Conventional Open Approach Research Articles

Comparison of pedicle screw fixation by four different posterior approaches for the treatment of type A thoracolumbar fractures without neurologic injury.

This study was designed to compare the pedicle screw fixation by four different posterior approaches for the treatment of type A thoracolumbar fractures without neurologic injury. A total of 165 patients with type A thoracolumbar fractures without neurologic injury who received pedicle screw fixation by posterior approaches from February 2017 to August 2018 were enrolled in this study. They were further divided into the following four groups according to different posterior approaches: Open-C group (conventional open approach), Open-W group (Wiltse approach), MIS-F group (percutaneous approach with fluoroscopy guidance), and MIS-O group (percutaneous approach with O-arm navigation). The demographic data, clinical outcomes, and radiologic parameters were evaluated and compared among the four groups. There were no significant differences in age, gender, fracture segment, and follow-up time. The incision length, blood loss, hospital stay time, and VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores at the early stage of post-operation were the worst in the Open-C group. The MIS-O group showed significantly higher accuracy rate of pedicle position than other groups. The preoperative and postoperative AVH (anterior vertebral height) and VWA (vertebral wedge angle) obtain obvious correction in all patients immediately after and 1 year post-operation. No difference was found among the four groups at the final radiographic follow-up. The four different posterior approaches are effective in treating type A thoracolumbar fractures in our study. Each approach has its own individual strengths and weaknesses and therefore requires comprehensive consideration prior to use. Proper approaches selection is critical to patients.

Comparison of surgical invasiveness between micro-endoscopic discectomy/microscopic discectomy and conventional hemilaminectomy in dogs.

Micro-endoscopic discectomy (MED) or microscopic discectomy (MD) have been performed for disc herniation in humans. The purpose of this study was to compare the invasiveness of the hemilaminectomy in dogs between the approach using a cylindrical retractor for the MED/MD and a conventional open surgical approaches in dogs. First, as preliminary studies, we analyzed the suitability of the cylindrical retractor for the vertebral body of small to medium-sized dogs on the X-ray computed tomographic images using the three-dimensional analysis software, and confirmed that it was possible to open a bone window of an approximate length of 1.72 clto the spinal canal with the cylindrical retractor with a diameter 17 mm using two medium-sized canine cadavers. Next, to determine difference in the invasiveness of hemilaminectomy, the magnitude of tissue damage, surgical stress and postoperative pain were compared between the conventional open approach (hemilaminectomy group: HL group, n=6) and the surgical approach using the cylindrical retractor (MD group, n=6) in 12 beagle dogs. The plasma creatine phosphokinase, C-reactive protein and cortisol concentrations, incision length and University of Melbourne Pain Scale scores after the hemilaminectomy were significantly lower in the MD group than in the HL group. There were no significant differences between the durations of surgery and the other evaluated indices. The approach using the MD can provide a less invasive hemilaminectomy than the conventional approach in dogs.

Laparoscopic cholecystectomy under spinal anesthesia in a 5-year-old child: A case report

Symptomatic cholelithiasis in pediatric patients should be dealt with cholecystectomy. Due to its minimally invasive nature, laparoscopic approach is better than conventional open approach. Although safety of spinal anesthesia (SA) in adult laparoscopic surgeries including cholecystectomy is well established, its use in pediatric laparoscopic surgeries is extremely limited with only a few studies being published till date. Here, we report a case of laparoscopic cholecystectomy (LC) in a 5-year-old child which was successfully managed with SA. This may be the very first case report of pediatric LC under SA.

Laparoscopic liver resection is associated with less significant muscle loss than the conventional open approach

BackgroundLaparoscopic liver resections (LLR) have been shown a treatment approach comparable to open liver resections (OLR) in hepatocellular carcinoma (HCC). However, the influence of procedural type on body composition has not been investigated. The aim of the current study was to compare the degree of skeletal muscle loss between LLR and OLR for HCC.MethodsBy using propensity score matching (PSM) analysis, 64 pairs of patients were enrolled. The change of psoas muscle index (PMI) after the operation was compared between the matched patients in the LLR and OLR. Risk factors for significant muscle loss (defined as change in PMI > mean change minus one standard deviation) were further investigated by multivariate analysis.ResultsAmong patients enrolled, there was no significant difference in baseline characteristics between the two groups. The PMI was significantly decreased in the OLR group (P = 0.003). There were also more patients in the OLR group who developed significant muscle loss after the operations (P = 0.008). Multivariate analysis revealed OLR (P = 0.023), type 2 diabetes mellitus, indocyanine green retention rate at 15 min (ICG-15) > 10%, and cancer stage ≧ 3 were independent risk factors for significant muscle loss. In addition, significant muscle loss was associated with early HCC recurrence (P = 0.006). Metabolomic analysis demonstrated that the urea cycle may be decreased in patients with significant muscle loss.ConclusionLLR for HCC was associated with less significant muscle loss than OLR. Since significant muscle loss was a predictive factor for early tumor recurrence and associated with impaired liver metabolism, LLR may subsequently result in a more favorable outcome.

Robotic vs Open Lateral Hernia Repair: A Multicenter Propensity Score–Matched Analysis of 30-day Outcomes

INTRODUCTION: Lateral ventral hernia repair (LVHR) is a challenging surgical dilemma due to location, different anatomical considerations, and low volume of cases. Our study aims to compare and assess early 30-day outcomes between open LVHR (oLVHR) and robotic-assisted LVHR (rLVHR) approach. METHODS: A retrospective review of prospectively collected data from the Abdominal Core Health Quality Collaborative (ACHQC) was performed to include all adult patients who underwent elective LVHR based on European Hernia Society classification. A 1:1 propensity score match (PSM) analysis was conducted for balanced groups. Univariate analysis was performed to compare the 2 groups (oLVHR and rLVHR) across preoperative, intraoperative, and postoperative timeframes. RESULTS: ACHQC database identified 2,569 LVHR patients. A PSM analysis stratified 665 patients to each oLVHR and rLVHR group. Median length of stay is higher in the oLVHR 3 days (interquartile range [IQR] 1 to 5) vs rLVHR 1 day (IQR 0 to 2; p < 0.001). The surgical site infection rate was higher in the oLVHR 3% vs 1% (p = 0.006). Surgical site occurrence (SSO) such as wound cellulitis was also found at a higher rate in the oLVHR 21% vs the rLVHR 0% (p < 0.001). Seroma rate was higher in the rLVHR (6.5% vs 5.6%, p < 0.001). oLVHR had 18% postoperative complication compared with rLVHR 12% (p < 0.001). There was no difference in quality-of-life measures (HerQLes and PROMIS pain 3a surveys) between groups at 30 days and 1 year. CONCLUSION: Robotic-assisted LVHR is safe with decreased length of stay and SSO compared with the conventional open approach. However, it does carry a higher seroma rate with no clinical significance.

Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer

BackgroundIn the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer.MethodsA total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale.ResultsThe mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis.ConclusionThe novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.

Unilateral axilo-breast approach (UABA) with gas insufflation versus open conventional hemithyroidectomy: A prospective comparative study

BackgroundThe objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. MethodsBetween August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. ResultsA total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p < 0.001), at hospital discharge and at 12-month follow-up. ConclusionUABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.

Novel Liver Parenchymal Transection Technique Using Saline-linked Monopolar Cautery Scissors (SLiC-Scissors) in Robotic Liver Resection.

IntroductionAlthough there are a number of benefits to using robotics in liver surgery over conventional open and laparoscopic approaches, liver parenchymal transection is still the most difficult aspect of robotic liver resection (RLR) due to the limitations of the currently available robotic instruments and the lack of a standardized method.MethodsWe present a novel method for transecting the liver parenchyma during RLR employing saline-linked monopolar cautery (SLiC) scissors (SLiC-Scissors method). Between September 2021 and April 2022, 10 RLRs were performed utilizing the SLiC-Scissors method for both anatomical and non-anatomical liver resections. We assessed the short-term results, as well as the safety and practicality of our robotic liver parenchymal transection technique.ResultsSix of the 10 patients had malignant liver tumors, and four of them had liver metastases from colorectal cancer. Except for S1, the target lesions were present everywhere, and their median size was 25 mm (14-43 mm). The median amount of intraoperative bleeding was 5 mL (5-30 mL), and the median operative and console times were 223 and 134 min, respectively. There were no conversions to open liver resections. The median length of the postoperative stay was seven (4-13) days, and there were no serious postoperative complications or mortality.ConclusionsThe SLiC-Scissors method is a safe and practical procedure for liver parenchymal transection in RLR. In order to standardize and broadly implement RLR into normal patient treatment, this unique approach enables an advanced, locally controlled preparation of intrahepatic vessels and bile ducts.

The outcome of conventional open reduction approach vs endoscopic approach for orbital floor repair

IntroductionBlunt trauma to the orbital rim is a frequent cause of both orbital fractures and damage to the surrounding facial bones and soft tissues. The inception of endoscopy and minimal invasive intervention has revolutionized the surgical treatment of blow out fracture of orbital walls. Thus, the present study was conducted to compare the outcome of conventional open reduction approach with endoscopic approach for orbital floor repair. Materials and methodThe study included 10 patients with clinical and radiographic evidence of orbital floor fracture, divided randomly into two groups: Group I-operated using endoscopic approach; and Group II- operated using conventional external approach. All the patients were evaluated clinically preoperatively, immediate post-operative and after 1 month for Diplopia, Extrinsic ocular motility, Enophthalmos and Hypoglobus. ResultsThe study consisted of 40% females and 60% males, with mean age of Endoscopic and Conventional group being 27.20 ± 6.14 years and 27.60 ± 7.23 years respectively. In relation to diplopia, an insignificant difference was observed statistically. The mean change in enophthalmos and hypoglobus in endoscopic and conventional group showed a significant difference statistically (p < 0.001). Unrestricted ocular motility was present only in one case of each group and significantly increased to 5 cases in both the groups (p = 0.048). The mean duration of surgery in endoscopic and conventional group showed a significant difference statistically. ConclusionDiplopia, hypoglobus and Enophthalmos correction was better achieved in endoscopic group as compared to conventional group. But duration of surgery was more in endoscopic group as compared to conventional group.

Minimally Invasive Surgery for Spinal Metastases

The incidence of metastatic spine disease (MSD) is on the rise and is currently present in 70% of patients presenting with systemic cancer. The majority of patients with MSD present with clinical symptoms such as neurological deficit, pathological fracture causing pain and spinal instability. Management of MSD is a multidisciplinary endeavor that involves surgery, radiotherapy (RT), and chemotherapy. The conventional open spine surgery approach has evolved into a less invasive surgery model categorized as minimally invasive spine surgery (MISS) or minimal access spine surgery. This evolution was brought about to address the complications associated with open surgery such as longer hospital stays and wound-related problems. MISS has been now widely explored in MSD due to lower wound-related complications, decreasing operative time, less neurological complications, and shorter hospital stays. Decompression and stabilization still remain the core concepts in MISS. Kyphoplasty/vertebroplasty, percutaneous pedicle screw fixation, separation surgery, and radiofrequency ablation are some of the minimally invasive techniques and procedures for surgical management of MSD. MISS is used in conjunction with other modern techniques like intraoperative neuromonitoring to help identify any adverse neurological events. MIS techniques will evolve with time, extending their application for the management of hypervascular tumors with significant anterior cord compression and recurrent tumors in which the open surgery currently remains the choice of approach.

Robot-Assisted vs. Open Appendicovesicostomy in Pediatric Urology: A Systematic Review and Single-Center Case Series.

IntroductionAppendicovesicostomy (APV) is the preferred choice of continent catheterizable channels in pediatric urology. The introduction of robot-assisted laparoscopic techniques has been correlated to superior cosmesis and convalescence and is now increasingly implemented for APV procedures. We aimed to perform a systematic review of the literature comparing open vs. robotic APV regarding possible differences in postoperative outcomes and to evaluate these findings with our own initial experiences with robotic APV compared to our previous open procedures.MethodsWe evaluated the first five patients undergoing robotic APV at our institution and compared 1-year outcomes with a consecutive series of 12 patients undergoing open APV. In a systematic literature review, we screened studies from PubMed, EMBASE, and CENTRAL comparing open and robotic APV in pediatric urology (current to December 2021) and performed meta-analyses on postoperative outcomes comparing the two groups and evaluated the grade of evidence.ResultsWe found significantly shortened postoperative length of stay in the robotic group (p = 0.001) and comparable 1-year complication rates in robotic vs. open APV patients. We systematically screened 3,204 studies and ultimately included three non-randomized studies comparing postoperative outcomes of robotic and open APV for quantitative analysis. The open and robotic approaches performed equally well regarding overall postoperative complications, surgical reintervention, and stomal stenosis. Two of the included studies reported comparable stomal continence rates and shortened postoperative length of stay in the robotic group, in agreement with the findings in our own series.ConclusionRobotic APV is equally safe to the conventional open approach with additional advantages in postoperative hospitalization length.

Percutaneous Versus Open Pedicle Screw Fixation for Pyogenic Spondylodiscitis of the Thoracic and Lumbar Spine: Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. This meta-analysis aimed to compare percutaneous (PPS) versus open pedicle screw (OPS) fixation for treatment of thoracic and lumbar spondylodiscitis. Pyogenic spondylodiscitis of the thoracic and lumbar spine can produce instability, deformity, and/or neurological compromise. When medical treatment is unsuccessful, surgical treatment is indicated, with the conventional open approach the usual standard of care. However, percutaneous techniques can be advantageous in medically vulnerable patients. A literature search was performed using the PubMed, Web of Science, and Scopus databases, looking for comparative articles on pyogenic spondylodiscitis requiring surgical stabilization with pedicle screws. This systematic review is reported according to PRISMA guidelines. From 215 articles initially identified, 7 retrospective studies were analyzed, encapsulating an overall sample of 722 patients: 405 male (56.1%) and 317 female (43.9%). The treatment modality was PPS fixation in 342 patients (47.4%) and OPS fixation in 380 (52.6%). For PPS, operating time was 29.75 minutes ( P <0.0001), blood loss 390.18 mL ( P <0.00001), postoperative pain 1.54 points ( P <0.00001), and length of stay 4.49 days ( P =0.001) less than with OPS fixation, and wound infection 7.2% ( P =0.003) less frequent. No difference in screw misplacement ( P =0.94) or loosening ( P =0.33) rates was observed. Employing PPS fixation to treat pyogenic spondylodiscitis of the thoracic and lumbar spine is associated with significantly reduced operating time, blood loss, postoperative pain, length of stay, and rates of wound infection than OPS fixation, with no difference between the 2 treatments in rates of screw misplacement or screw loosening.

Hemitiroidectomía vía abordaje axilo-mamario unilateral (UABA) con insuflación de gas vs. convencional abierta: estudio prospectivo comparativo

BackgroundThe objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. MethodsBetween August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. ResultsA total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p<0.001), at hospital discharge and at 12-month follow-up. ConclusionUABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.

Open Muscle-Preserving Pedicle Screws Fixation Versus Conventional Open Posterior Approach in Thoracolumbar Burst Fracture without Neurologic Injury

Introduction: Patients who sustained thoracolumbar spine fracture without neurological deficit often require surgical treatment. The conventional open posterior approach had some disadvantages including post-operative pain, blood loss, and duration of the operation. The minimally invasive approach, open muscle-preserving pedicle screw fixation, was proposed to have more benefit than the conventional approach. This study evaluated the clinical and perioperative outcomes of thoracolumbar burst fracture fixation using the open muscle-preserving approach and the conventional open posterior approach. Methods: A prospective cohort study from June 2016 to June 2017 of the open muscle-preserving pedicle screw fixation approach was done compared to the historical control of the conventional open posterior approach from May 2015 to May 2016. The post-operative pain score, blood loss, duration of operation and clinical outcome were analyzed. Results: Twenty-three patients were enrolled in the muscle-preserving approach group, and 27 patients treated with the conventional open posterior approach were the control group. Post-operative VAS was significantly better in the muscle-preserving group (P&lt;0.001). The mean operating time was significantly shorter in the muscle-preserving group (60.4±17.3 min. vs. 90.9±18.9 min., p&lt;0.001). Moreover, the mean intra-operative blood loss of the muscle-preserving group was also significantly lower (156.96±96.3ml. vs. 269.26±147.6ml., p=0.003). Conclusion: Our study results indicate a superiority of the open muscle-preserving approach over the conventional open posterior approach for a thoracolumbar burst fracture without neurologic injury in terms of post-operative pain score, blood loss and duration of operation. The open muscle-preserving approach is an alternative treatment for thoracolumbar burst fractures.

Comparative outcomes of minimally invasive and open gastrectomy.

271 Background: Gastric cancer(GC) is associated with significant mortality worldwide. Radical gastrectomy with lymphadenectomy is considered the only curative option for GC. Laparoscopic(LG) and more recently robotic(RG) techniques have been developed as a way to potentially decrease the peri-operative morbidity associated with gastrectomy. We sought to compare oncologic outcomes with minimally invasive and open techniques for gastrectomy. Methods: Utilizing the National Cancer Database we identified patients with gastric cancer who underwent gastrectomy. We then stratified technique, RG, LG, or OG. Mann-Whitney U and Kruskal were used to compare continuous variables and Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. Multivariate analysis (MVA) was performed to identify predictors of survival. A p &lt; 0.05 was considered significant. Results: We identified 2,530 patients RG, 10,790 in the LG and 25,810 in the OG group with median ages of 66, 66 and 67 years respectively, p &lt; 0.001. There were higher numbers of poorly differentiated tumors in the OG 60% compared to RG (49.7% and LG 49.1%, p &lt; 0.001. Additionally, there were increased numbers of signet ring GC in the OG 16.7%, compared to 13.8% in the RG and 13.8% in the LG, p &lt; 0.001. There were higher numbers of early stage GC’s in the RG and LG compared to more advanced stages (stage II and III in the OG), p &lt; 0.001. RG and LG did demonstrate higher numbers of R0 resections 92.8% and 89.9% compared to OG at 85.2%, p &lt; 0.001. Length of stay was shorter in the RG and LG at 7 (4-10) days compared to 8 days (6-12) in the OG cohort, p &lt; 0.001. Thirty and 90-day mortality rates were higher in the OG (4.3% and 8.3%) compared to 2.1% and 4% in the RG and 2.7% and 5.4% in the LG patients. Median and 5-year survival was higher in the RG (84.7mo and 61%) and LG (90.3mo and 58%) compared to the OG at 48.3mo and 46%, p = 0.001. When adjusted by stage this survival benefit persisted across all stage cohorts (stage 0-1, p = 0.001, stage 2, p = 0.001, and stage 3, p = 0.001). Multivariate analysis revealed that age, sex, Charlson/Deyo score, tumor location, histology, grade, stage, facility volume, and neoadjuvant therapy were all predictors of survival. Conclusions: Robotic and laparoscopic approaches to gastrectomy demonstrate improved median and overall survival compared to conventional open approaches. This benefit was demonstrated across all stages.

Laparoscopic management of cholecystoduodenal fistula: A case report

Fistula between gall bladder and gastrointestinal tract occurs anywhere for example stomach, duodenum, and colon. Results of inflammatory reaction adhesion may be occur and between two organs and gall stone’s pressure may be contribute this process. Laparoscopic cholecystectomy has been the most widely accepted modality of treatment for patients with gall bladder disease. With time and increasing experience laparoscopic cholecystectomy is now being successfully attempted to treat almost all benign gall bladder pathology and their complications. One such uncommon infrequent complication of cholecystolithiasis is the cholecystoenteric fistula. Management of cholecystoduodenal fistula was traditionally performed by open method. With increasing newer laparoscopic techniques and advancement in the field, cholecystoduodenal fistula, an uncommon clinical entity is now being successfully treated via laparoscopic approach. It is feasible and safer than the conventional open approach in experienced hands, thus decreasing the overall morbidity and mortality attributed to the condition. We report a case of 55yr old female with cholecystoduodenal fistula treated successfully by laparoscopic approach using an Endovascular Gastro-Intestinal Anastomosis (GIA endo) stapler at H.B.T. Medical College &amp; Dr. R.N. Cooper Municipal General Hospital, Juhu, Mumbai. Keywords: cholecystoduodenal fistula; laparoscopic cholecystectomy.

Indication for the endoscopic treatment of Zenker’s diverticula

: Zenker’s diverticulum (ZD) is a false pulsion diverticulum located in Killian’s triangle. It accounts for about 70% of all esophageal diverticula. ZD incidence is uncommon, and it is mostly present in the elderly population. Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. For this reason, the current therapeutic modalities are based on CPM myotomy to eliminate diverticular bolus retention, improve bolus flow, relieve outflow obstruction, and mitigate neuromotor impairment. The conventional open approach through a left cervicotomy has been mostly replaced by transoral techniques using either rigid endoscopy or flexible endoscopes. The minimally invasiveness of these techniques allows for reinterventions in case of recurrence. Endoscopic techniques present several advantages in terms of lower risk of adverse events, can be accomplished without the need for general anesthesia and neck hyperextension, and provide for a rapid patient recovery. The recent introduction of cutting-edge technology Z-POEM allows through a direct septal visualization for a complete myotomy, leading to a lower recurrence rate and higher symptoms resolution than endoscopic septotomy. The potential advantages also account for lower complication rates making it a promising technique.

OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH

Abstract Aim to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures Material and Methods we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia. Results laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD. Conclusions laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.

JUVENILE NASOPHARYNGEALANGIOFIBROMA: OUR EXPERIENCE AND LITERATURE REVIEW

ABSTRACT&#x0D; Introduction: Juvenile nasopharyngeal angiofibroma is a benign vasculartumor.It is commonly found in teen age males. Its site of origin is sphenopalatine foramen. Exact pathogenesis of angiofibroma is not known. It has predictable natural history and growth pattern. This tumor most often involves nasopharynx, nasal cavity, paranasal sinuses, pterygopalatine fossa and infratemporal fossa. It can also involve orbit and can spread intracranially. Its very important to diagnose this tumor very early on the basis of clinical examination and imaging. As early tumor confined to nose and sinuses can be removed exclusively with endoscope. It is very helpful to do angiography before surgery to ascertain itsblood supply and then embolization can be done to reduce intraoperative bleeding. Objective: To describe our experience of Juvenile Nasopharyngeal Angiofibroma cases in ENT Unit-I of Lahore General Hospital. Study Design: Descriptive Study with retrospective analysis after approval from Institutional Review Board (IRB) of LGH/PGMI/AMC Lahore. Methods: We studied 20 patients who underwent surgery in our department from October 2019 to October 2020. We analyzed following factors: age, gender, symptoms, staging, mode of surgery and need for intraoperative blood transfusion, hospital stay, complications and recurrences. Results: Range of patient’s age was 12 to 25 years. Eight patients underwent surgery with endoscope. Mean blood loss was about 400 ml and mean operating time was 140 minutes. All the cases were embolized preoperatively. Conclusion: Endoscopic surgery is a safe and effective method in early stage JNA patients. While patients with advance stage tumors should be managed with combined endoscopic and conventional open approaches.&#x0D; KEYWORDS: juvenile nasopharyngeal angiofibroma, JNA, endoscopic surgery&#x0D;

Clinical outcome and multifidus muscle changes of transforaminal lumbar interbody fusion

Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has shown to have smaller skin incision, decreased muscular dissection, and less retraction of the thecal sac, compared to conventional open approach. However, its effects on long term functional outcome and degenerative changes of paraspinal muscles are still obscure. Materials and Methods: We studied 81 patients treated by one team of surgeons at a single institution. In the two level spinal fusion, 18 patients underwent conventional TLIF (C TLIF) and 20 patients underwent MIS TLIF. In three level spinal fusion, 23 patients were treated with C TLIF and 20 patients were treated with MIS TLIF. Clinical outcomes included mean operative times, volume of blood loss, percentage of early ambulation, visual analog scale (VAS), and oswestry disability index (ODI) were analyzed. The change of multifidus muscle was calculated from magnetic resonance imaging (MRI) taken before and 6-month after the operation. Results: Lesser blood loss was noted in the MIS TLIF group compared to the conventional group in two- or three-level circumferential spinal fusion. Early ambulation (within 3 days after operation) was found in the MIS TLIF groups. Analysis of VAS scores at leg area showed no significant differences in improvement between each group at 18 month follow up. The postoperative ODI score was significantly less in the MIS TLIF groups than in the C TLIF groups after 6 month follow up. In three segment spinal fusion, MIS TLIF minimized multifidus muscle atrophy, when compared with C TLIF. Conclusion: MIS TLIF in three level lumbar fusion not only has a better functional recovery but also ameliorates the degenerative change of multifidus muscle.