Open Surgical Correction Research Articles

Intraoperative Intracranial Pressure Changes in Children With Craniosynostosis Undergoing Endoscopic-Assisted Strip Craniectomy.

Craniosynostosis can lead to progressive cranial and skull base deformities and can be associated with increased intracranial pressure (ICP), ophthalmological manifestations, behavioral changes, and developmental delay. Most published data on the incidence of elevated ICP include older children undergoing open surgical correction. Endoscopic-assisted release of fused sutures with postoperative helmet therapy is an established method for managing craniosynostosis presenting at an early age; however, the immediate effect of this approach on ICP in a young cohort has not been previously reported. Prospective data on 52 children undergoing endoscopic-assisted release of stenosed cranial sutures were included. Individuals were excluded if they underwent open correction or had previous cranial surgery. Individuals underwent a standardized endoscopic approach for each suture type. ICP was measured using an intraparenchymal sensor both before creation of the neosuture and after complete release of the stenosed suture. An ICP reading of >10 mm Hg was considered elevated. The mean age was 5.3 months, range 1 to 32 months, and 94% was younger than 12 months. The mean opening pressure was 12.7 mm Hg, and the mean closing pressure was 2.9 mm Hg. Opening ICP ≥10 mm Hg was present in 58%, ≥15 mm Hg was present in 31%, and ≥20 mm Hg was present in 23%. No patient had an ICP above 10 mm Hg at closing. The mean percentage change in ICP among all craniosynostosis cases was a 64% decrease. Optic disk swelling was identified in 28 children preoperatively and improved in 22 children at follow-up. Elevated ICP may occur in infants with craniosynostosis at higher rates than previously reported. Endoscopic-assisted craniectomy has an immediate effect on lowering ICP and improving postoperative ophthalmological findings.

Possibilities of modern methods of cardiac imaging in the diagnosis and preoperative planning of transposition of the great arteries in children: a prospective study

INTRODUCTION: Transposition of the great arteries (TGA) is the classic, most common and severe form of cyanotic congenital heart defects in children, which is characterized by a variety of anatomical and hemodynamic variants, combined with other cardiac anomalies and high infant mortality rates. The surgical treatment and the possibility of performing simultaneous correction of TGA depend on the anatomical and hemodynamic features of the TGA and the presence of combined intra- and extracardiac anomalies, which must be determined using cardiac imaging techniques on the preoperative stage.OBJECTIVE: To evaluate the capabilities of TTE and cardiac CT in the diagnosis and surgical planning of TGA in children.MATERIALS AND METHODS: The study included 29 children with an incoming diagnosis of transposition of the great arteries. The average age of the patients was 31 (14.5; 67) days. All children underwent TTE, 21 — cardiac CT with intravenous contrast enhancement, 6 — catheterization of the cardiac cavities with conventional angiography. Cardiac MRI was not performed due to the severe and unstable general condition of all patients and the significant risks from a longer stay in anesthesia. Capabilities of TTE and cardiac CT in determining combined intra- and extracardiac anomalies were assessed and compared. All data from TTE and cardiac CT were compared with the results of conventional angiography and intraoperative data. The interval between TTE, cardiac CT and angiography or surgery was less than 10 days.RESULTS: The accuracy of TTE and cardiac CT in TGA diagnosis and determining its type was 100% for both methods, however, with regard to determining combined intra- and extracardiac anomalies, the methods play a different role: the accuracy of cardiac CT in determining combined intracardiac anomalies in patients with TGA was 87.7% (AUC 89.3%), for TTE — 97.1% (AUC 97.3%). Comparing the capabilities of the techniques in determining intracardial anomalies, no statistically significant difference was obtained (p=0.092). The diagnostic accuracy of cardiac CT in determining concomitant anomalies of the great vessels and extracardiac pathology was 98% (AUC=98.9%). The sensitivity and specificity of TTE in the comprehensive assessment of concomitant extracardiac anomalies were 58% and 98%, respectively (accuracy 89.1%), AUC 81.1%. Comparing the capabilities of techniques in determining intracardial anomalies, cardiac CT showed to be a more accurate tool in comparison with TTE (p=0.041).DISCUSSION: Results of our study demonstrate the high efficiency of TTE in determining indications for emergency palliative correction of transposition of the great arteries, however, the method has limited diagnostic capabilities in assessing surgical risks when planning radical correction of the defect. Cardiac CT has proven to be a highly accurate tool both in making a diagnosis and in identifying combined intra- and extracardiac anomalies, which play a decisive role in planning open surgical correction of transposition of the great arteries in children.CONCLUSION: For patients with TMA and critical hypoxia, transthoracic echocardiography is the definitive diagnostic tool for planning endovascular repair. When planning open surgery, transthoracic echocardiography should be complemented by cardiac CT with ECG gating to assess the anatomy of the coronary arteries and possible associated extracardiac anomalies.

Elevation of Depressed Skull Fracture in Neonates Using a Breast Pump and a Custom-Molded Flange.

"Ping-pong fractures" (PPF) can occur in neonates and result in cosmetic deformity and local mass effect. Standard treatment involves surgical elevation of the depressed bone when the indentation is considerable or cosmetically apparent. Surgical correction of PPF subjects patients to the risks of surgery and general anesthesia. This article and corresponding video demonstrate a novel means of correcting PPF at bedside without surgery or anesthesia. We used a hospital-grade breast pump connected to a custom-fabricated flange to successfully elevate PPF in two neonates. Two moderately preterm infants were noted at birth to have large parietal PPF. To avoid surgical intervention, elevation using a suction device was attempted. A hospital-grade breast pump was used to provide suction. A custom device was fabricated out of a breast pump flange and molded Coloplast Brava® protective seal rings. This device was carefully applied to the skull to exactly match the diameter of the PPF and contour of the bone. Brief (15-30 seconds) periods of suction were applied several times until the PPF was successfully elevated as documented on subsequent computed tomography scans. Both infants achieved excellent cosmetic results with no adverse effects over 24- and 9-month follow-ups, respectively. This technique eliminates the risks of open surgical correction and corrected the PPF without general anesthesia or adverse effects to the infant. While there may be limitations due to patient age and/or location of the PPF, the use of widely available and inexpensive custom-fitted materials with a hospital grade breast pump achieves maximal efficacy without requiring higher negative pressure suction application. Elevation of PPF can be safely achieved in some neonates using readily available equipment: a hospital-grade breast pump, flange, and moldable adherent material. This technique is reasonable to attempt in lieu of surgical elevation.

Less correction with minimally invasive surgery for adolescent idiopathic scoliosis compared to open surgical correction.

In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis. The correlations between the Cobb's angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation. The Cobb's angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° (p < 0.001) in the open surgical correction group and from 51.2° ± 11.4° to 11.7° ± 5.8° (p < 0.001) in the minimally invasive surgery group before and after surgery, respectively. The percentage of curvature correction was 88.2% ± 8.0% and 77.7% ± 10.7% (p < 0.001) in the open surgical correction and minimally invasive surgery groups, respectively. The estimated blood loss was higher in the open surgical correction group than in the minimally invasive surgery group (208.7 ± 113.4 vs 564.3 ± 242.7 mL). Axial rotation was changed from 29.1°± 7.5 to 17.1°± 6.8 (p < 0.001) in the open surgical correction group and from 28.9°± 7.8 to 19.4°± 6.4 (p < 0.001) in the minimally invasive surgery group. The duration of surgery was shorter in the open surgical correction group than in the minimally invasive surgery group (266.6 ± 64.3 vs 346.2 ± 70.5 min). A positive correlation between time of operation and Cobb's angle correction (in °) in open surgical correction (r = 0.37) and minimally invasive surgery (r = 0.43) was found. The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb's angle. III.

Neuropsychological outcome in survivors of congenital diaphragmatic hernia at 5 years of age, what does it tell?

Previous studies have frequently reported neurocognitive deficits in children born with congenital diaphragmatic hernia (CDH) at school age, which may contribute to academic difficulties. Yet, age at onset of these deficits is currently unknown. We evaluated neurocognitive skills with possible determinants in preschool children born with CDH. Eligible 5-year-old children born with CDH (2010–2015) who participated in our prospective structural follow-up program were included. We used the WPPSI-III to assess intelligence, subtests of the Kaufman-ABC for memory, and NEPSY-II to assess inhibition and attention. We included 63 children. Their test scores generally were within or significantly above normal range: total IQ = 103.4 (15.7) (p = 0.13); Verbal memory = 10.2 (2.8) (p = 0.61); Visuospatial memory = 11.4 (2.6) (p < 0.01); Inhibition = 10.5 (2.2), (p = 0.10). In univariable analyses, length of ICU-stay was negatively associated with IQ, and maximum vasoactive inotropic score and open repair were negatively associated with inhibition skills. In multivariable regression analysis, the latter association remained (B = 5.52, p = 0.04 (CI 0.32–10.72)). Conclusions: In these tested 5-year-old children born with CDH, neuropsychological outcome was normal on average. While problems in 8-year-olds are common, we did not detect onset of these problems at age 5. Yet, we cannot rule out that this cohort had a relatively mild level of disease severity; therefore, conclusions should be interpreted with caution. However, given the growing-into-deficit hypothesis, meaning that deviant brain development in early life is revealed once higher cognitive brain functions are demanded, follow-up should be conducted up to school age, and preferably beyond.What is Known:• Children born with CDH are at risk for academic difficulties at school age.• Whether these difficulties can be detected already before school age is unknown.What is New:• At age 5 years, intelligence, inhibition, attention, and memory skills were all within normal range, or even above, in children with CDH. This is supportive of the growing-into-deficit hypothesis in this patient population.• Those who underwent open surgical correction had poorer inhibition skills than those who were corrected with minimal access surgery.

Are severe mitral annular calcification still a contraindication to open surgery?

Abstract Background Mitral annular calcifications are considered a contraindication to open mitral valve repair/replacement, being associated with a significant risk of rupture of the atrioventricular groove or prosthesis detachment/paraprosthetic leak. Recently a scoring system has been proposed, to quantify the severity of MAC and predict the success of transcatheter valve in MAC implantation. Objective We present a series of consecutive patients with MAC undergoing sugical mitral valve replacement in recent years. Patients and methods 82 consecutive patients with MAC underwent open surgical correction from January 2019 at our centre. This was a complex cohort of patients with a high surgical risk profile (STS 5.3±3.2). The degree of MAC was moderate in 60 and severe in 22. Annular decalcification was required in 16 patients, and patch reconstruction of the AV groove in 4. The main predictor of the need for annular decalcification and reconstruction was the depth of calcium infiltration in the ventricular wall at CT. At intraoperative TEE only one patient had a significant paraprosthetic leak, that was repaired during a second short period of aortic cross-clamping. 30 days mortality was 1.2% (one patient), and 87% of patients were alive and well at one year. Comment The presence of significant mitral annular calcificaion per se should not be considered a contraindication to open mitral valve surgery. The depth of the calcifications in the ventricular wall, as measured at CT 3D multiplanar reconstructions is the best predictor of the need to decalcify/reconstruct the AV groove. Detailed imaging analysis is crucial for the success of the procedure. Funding Acknowledgement Type of funding sources: None.

Radiographic Correction of Bunionette Deformity using Minimally Invasive Fifth Metarsal and Akinette Osteotomy

Category: Midfoot/Forefoot; Lesser Toes; Other Introduction/Purpose: Bunionette Deformity is defined as a painful lateral prominence of the fifth metatarsal head. Conservative treatment entails footwear and activity modification. Symptoms can be exacerbated in the athletic population and activities with specific footwear such as cycling, winter sports and water sports. In refractory cases, patients may pursue operative intervention. Historically, open surgical correction carried risks of wound complications, prolonged recovery time, and nonunion risk. Minimally invasive techniques have gained popularity due to the decreased risk of wound complications, preservation of blood supply and healing potential, and faster operative and recovery times. The purpose of the current study is to examine radiographic and clinical outcomes of minimally invasive bunionette correction with a sliding distal 5th metatarsal osteotomy and lateral closing wedge proximal phalanx (Akinette) osteotomy. Methods: A retrospective review examined 36 feet in 28 patients who underwent minimally invasive bunionette correction from 01/2021 to 12/2021. The study patients were treated at a single center by 3 participating providers trained in minimally invasive techniques. All patients underwent a distal 5th metatarsal osteotomy and Akinette osteotomy of the proximal phalanx. Length of follow up ranged from 3 to 12 months. Radigraphic measurements including 4,5 intermetatarsal angle (IMA), 5th metatarsophalangeal angle, and osteotomy displacement (mm) were compared pre and postoperatively. Patients were asked to complete postoperative satisfaction survey and lesser toe American Orthopaedic Foot &amp; Ankle Society (AOFAS) score. Results: Preliminary analysis shows a radiographic 4,5 IMA correction of 4.9 degrees to 3.4 degrees. Fifth metatarsophalangeal angle was corrected from 20.3 degrees preoperatively to 5.3 degrees postoperatively. Average medial displacement of the metatarsal osteotomy was 2.64 mm. There was one nonunion of the 5th metatarsal in a revision case that had previously been treated at an outside facility with open techniques, which was treated with bone grafting. Two other patients underwent revision surgery for complications from concomitant procedures that were performed (1 lapidus nonunion and 1 lapidus wound dehiscence). There were no wound or neurovascular complications involving the 5th ray. Conclusion: Our data shows that minimally invasive bunionette correction with sliding 5th metatarsal and Akinette osteotomy leads to reliable radiographic correction and clinical improvement. This operation has favorable safety profile with low incidence of complications and a high union rate.

Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation.

To report outcomes after the correction of ectopic ureter (EU) by open surgery or cystoscopic-guided laser ablation (CLA) in female dogs. Retrospective study from 2011 to 2018. Twenty-five female dogs. Data collected included signalment, clinicopathologic data, procedural data, complications, and short-term and long-term outcomes. Complications were graded as minor or major if a surgical revision was required. Continence status was scored subjectively (1=completely incontinent to 10=fully continent). Fifteen dogs had bilateral EU and 24 had intramural EU (iEU). Open surgical correction included 13 neoureterostomies, 2 neocystoureterostomies, and a combination of these in 2 dogs. Eight dogs underwent CLA. Eighteen dogs experienced minor complications (72%), and 2 experienced major complications (8%). One-month postoperative continence was achieved in 20/25 (80%) dogs (median score of 10). Incontinence recurred at a median time of 24.9months in 5 dogs but responded to medical treatment. Overall, dogs remained continent for 66 months (median) and 22/25 (88%) dogs achieved continence with adjunction of medical/surgical treatment in incontinent ones. Fewer minor complications and postoperative recurrences of incontinence were documented after CLA than neoureterostomy (P < .01 and P < .05). Ectopic ureter correction by open surgery or CLA resulted in a subjectively good prognosis, most dogs reaching continence within a month of surgery, although incontinence occasionally recurred in the long term. CLA was associated with fewer complications and incontinence recurrences than neoureterostomy. Cystoscopic-guided laser ablation should be preferred to correct iEU to prevent short-term complications and the recurrence of incontinence. Further studies should investigate the cause of postoperative recurrence of urinary incontinence.

3rd generation MICA with the \u201cK-wires-first technique\u201d - a step-by-step instruction and preliminary results

BackgroundMinimally-invasive techniques for hallux valgus correction are becoming increasingly popular. In the last decades, multiple techniques for minimally-invasive hallux valgus correction have been described. MICA (Minimally-invasive Chevron & Akin), representing the 3rd generation of minimally-invasive hallux valgus correction, combines the advantages of an extraarticular osteotomy, stable internal fixation, and high potential for correction.This report aims to provide a step-by-step instruction of the surgical technique with the “K-wires-first” MICA modification, illustrated by detailed imaging of both intraoperative fluoroscopy and clinical imaging as well as corresponding sawbone models for each step. Preliminary results including radiological outcome and complications of the first 50 cases will be discussed.MethodsBetween May 2018 and May 2021, 50 consecutive MICAs in 47 patients were performed with the K-wires-first technique. There were 40 women and 7 men with an average of 57.4y (range 25–78). The mean preoperative IMA was 16.2° (range 11.0–21.5), the HVA 30.6° (range 21.8–42.1).ResultsThere was one intraoperative conversion to an open surgical bunion correction corresponding to a 2% conversion rate respectively (1/50). On 3 feet (2 patients), removal of the Chevron screws was performed after 7, 9, and 12 months due to prominent and disturbing screw heads at the level of the medial cortex, accounting for a revision rate of 6% (3/50). There were no other secondary revision surgeries. The IMA decreased after MICA by a mean of 10.8° from 16.2° to 5.4° and the HVA by a mean of 22.1° from 30.6° to 8.5°, demonstrating MICA’s high potential for correction.ConclusionsCompared to other MICA techniques, the K-wires-first modification helps to reduce hardware malpositioning and the risk of conversion to open surgery. Furthermore, our preliminary results demonstrate a high potential for correction even for severe hallux deformities.Trial registrationRetrospectively registered, swissethics BASEC-ID 2021–01537, July 16th, 2021 (www.raps.swissethics.ch).

Percutaneous embolization of a ruptured mycotic visceral aortic aneurysm stump hemorrhage

Introduction and Objective Managing infected endovascular aortic stent grafts is difficult and often has morbid consequences. We report a complicated case of endovascular aortic stent graft infection treated through complex surgical and endovascular management. A standard attempt at open surgical correction was made, however, due to the complex nature of the patient's condition; much of the treatment accomplishedvia endovascular techniques for ultimate resolution. Case Report Graphical AbstractA) CTA maximum intensity projection after initial surgical repair demonstrating an axillary-femoral and femoral-femoral bypass creation (star), distal aortic and bilateral artery ligation (asterisks). B) Sagittal abdominal CTA 2 weeks after initial surgery demonstrating contrast extravasation from the aortic stump (arrow). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) Posterior projection of a volume rendered CTA after the second surgical repair demonstrating distal thoracic aorta ligation (open arrow), previous ligations (asterisks), bypass grafts from the distal thoracic aorta to the SMA (white arrow), splenic artery (open arrowhead), and left renal artery (white arrowhead). B) Sagittal abdominal CTA demonstrating recurrent hemorrhage in the visceral aorta (arrow), with themultiple ligations (asterisks) of the aorta and SMA, as well as the celiac bypass (arrowhead). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) Oblique image of the aortic stump access using an 18-gauge Hawkins needle (Cook, Bloomington, IN) (white arrowheads) shows inflow at the celiac ostium as a contrast void (white circle), opacification of the replaced right hepatic (black arrow), right renal artery (black arrowhead), and visceral aorta with extravasation of contrast (white arrow). B) SOS 2 catheter (Cook, Bloomington, IN) selection of the celiac artery (white arrow head) with retrograde flow in to the aortic lumen (white circle), inflow from the splenic artery stump bypass (black arrowhead), and antegrade flow into the common hepatic artery (black arrow). View Large Image Figure Viewer Download Hi-res image Graphical AbstractThe ostia of the celiac artery, right renal artery, and direct aortic origin right hepatic celiacartery origin were embolized using multiple techniques. A) A 0.24 microcatheter (white arrowhead) was advanced into the splenic artery and used to place an Amplatz IV (6 × 11mm) (St. Jude Medical, St. Paul, MN) (black arrowhead) into the ostium of the celiac artery to exclude the aortic stump but preserve hepatic arterial supply. Direction of blood flow from the splenic bypass towards the celiac ostium and into the common hepatic artery is demarcated with open arrows. B) The replaced right hepatic artery was embolized with multiple 0.018 6mm and 4mm detachable coils (Boston Scientific S Interlock, Marlboro, MA) (arrow). C) The visceral aortic lumen and right renal artery were embolized with 0.035 and 0.018 detachable coils (Boston Scientific S Interlock, Marlboro, MA), a 0.035 Benson wire with removed mandrel (Cook,Bloomington, IN) and n-BCA glue (TruFill Johnson and Johnson, Miami, FL). The aortic access track was then closed with an 8mm Amplatz plug and n-BCA glue (arrowhead). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) 3-year post-operative follow up 3D rendered image showing patents bypasses to the SMA (white arrow), splenic artery (open arrowhead), and left renal artery (white arrowhead), stable ligation of the distal thoracic aorta and embolized visceral abdominal aorta. B) 3-year post-operative sagittal CT showing absence of perfusion to the visceral aortic (arrow). View Large Image Figure Viewer Download Hi-res image Discussion Complex aortic surgery is challenging especially in the presence of recurrent infection. This case was a unique situation in which a less invasive endovascular correction was successful for a patient with multiple recent aortic surgeries in which perioperative mortality for any additional surgeries was likely. Managing infected endovascular aortic stent grafts is difficult and often has morbid consequences. We report a complicated case of endovascular aortic stent graft infection treated through complex surgical and endovascular management. A standard attempt at open surgical correction was made, however, due to the complex nature of the patient's condition; much of the treatment accomplishedvia endovascular techniques for ultimate resolution. Complex aortic surgery is challenging especially in the presence of recurrent infection. This case was a unique situation in which a less invasive endovascular correction was successful for a patient with multiple recent aortic surgeries in which perioperative mortality for any additional surgeries was likely.

Minimally invasive hallux valgus correction with Internal Hallux Fixator® — A comparative cadaver study

BackgroundThe Internal Hallux Fixator® (IHF®; Waldemar Link, Hamburg, Germany) was designed for open surgical hallux valgus correction. It allows a defined lateralisation of the first metatarsal head after V-shaped, Chevron-like distal metatarsal osteotomy in order to correct mild to middle hallux valgus deformities. The intramedullary fixation provides dynamic compression of the osteotomy and thus postoperative full weight bearing mobilization is an integral part of the therapy.This comparative cadaver model study investigates the feasibility of implanting the device using a minimally invasive technique and compares its capability of first metatarsal head lateralisation to the established 3rd generation MICA (Minimally Invasive Chevron and Akin osteotomy) technique. Methods16 fresh frozen cadaveric feet (8 left, 8 right) of 8 body donors received either MICA (Group 1), or an IHF® in a minimally invasive technique (Group 2). The achievable first metatarsal head lateralisation and operating time were measured and pitfalls recorded. ResultsThis cadaver model study confirmed, the minimally invasive implantation of the Internal Hallux Fixator® can be performed reliably via 10 mm mini incision with V-shaped distal metatarsal osteotomy. The mean first metatarsal head lateralisation was comparable between the groups with no statistically significant difference (7.2 (±1.9) mm in G1, or 8.3 (±0.8) mm in G2; p = 0.09).The IHF® was inserted and fixed in mean 3.7 (±0.6) min, whereas double screw fixation needed 10 (±3.7) min. Level of Clinical Evidence5, Cadaver model study.

Deep venous thrombosis and abortion: an unusual clinical manifestation of severe form of pectus excavatum

Pectus excavatum is a chest wall malformation with a strong psychological and aesthetic impact. Rarely, pectus excavatum patients can show respiratory or cardiac symptoms occurring mainly during physical exertion. We report a case of a 34-year-old pregnant woman with a severe degree of pectus excavatum who developed serious cardiovascular disease resulting in spontaneous twin abortion at the twenty-first week of gestation. Cardiovascular disease was resolved after open surgical correction of pectus excavatum. This case shows how a tardive diagnosis and a delayed surgical approach for pectus excavatum can lead to severe consequences.

Ранні та віддалені результати після операції Soave-Boley при хірургічному лікуванні агангліозу кишечника у дітей

Introduction. Сolon agangliosis (CA) belongs to a group of severe congenital malformations of the colon that can only be treated by surgical approach. The Soave-Boley technique is one of the most physiological and technically acceptable among pediatric surgeons from from all over the world. Aim – evaluate the early and long-term results of surgical treatment of CA in children by Soave-Boley method. Materials and methods. We analysed surgical treatment of 774 children with various forms of CA aged from birth to 18 years for the period from 1980 to 2020, using the Soave-Boley method by the formation of the primary colo-anal anastomosis by manual (suture) and mechanical (stapler) method. Results. All patients survived. Early postoperative surgical complications were seen in 19 (2.45%) of 774 children operated by Soave-Boley method: in 15 – after the formation of the primary colo-anal anastomosis by manual (sutures) method and 4 – after the imposition of a colo-anal anastomosis by mechanical (stapler) method. Long-term postoperative complications were noted in 15 (1.94%) of 774 children operated by Soave-Boley method: 14 – with a manual (suture) and 1 – with a mechanical (stapler) colo-anal anastomosis. Re-operation was successfully performed in 30 (3.87%) patients with reconstructing colo-anal anastomosis manually with Soave-Boley method after initial correction of CA in other clinics by other methods. Periodic episodes of soiling were seen in the remote period in 47 (6.07%) of 774 operated children which was treated conservatively. The success of the Soave-Boley technique is confirmed by a much lower number of early (2.45%) and long-term (1.94%) postoperative surgical complications, compared with those after the use of other methods of open surgical correction – 17.52% and 16.35%, respectively. Conclusions. Soave-Boley operation with colo-anal anastomosis by manual (suture) and mechanical (stapler) methods in comparison with other methods is the most effective method of radical correction of CA as open surgical approach in children of different age groups as single staged or double staged interventions. According to the technical capabilities and results of the early and long period, the Soave-Boley technique with colo-anal anastomosis by manual (ligature) method is the operation of choice for both primary and re-surgical correction of CA compared to any other methods. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interest was declared by the authors. Key words: agangliosis, colon, children, surgical treatment, results.

Surgical Correction of Hirschsprung's Disease in Children Using the Soave-Boley Technique with Manual Colorectal Anastomosis

Introduction. Current trends in surgical treatment of Hirschsprung's disease are aimed at minimally invasive interventions. However, the experience of using Soave-Boley procedure in surgical treatment of Hirschsprung's disease in children of different ages is valuable in the arsenal of differentiated approach to the treatment of this pathology.&#x0D; The objective of the research was to evaluate the results of surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis.&#x0D; Materials and Methods. The analysis of surgical treatment of 1,187 children with different forms of Hirschsprung’s disease aged from birth to 18 years over the period 1980-2020 was conducted in the National Children's Specialized Hospital“ Okhmatdyt”. Surgical correction of Hirschsprung's disease using the Soave-Boley technique was performed in 597 children. Before surgery, 156 patients underwent the first stage of treatment that consisted in the creation of a protective colostomy; in 441 cases, this intervention was performed without an intestinal stoma; the benefits of the Soave-Boley technique were evaluated.&#x0D; Results. All the patients survived. In 15 (2.51%) out of 597 children, in the early postoperative period, there were observed: retrocolic hematoma (n = 2), retrocolic abscess (n = 7), anastomotic leak (n = 2), adhesive intestinal obstruction (n = 3), intussusception (n = 1). Fourteen (2.36%) patients developed surgical complications in the long-term period: residual aganglionosis (n = 9), anastomotic stenosis (n = 4) and coloptosis. Repeated Soave-Boley operation with manual colorectal anastomosis was successfully performed in 26 (4.362%) patients after primary correction of Hirschsprung's disease using different methods. Periodic episodes of fecal smearing in the remote period in 45 (7.53%) children were eliminated by conservative treatment. The success of this technique is confirmed by a much lower number of early (2.51%) and late (2.36%) postoperative surgical complications, as compared to those after using other methods of open surgical correction - 17.52% and 16.35%, respectively.&#x0D; Conclusions. Surgical correction of Hirschsprung's disease in children using the Soave-Boley technique with manual colorectal anastomosis allows better control over applying each suture, anatomical joining the edges of the bowel, and reducing trauma to the rectal mucosa, which ensures the high reliability of colorectal anastomosis; it is the most effective way of radical correcting Hirschsprung' s disease in children in an open way in one-stage or two-stage interventions, and this technique is the operation of choice for secondary surgical correction of Hirschsprung's disease.

Posterior Femoral Cam Decompression Through an Arthroscopic Anterior Approach With Pre-Bent Hip Burrs

Hip arthroscopy has been increasingly used to treat labral tears and cam and pincer lesions found in femoroacetabular impingement. Although the classic impingement with cam deformity at the proximal femoral anterolateral quadrant is most common, there has been evidence of cam impingement extension to the anteromedial and posterior quadrants of the proximal femur. Posterior cam decompression carries a theoretical risk of vascular insult and subsequent osteonecrosis, which have led investigators to approach these posterior lesions through an open surgical correction. Recent improvements have led to the development of pre-bent burs that allow for bonier resection flexibility. Here, we report on an arthroscopic posterior cam decompression using the traditional anterior portals and curved hip burs via a figure-of-four positioning technique.

Clinical cases referring to current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of-in analogy to the heart team-aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta-the aortic root, in particular in acute type A aortic dissection-which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association

Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of-in analogy to the heart team-aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta-the aortic root, in particular in acute type A aortic dissection-which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

PD55-06 EPIDEMIOLOGICAL DESCRIPTION AND MANAGEMENT OUTCOMES OF BENIGN URETEROENTERIC STRICTURE AFTER RADICAL CYSTECTOMY: A SINGLE-CENTRE EXPERIENCE

You have accessJournal of UrologyBladder Cancer: Invasive V (PD55)1 Apr 2020PD55-06 EPIDEMIOLOGICAL DESCRIPTION AND MANAGEMENT OUTCOMES OF BENIGN URETEROENTERIC STRICTURE AFTER RADICAL CYSTECTOMY: A SINGLE-CENTRE EXPERIENCE Jose Mari Gaya*, Christian Martinez Osorio, Iacopo Meneghetti, Andres Caillabet, Davide Vanacore, Matteo Talle, Lucia Mosquera, Jorge Huguet, Antonio Rosales, Joan Palou, and Alberto Breda Jose Mari Gaya*Jose Mari Gaya* More articles by this author , Christian Martinez OsorioChristian Martinez Osorio More articles by this author , Iacopo MeneghettiIacopo Meneghetti More articles by this author , Andres CaillabetAndres Caillabet More articles by this author , Davide VanacoreDavide Vanacore More articles by this author , Matteo TalleMatteo Talle More articles by this author , Lucia MosqueraLucia Mosquera More articles by this author , Jorge HuguetJorge Huguet More articles by this author , Antonio RosalesAntonio Rosales More articles by this author , Joan PalouJoan Palou More articles by this author , and Alberto BredaAlberto Breda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000965.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroenteric anastomosis stricture (UES) is a common complication, between 3-10%, after radical cystectomy (RC). Although open ureteral reimplantation is the gold standard treatment, endoscopic approach and laparoscopic-robotic reimplantation have achieved popularity in the last decades. Predictors of success of every treatment option are poorly defined. Our objectives were to characterize the UES and outcomes after its treatment and identify risk factors for treatment failure and UES recurrence. METHODS: We performed a retrospective review of 111 patients with UES after RC, diagnosed between August 1999 and February 2019 in a single-centre. Baseline clinicopathologic characteristics, details of UES, and perioperative outcomes were collected and analysed. Predictors for stricture recurrence and treatment failure were assessed by univariable testing and multivariable stepwise regression. RESULTS: Between May 1990 and October 2018, 2520 RC were performed in our centre, of which 111 patients (4.4%) were diagnosed with benign UES with intention to treat. Among these, 59 (53.2%) patients developed a stenosis in the left ureter, 23 in the right (20.7%) and 29 (26.1%) bilaterally. The median time to primary UES was 8.3 months (range 0.5 - 377.2 months) and 30 (27%) patients were asymptomatic. 79 (71.2%) patients required emergency nephrostomy tube before primary treatment and 49 patients were cured (44.1%) with the primary treatment. In 84 (75.7%) patients there was an intention to treat endoscopically as a primary treatment and in 51 cases the treatment was completed, with a success rate of 33.3%. 15 (13.5%) patients went to primary open or laparoscopic surgical correction with a success rate of 93.3%. After failure of primary endoscopic management, 19 (28.36%) went to endoscopic management again, with a success rate of 26.3% and 25 (37.31%) underwent ureteral reimplantation with a success rate of 76%. 180-day Major complications (Clavien> 3a) were found in 3 (20%) patients treated with primary ureteral reimplantation and in no patient who underwent endoscopic management. The multivariate analysis showed bilateral UES, endoscopic primary treatment and time to UES less than 6 months were independent risk factors for failure primary treatment. CONCLUSIONS: Endoscopic approach is a safe alternative treatment of UES with acceptable results and very low comorbidity. Although success rate is not as high as reconstructive surgery, endoscopic failure does not affect subsequent results of open or laparoscopic surgical correction. Identification of risk factors of endoscopic treatment failure could help to provide better patient selection in order to improve success rate. Source of Funding: No. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1184-e1184 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Mari Gaya* More articles by this author Christian Martinez Osorio More articles by this author Iacopo Meneghetti More articles by this author Andres Caillabet More articles by this author Davide Vanacore More articles by this author Matteo Talle More articles by this author Lucia Mosquera More articles by this author Jorge Huguet More articles by this author Antonio Rosales More articles by this author Joan Palou More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...

Calculated Blood Loss and Transfusion Requirements in Primary Open Repair of Craniosynostosis.

Background:Open surgical correction is effective in the treatment of craniosynostosis but may result in significant blood loss and transfusions. This study seeks to compare surgeon estimated blood loss with calculated blood loss and provide contemporary data that objectively quantify blood loss and transfusion rate associated with open repair of craniosynostosis.Methods:A retrospective review of patients undergoing primary open repair of craniosynostosis between May 2011 and November 2016 was performed. The medical records of 43 patients were reviewed to obtain the operative age, weight, affected suture, pre- and postoperative hematocrit, blood transfusion volume, estimated blood loss, and syndromic status. Estimated blood volume (EBV) and red cell mass were calculated for analysis.Results:The median age and weight at the time of surgery were 9 months and 8.6 kg, respectively. Mean surgeon estimated blood loss was 207.4 mL (28.1% of EBV). Mean calculated blood loss was 318 mL (44.3% of EBV). The mean transfusion volume was 188 mL (26.5% of EBV). The mean transfusion as a percent of estimated red cell mass was 59.1%. Fourteen percent of patients did not require any transfusion.Conclusions:We report intraoperative blood losses and transfusion requirements that are lower than those of many previous studies of open repair of craniosynostosis. Additionally, we found that calculated blood loss estimates may be more reliable than surgeon-derived estimated blood loss. We hope that these updated, objective data will be useful in comparisons of open repair to minimally invasive surgery or to new blood loss reducing procedures.

Inferior Mesenteric Artery as an Inflow for Unilateral Renal Artery Revascularization

Introduction: To report a successful unilateral renal revascularization via an inferior mesenteric artery to left renal artery bypass with return of renal function to baseline postoperatively. Methods: A 73-year-old female presented with rapidly deteriorating renal function and uncontrolled hypertension secondary to ischemic nephropathy due to chronic renovascular occlusive disease. The patient had failed prior Percutaneous Transluminal Angioplasty (PTA) attempts. Preoperative evaluation showed the right kidney to be atrophied and normal size left kidney. Intraoperative exploration revealed porcelain abdominal aorta and both common and external iliac arteries were heavily calcified and were not suitable for appropriate clamping or to be used as an inflow for renal revascularization. Although the patient was asymptomatic, both celiac artery and Superior Mesenteric Artery (SMA) were nearly occluded and severely stenosed, respectively, at their origins. Therefore, the splenic artery and SMA were not used for reconstruction. Further exploration revealed a minimally diseased and widely patent Inferior Mesenteric Artery (IMA). A unilateral renal revascularization was performed via an IMA to left renal artery bypass using PTFE graft via a midline laparotomy. Results: The patient was discharged on postoperative day 8 in good condition. Glomerular Filtration Rate (GFR) and blood pressure returned to baseline within 6 weeks postoperatively. CT angiogram undertaken 24 months postoperatively revealed a patent renal bypass. The patient maintained normal renal function and adequately controlled blood pressure 24 months postoperatively. Conclusion: Open surgical correction of atherosclerotic renovascular disease can retrieve renal function in selected hypertensive patients with ischemic nephropathy. In the absence of other suitable inflow sources, the inferior mesenteric artery can be used as an alternative with acceptable outcomes.