancreatic head and periampullary region.&#x0D; Materials and methods. The present study involved the analysis of treatment outcomes for a cohort of 370 patients diagnosed with cancer of the pancreatic head and periampullary region who underwent pancreatoduodenectomy during the years 2015—2021. Between November 2018 and December 2021, a total of 141 patients were operated on using our modified pancreatic fistula risk score, an evaluation of preoperative sarcopenia status, and our risk mitigation strategies aimed at minimising postoperative complications. These patients made up the main group. The comparison group included a total of 229 patients. The surgical procedures were conducted between January 2015 and October 2018, employing generally accepted methods. However, the risk evaluation of potential pancreatic fistulas, the presence of sarcopenia, and the implementation of suggested prevention strategies were not taken into account.&#x0D; Results. The incidence of postoperative complications was significantly higher in the comparison group, with complications occurring in 94 (41.0%) patients, while in the main group, complications occurred in 43 (30.5%) patients (χ2=4.1; p=0.04). In the main group, a total of 16 (11.3%) patients experienced a clinically relevant grade B postoperative pancreatic fistula, which was significantly lower than in the comparison group, where the grade B or grade C fistula occurred in 64 (27.9%) patients (χ2=14.2; p=0.0002). In the main group, 2 patients died; the mortality rate was 1.4%. In the comparison group, 5 patients died, and the mortality rate was 2.2%. This rate was shown to be higher (χ2=0.27; p=0.6) when compared to the main group.&#x0D; Conclusions. The implemented approach demonstrated a substantial reduction in the incidence of postoperative pancreatic fistulas from 27.9% to 11.3%, the number of postoperative complications from 41.0% to 30.5%, and mortality from 2.2% to 1.4%.&#x0D;

Safe thoracoscopic repair of recurrent congenital diaphragmatic hernia after initial open abdominal repair.

The optimal surgical approach for recurrent congenital diaphragmatic hernia (CDH) remains controversial. We compared the surgical outcomes of a thoracoscopic approach versus an open abdominal approach for recurrent CDH after initial abdominal open repair. The subjects of this comparative study were patients who underwent open abdominal or thoracoscopic surgery for recurrent CDH following an initial open abdominal repair. Among 166 patients with Bochdalek-type CDH, 15 underwent reoperation for recurrent CDH following an open abdominal repair. Seven patients underwent open abdominal surgery (group O) and eight underwent thoracoscopic surgery (group T). The operative duration was similar for the two groups, with less blood loss (17.2ml/kg vs. 1ml/kg, P = 0.001) and fewer intraoperative complications in the T group (n = 6 vs. n = 0 cases, P = 0.001). There was no significant difference in the number of postoperative complications (n = 1 vs. n = 1, P = 1.0) or in the number of patients with a second CDH recurrence (n = 2 vs. n = 1, P = 0.569) between the two groups. Thoracoscopic surgery is preferable to the open surgical approach for recurrent CDH following an initial abdominal open repair.

The effect of surgical correction of Lenke types I and III scoliotic deformities on the spinal balance in patients aged 15–35 years

Objective. To analyze the effect of spinal deformity correction on the parameters of the frontal and sagittal balance in patients aged 15-35 years with Lenke types I and III idiopathic scoliosis.Material and Methods. The dynamics of sagittal and frontal parameters of the spinal balance was assessed in 268 patients aged 15 to 35 years with Lenke type I and III idiopathic scoliosis before and after surgical treatment. The patients’ quality of life and the number of postoperative complications were assessed depending on the imbalance severity.Results. More than half of patients (55.6 %) with Lenke types I and III idiopathic scoliosis have initial balance disorders, and 14.6 % of them have pronounced abnormalities. Significant balance disorders are predicted by severe scoliosis (85.3° ± 30.3°), greater L5 tilt (10.3 ± 7.9 before surgery; 5.3 ± 4.8 after surgery) and initial sagittal imbalance (32.75 ± 27.7), large residual scoliotic curve (43.3° ± 23.1°), large angle of residual thoracic kyphosis (32.3° ± 15.9°), and smaller angle of lumbar lordosis after surgery (52.3° ± 14.1°); p &lt; 0.05. The main compensatory elements, in addition to PT and SS, are the angle of L5 tilt in the frontal plane and the L5–S1 angle in the sagittal plane. In young patients aged 15-35 years, disc mobility at the L5–S1 level is sufficient to achieve a more balanced body position, even with a significant change in the PI-LL ratio.Conclusion. In the long-term postoperative period, a pronounced imbalance of the spine increases the risk of mechanical postoperative complications up to 50 %, while the quality of life of patients does not decrease, and repeated surgical interventions are required in singular cases. Correction of scoliotic deformity allows increasing the number of patients without balance disorders by 6 %, and reducing the number of gross deviations by 2 times.

Impact of external beam radiation on total shoulder arthroplasty outcomes: a propensity-matched cohort study.

External beam radiation therapy has a number of deleterious effects on the body, and a number of post-operative complications have been reported for several surgeries including total knee arthroplasty. However, few studies have investigated the impact of external beam radiation therapy for total shoulder arthroplasty (TSA). Our study aimed to assess the systemic and joint complications associated with TSA in patients with prior radiation exposures, as well as evaluate the surgical outcomes of radiation patients compared to non-radiation TSA patients. A retrospective cohort analysis was conducted using the TriNetX Analytics Network. A 1:1 propensity score matching function was utilized to create two cohorts with matched baseline characteristics within the TriNetX network. Comparisons of the primary and secondary outcomes between the two cohorts were made using odds ratios. A p value of < 0.05 was determined to be significant. A total of 75,510 patients that received TSA were identified with 1505 having a history of radiation therapy (RT) and 73,605 with no radiation therapy (non-RT). After propensity matching, both groups contained 1484 patients. RT patients were at higher risk for developing prosthetic joint infection, acute renal failure, altered mental state, cerebrovascular event, DVT, PE, pneumonia, respiratory failure, and UTI compared to non-RT patients at different time points (p < 0.5). Patients with prior history of external beam radiation undergoing TSA had a higher risk of systemic complications and prosthetic joint infection compared to patients without a prior history. These complications suggest a more complicated post-operative management course for these patients.

Dynamics of acute-phase and endothelial reactions and immune complex formation during bone replacement with germanium-doped calcium-phosphate ceramics of bone fragment fractures in dogs

Bone defects that occur with fragment fractures lead to an increase in the number of postoperative complications. Therefore, to restore the structure and function of the bone, there is a need for bone replacement, in particular doped calcium-phosphate ceramics. The purpose of the work is the biochemical assessment of acute-phase and endothelial reactions and immune complex formation during bone replacement with germanium-doped calcium-phosphate ceramics of bone fragment fractures in dogs. Dogs with fragment fractures of long tubular bones and plate osteosynthesis were included in the study. In the experimental group (n = 10), bone defects were replaced with germanium-doped calcium-phosphate ceramics (HА/β-TCP/l-Gе-700), in the control group (n = 10) – unalloyed (HА/β-TCP-700). Blood samples were taken after the injury and on the 3rd, 7th, 14th, 30th, and 60th days after osteosynthesis. Partial recovery of limb function in the experimental group was faster by 1.3 times (P &lt; 0.001) and full by 1.2 times (P &lt; 0.01) compared to the control. On the 60th day, in experimental animals, the defect was filled with a regenerate of high X-ray density without a periosteal reaction, while in the control animals, the bone regenerate did not have sufficient density with a significant periosteal reaction. In both groups, total protein and albumin content varied within the normal range. The activity of protein C on the 3rd day in the experimental group was 1.3 times higher (Р ˂ 0.001), and on the 7th day, it was twice as high (P ˂ 0.001) compared to the control group with normalization by the 14th day. The concentration of ceruloplasmin from the 7th day in the control animals was 1.1 times higher (Р ˂ 0.001) than in the experimental animals, with normalization in the latter by the 60th day. The level of small molecular circulating immune complexes (CIC) after the injury increased by 1.1 times (Р ˂ 0.001) and reached a peak in the control and experimental groups on the 14th day, with an increase in indicators by 2.1 and 1.4 times (Р ˂ 0.001), respectively, with normalization in the experimental group on the 60th day. The level of nitric oxide (NO) in the control group increased from the 7th to the 60th day, with a peak on the 30th day, and in the experimental group – from the 3rd to the 30th, with a peak on the seventh day. Osteoreplacement of fragment fractures of long tubular bones in dogs with calcium-phosphate ceramics doped with germanium is accompanied by a moderate level of the acute phase reaction and immune complex formation, an increase in the endothelial reaction and the anticoagulant potential of the blood, which contributes to a decrease in the intensity of the inflammatory-resorptive stage of reparative osteogenesis and an increase in its proliferative phase, which, respectively, accelerates the consolidation of fractures.

Outcomes of Surgical Repair of Tetralogy of Fallot: A Comparison Between the Adult and Pediatric Population.

Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Early detection and timely treatment have provided successful repair of the anomaly in the developed world. However, in the developing world, there is still a burden of uncorrected TOF patients reaching adulthood. The goal of this study is to determine whether there is any difference in postoperative complications between adult and pediatric populationsfollowing surgical correction for TOF. Methods This study involved all those patients who received primary or secondary surgical repair for TOF in our facility between January 2017 and December 2020. The patients were split according to their age into the pediatric groupif they were under 18 years and the adult groupif they were 18 years or older. Patients with absent pulmonary valve or pulmonary atresia were not included in this study. Patients with large major aortopulmonary collateral arteries (MAPCA) were also excluded from this study. All patients underwent total correction through a median sternotomy approach. The ventricular septal defect was closed with a Bard knitted fiber patch. The right ventricular outflow tract (RVOT) was augmented by excising muscle bands or fibrous bands in the RVOT. If the annulus was smaller than the 3.5 z score, then a transannular patch was done using an autologous pericardium. The main pulmonary artery was augmented in every surgery using an autologous pericardial patch. All patients were shifted to the ICU on the ventilator and were extubated after fulfillment of the extubation criteria. Postoperative complications measured included re-opening, re-intubation, prolonged ventilation (>24 hours), and mortality within the index hospital admission. The clinical data of all patients were prospectively collected and analyzed using the chi-square test and t-test. A p-value of less than or equal to 0.05 was considered significant. Results The total number of patients was 134. This included 83 males (60.1%). A total of 114 patients who were aged below 18 years were included in the pediatric group, and 20 patients aged equal to or more than 18 years were included in the adult group. The mean average perfusion time in minutes in the adult group was 125.8 and in the pediatric group, it was 98.79. Similarly, the mean average of the cross-clamp time was also longer in the adult group at 89.55 minutes versus 69.63 minutes in the pediatric group. Overall, in the adult group, three (15%) patients had postoperative complications, while in the pediatric group, a total of 14 (11.9%) patients had postoperative complications (p = 0.001). However, there was no significant difference in the number of re-openings (8.5% vs. 10%; p = 0.8). The total mortality observed was 16 (11.59%). This included 14 (11.9%) in the pediatric group and two (10%) in the adult group. There was no significant difference between the two groups (p = 0.8). Conclusions Surgical repair of TOF can be performed in both adult and pediatric populations with acceptable outcomes. The mortality rate was found to be slightlygreater in the pediatric population compared to the adults. However, it can be seen that the number of postoperative complications is greater in adults. Further research is needed to optimize outcomes for both pediatric and adult patients with TOF.