Duration Of Surgery Research Articles

Robotic vs laparoscopic distal gastrectomy with Billroth I and II reconstruction: a systematic review and meta-analysis.

Robotic distal gastrectomy (RDG) has been increasingly used for the treatment of gastric cancer, however, its comparative safety and efficacy against the laparoscopic approach (LDG), remains unclear, especially when accounting the reconstruction method as a confounder. This systematic review and meta-analysis aims to evaluate the short-term outcomes of RDG vs LDG In patIents with gastric cancer, undergoing Billroth I and II reconstruction. A systematic review was conducted in accordance with PRISMA guidelines. We searched Pubmed, Scopus and the Cochrane Library, up to October 22nd, 2024. The primary outcomes analyzed were the blood loss, operative duration, and the number of harvested lymph nodes and the secondary outcomes included overall complications, time to oral intake, duration of hospitalization and time to first flatus. Random-effects models were used to calculate weighted mean differences (WMD) and Odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the I2 statistic. P values were also calculated. Sensitivity analysis was performed for outcomes with moderate to high heterogeneity. Five studies were included, involving 811 patients (RDG: n = 289, LDG: n = 522). RDG was associated with a significantly longer operative duration compared to LDG (WMD = 34.14min, 95%CI 10.92 to 57.35, P = 0.004, I2 = 91%). RDG patients initiated oral intake earlier (WMD = -0.20days, 95%CI -0.39 to -0.01, P = 0.03, I2 = 45%). RDG resulted in shorter hospital stays (WMD = -1.48 days, 95%CI -2.91 to -0.04, P = 0.04, I2 = 86%). RDG patients had a faster return to bowel function (time to first flatus) (WMD = -0.33days, 95%CI -0.50 to -0.15, P = 0.00003, I2 = 57%). No statistically significant differences were observed regarding blood loss between RDG and LDG (WMD = -3.88mL, 95%CI -21.63 to 13.87, P = 0.67, I2 = 78%). There was no statistically significant difference in complication rates (OR = 0.61, 95%CI 0.36 to 1.03, P = 0.06, I2 = 0%). No significant differences were observed regarding the number of lymph nodes harvested (WMD = -0.49, 95%CI -3.02 to 2.04, P = 0.70, I2 = 24%). Sensitivity analysis confirmed the robustness of the findings of operative duration and time to first flatus. RDG with BI/ BII requires longer operative duration, but it associated with faster recovery compared to LDG. No differences were observed between RDG and LDG with regards to overall complications, number of harvested lymph nodes and blood loss, showing that RDG is as safe and oncological equivalent to LDG. Future studies particularly, multi-center randomized clinical trials, should have a longer follow up period and examine the type of reconstruction separately. PROSPERO registration: CRD42024605895.

Surgical Trauma Comparison of Inframammary Fold versus Endoscopic Transaxillary Approaches in Breast Augmentation: A 7-Year Cohort Study.

This retrospective cohort study aimed to assess differences in surgical trauma between the inframammary fold approach and endoscopic transaxillary approach in breast augmentation surgery. One hundred and ninety-four patients who underwent breast augmentation using either an inframammary fold or endoscopic transaxillary approach were enrolled. All procedures were primary and bilateral cases. Patients' demographics and indicators, such as operation duration, postoperative volume of drainage, drainage duration, length of hospital stay, and postoperative pain scores, were observed and analyzed. One hundred and five patients underwent inframammary fold incisions, while the remaining 89 received transaxillary incisions. The operation duration was significantly shorter in the inframammary fold group than in the transaxillary group, while the VAS scores were significantly lower (p < 0.001). Similarly, differences in the age and fertility status between the two groups were statistically significant (p < 0.05). However, no statistically significant differences were noted in the scores of the remaining indicators (p < 0.05). This research demonstrated that while patients in the endoscopic transaxillary group were typically younger, which is commonly hypothesized to result in superior results, the inframammary fold approach may offer a surgical option with reduced trauma and pain and concomitantly greater convenience and efficiency, yielding high satisfaction levels among Chinese women. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Advancements in Laparoscopic Techniques for Perineal Hernias—Technical Success and Complications Data

Purpose: Multimodal approaches, including radiochemotherapy and surgical resection, are commonly used to treat rectal malignancies. Postoperative perineal hernias, though not uncommon, have shown an increasing incidence in recent years. Managing symptomatic perineal hernias presents a challenge, with a high recurrence rate after repair. This retrospective study investigates the laparoscopic placement of a non-absorbable mesh for treating pelvic floor hernias involving bowel displacement. Methods: This study included all consecutive patients requiring hernia repair due to symptomatic perineal hernias following minimally invasive abdominoperineal resection. All patients had a history of local radiation therapy. Data were collected on surgery duration, intra- and postoperative complications, and hernia recurrence rates. Results: Laparoscopic displacement of the small bowel from the pelvis was performed on eight patients, and closure of the pelvic floor hernia area was achieved using non-absorbable mesh placement. All procedures were successful, and no perioperative complications were recorded. Only one early complication occurred, classified as Clavien-Dindo II. Conclusions: The laparoscopic procedure, serving as a safe method for repositioning the small intestine and closing a perineal hernia using a mesh, has shown promising outcomes. The use of a non-absorbable mesh as an alternative to native tissue appears to be effective, with no observed recurrent hernias. However, further evaluation through long-term results or a larger cohort study is still pending.

The effect of ultrasound–guided dexamethasone compound ropivacaine iliofascia space space block on pain caused by lumbar anesthesia in patients with total hip replacement

Abstract: Objective To observe the effect of dexamethasone complex ropivacaine on reducing lateral side pain in patients undergoing total hip arthroplasty. Methods 120 patients aged 45 to 75 years who were proposed to undergo unilateral total hip replacement, ASA ∼grade, and L2-3Gap for puncture. The 120 patients were randomly divided into four groups of 30 each. In group A, 5 μ g sufentanyl injection was injected before lumbar anesthesia; in the other three groups; in group 1, ropivacaine and saline in group B; dexmedetomidine combined with ropivacaine in group C; dexamethasone plus ropivacaine in group D. After entering the operating room, electrocardiogram and pulse oxygen saturation were routinely monitored (SpO2), Invasive mean arterial pressure (MAP), heart rate (HR), and pain visual analogue score (VAS). Monitoring and recorded into the operating room (T0), The iliac fascia lacuna block or vein, 5min after administration (T1), 10min after iliac fascia space block (T2), 15min after iliac fasspace block (T3, When SA changes the body position) of HR, SpO2, MAP, and VAS score values. The operation duration, anesthesia operation duration, intraoperative bleeding volume, patient anesthesia satisfaction, adverse reactions of hypotension, bradycardia, chills and nausea and vomiting, and the number of postoperative intravenous analgesia pump dosage presses were recorded. Results Sex, age, height, weight, and bleeding conditions (P&amp;gt; 0.05).(1) Comparison of the hemodynamic changes between the groups: in T2The fluctuations in heart rate and arterial blood pressure in group D (10min after dose) were smaller than those of the other three groups, with statistically significant differences (P &amp;lt;0.05); in T3The arterial blood pressure and heart rate fluctuations in groups B, C and D were smaller than those in group A, with A statistically significant difference (P &amp;lt;0.05).(2) Comparison of VAS scores: change within ①group: four groups of patients, T2, T3Time points with T0 Significant changes in VAS scores were statistically significant (P &amp;lt;0.05); where D group T1Time point VAS score with T0Comparison, statistically significant (P &amp;lt;0.05); change between ②groups: Group D compared to groups A, B and C in T1The changes in VAS scores were statistically different (P &amp;lt;0.05); compared with group A, groups B and C were in T1The difference in VAS score change at time points was not statistically significant (P&amp;gt; 0.05); in T2, T3VAS scores, but in groups B, C and D, were statistically lower (P &amp;lt;0.05); (3) Comparison of intraoperative complications: the incidence of hypotension, bradycardia, nausea and vomiting, and local anesthetic poisoning (P&amp;gt; 0.05). In groups C and D, the number of postoperative analgesic pump dosage presses was significantly less than that in groups A and B, with a significant difference (P &amp;lt;0.05). Conclusion Ultrasound-guided dexamethasone compound ropivacaine iliac cia space block can significantly reduce the pain caused by lateral lumbar anesthesia in total hip replacement surgery, and facilitate the hemodynamic stability of patient, better patient comfort and higher satisfaction with anesthesia. Combined dexmedetomidine and dexamethasone had better postoperative analgesia and less opioid use in the analgesic pump. Compared with the dexamethasone compound ropivacaine group, the nerve block was faster and patients were more satisfied with anesthesia, which was conducive to postoperative rehabilitation and worthy of clinical promotion and application.

Efficacy of wound exclusion combined with silicone tube bicanalicular intubation in the treatment of pigmented nevi of the lacrimal punctum

Objective: To investigate the clinical efficacy of wound exclusion combined with silicone tube bicanalicular intubation for treatment of pigmented nevi of the lacrimal punctum. Methods: A retrospective case series analysis was conducted. Clinical data were collected from patients with pigmented nevi of the lacrimal punctum who underwent wound exclusion combined with silicone tube bicanalicular intubation at the Ophthalmology Center of Zhejiang Provincial People's Hospital from April 2020 to February 2023. During the surgery, a linear silicone tube was annularly placed to support the punctum and lacrimal canaliculus under local anesthesia, followed by the pigmented nevus excision under a surgical microscope. The linear silicone tube was removed at 4 to 6 weeks postoperatively. The duration of surgery and postoperative recovery status were recorded and summarized, including the recurrence of the pigmented nevus, epiphora, shape and position of the punctum, medial canthal morphology, and local scar condition. Results: This study included a total of 15 patients, 5 males and 10 females, with an average age of (47.7±13.5) years (range, 19 to 65 years). Two patients had pigmented nevi of the upper punctum, and 13 had pigmented nevi of the lower punctum. All nevi grew around the punctum and were completely excised during the surgery, which lasted (21.8±2.4) minutes on average. By 2 weeks postoperatively, all wounds healed with conjunctivalization, and new punctum openings formed. By 4 to 6 weeks postoperatively, the eyelid margin morphology was almost normal, when the linear silicone tube was removed. The follow-up ranged from 6 months to 2 years. No recurrence of the pigmented nevus was observed during the follow-up. The puncta were well formed without the symptom of epiphora, the medial canthal morphology was basically symmetrical to the healthy side, and the eyelid margin scars were inconspicuous, with a satisfactory appearance. No complications such as punctal occlusion, trichiasis, entropion, and ectropion occurred. Conclusions: For exophytic pigmented nevi of the punctum that do not deeply involve the lacrimal canaliculus, using the wound exclusion combined with silicone tube bicanalicular intubation during the nevus excision may reduce surgical trauma. This simple and feasible method can achieve good therapeutic effects and cosmetic outcomes.

Economic Evaluations of Worksite Health Centers: A Systematic Review.

To systematically review the cost-effectiveness or return on investment (ROI) from worksite health centers (WHCs) in the US. We searched four databases and the grey literature for studies that conducted economic evaluation and provided economic outcomes of US-based WHCs. The quality and risk of bias were assessed using JBI Critical Appraisal Tools of Economic Evaluations. Ten studies met the inclusion criteria. Nine reported WHCs were cost-effective or yielded positive ROI for employers, with annual cost savings per WHC ranging from $35,479 to $2,124,723 and ROI from $1.09 to $15.88 per $1 of investment. Key contributors to higher ROI included company size, utilization, and duration of operations. WHCs may provide economic savings for large employers. Future studies should consider clinical effectiveness and service quality and investigate the specific mechanisms driving employer cost savings.Protocol Registration: PROSPERO (CRD42024506086).

Comparative analysis of suture-based and Hem-O-lok closure techniques in laparoscopic appendectomy for uncomplicated acute appendicitis: a retrospective propensity score matching study.

The optimal method for appendix stump closure in laparoscopic appendectomy (LA) remains debated. This study aims to evaluate the impact of suture-based closure and Hem-O-lok techniques on postoperative complications following LA for uncomplicated appendicitis. A retrospective analysis was conducted on patients with uncomplicated appendicitis treated by LA from January 2019 to December 2021. These patients were categorized into two groups: the suture-based closure group (223 cases) and the Hem-O-lok group (272 cases). Propensity score matching addressed potential discrepancies between the groups. Intraoperative and postoperative parameters of both groups were then compared. Post-matching, the operative duration in the suture-based group was longer than in the Hem-O-lok group (45.9 ± 9.7min versus 42.8 ± 8.9min, P = 0.001). The incidence of postoperative intra-abdominal abscesses and fluid collections was significantly lower in the suture-based closure group (P = 0.032). Multivariate logistic regression analysis revealed that the Hem-O-lok clamp technique [odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.01-64.25, P = 0.047] was a notable risk factor for intra-abdominal abscesses and fluid collections. The suture-based closure technique significantly reduced the incidence of postoperative intra-abdominal abscesses and fluid collections compared with the Hem-O-lok technique in patients undergoing LA for uncomplicated appendicitis.

Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study.

To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester. We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations. A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76-6.47; and p<0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15-5.70; and p=0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester. In-hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected.

Comparison Effect of Clonidine and Magnesium Sulfate on Bleeding Volume during Septorhinoplasty: A Double-Blind, Randomized Clinical Trial

Background: Control of hemodynamic changes and blood loss is a daily challenge in general anesthesia for patients undergoing septorhinoplasty. This study aimed to evaluate the effects of magnesium sulfate and clonidine on the control of hemodynamic factors and bleeding volume during this procedure. Methods: This double-blind, randomized clinical trial study was conducted on 60 patients undergoing septorhinoplasty at 5th Azar Medical &amp; Educational Centre of Gorgan in 2021-2022. Patients were divided into two intervention groups (50 mg/kg of magnesium sulfate) and control group (5 μg/kg of clonidine) with permutation random block allocation. All patients underwent induced hypotension. Before induction of anesthesia and every 5 minutes afterwards, blood pressure was recorded. Blood loss volume was calculated at the end of the surgery. Results: In the magnesium group, 36 individuals were evaluated, while in the clonidine group, 24 individuals were examined. There were no statistically significant differences in baseline characteristics of patients in the two groups and the duration of surgery. Both drugs were equally effective in inducing hypotension, however blood pressure changes in magnesium group were more trivial than clonidine group. The bleeding volume in the magnesium sulfate and clonidine groups was 139.44 ml and 141.25, respectively and this difference was not statistically significant (p-value=0.634). Conclusion: The results of this study showed that magnesium sulfate can be effectively used as an alternative to clonidine in controlling hemodynamic changes and ultimately reducing blood loss volume during septorhinoplasty surgery. In addition, magnesium is at least as effective as clonidine in stabilizing hemodynamic changes.

Biomechanical and clinical evaluation of PSO, modified PSO and VCR treating OVCF kyphosis: a finite element analysis

ObjectiveTo confirm the effect of surgery on spinal column biomechanics and to provide theoretical support for the advantages and disadvantages of different surgical methods and their clinical efficacy.Methods33 continuous patients with no significant difference in risk factors related to the mechanical complications were enrolled in this retrospective study. Sagittal parameters were measured in the pre-, post-operative and following-up lateral radiograph of spine. An finite element (FE) model was created using CT scanning from a female volunteer with osteoporotic vertebral compression fracture (OVCF) with solely kyphosis. Pedicle subtraction osteotomy (PSO), vertebral column resection (VCR) and modified PSO(mPSO) for OVCF were simulated on FE model. Stress distribution and deformation of the FE model were measured.ResultsClinical - All differences in preoperative spinal sagittal parameters were not statistically significant. mPSO showed it is superior to PSO and VCR in multiple postoperative and following-up spinal sagittal parameters. The operation duration and intraoperative blood loss of mPSO are less than the other two. For postoperative mechanical complications, no statistically significant differences were observed. Biomechanical - Six operating conditions (flexion, extension, left/right bending, left/right twisting) for each post-operative FE model have been examined. In most conditions, the displacement of mPSO is similar to that of PSO, with both larger than that of VCR. All the maximum equivalent stress on the vertebral body is within the safe range. The stress is mainly distributed on the T10 vertebral body and the fixed vertebral body L2, while the stress of VCR is greater than that of mPSO and PSO. The intervertebral disc pressure is highest in VCR, followed by PSO, and lowest in mPSO under all conditions. The maximum pressure on the intervertebral discs is located between T10 and T11.ConclusionThe finite element analysis showed that mPSO has a similar spine stability to PSO, and possibly creates a better environment for bone-to-bone fusion and prevents adjacent segments degeneration. Combined with its less surgical risks, we believe that the modified pedicle subtraction osteotomy may be an appropriate strategy for indicated cases of OVCF.

Improved Gynecomastia Surgery: Power-Assisted Liposuction With Stab-Flatten Technique Without Resection.

Gynecomastia, the enlargement of male breast tissue, significantly impacts both physical and psychological health. Surgical intervention is often necessary, utilizing various techniques to reduce glandular and fatty tissue. This paper introduces an innovative surgical method combining power-assisted liposuction with the stab-flatten technique to enhance precision and cosmetic results. We present our clinical experience and evaluate its effectiveness in gynecomastia treatment. From June 2021 to January 2023, 128 gynecomastia patients underwent power-assisted liposuction and the stab-flatten method via a single axillary incision. We collected demographic and clinical data, including surgery duration, complications, and patient satisfaction regarding physical appearance, mental state, and social interactions. The BODY-Q questionnaire was used preoperatively and 3 months postoperatively for assessment. The study included 128 male patients, treating 252 breasts, with an average age of 35 years and a mean BMI of 27.7kg/m2. Most procedures were bilateral (96.9%), with an average fat removal of 224.5mL and a surgery duration of 147 minutes. The complication rate was low at 2.0%, with bruises in 5 breasts. The average hospital stay was 2 days. Significant improvements were noted in BODY-Q scores for appearance satisfaction and health-related quality of life, with increased appearance satisfaction and reduced appearance-related distress. Since June 2021, the combined use of power-assisted liposuction and the stab-flatten technique has been effective in managing gynecomastia. This synergistic approach not only achieves aesthetically pleasing outcomes but also minimizes the surgical risks associated with traditional methods.

Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in "Acute Obstructive Uropathy": A Critical Evaluation.

Aim: To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. Patients and Methods: Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. Results: A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (p < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% vs 7.3%). Conclusions: Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.

Comparison Between Oral and Intravenous Tranexamic Acid in Endoscopic Sinus Surgery

Background: The goal of this study is to assess oral and intravenous administration of tranexamic acid's (TXA) on intra-operative bleeding during endoscopic sinus surgery and to compare with control group. Methods: Forty-eight patients who were scheduled for endoscopic sinus surgery were chosen and randomly assigned to three groups. In first group 20mg/kg intravenous tranexamic acid, in second group 1000 mg 4 times daily for 48 hours and in third group 10 ml of normal saline were administered. The quality of the surgical field was estimated every 15 minutes by Boezaart scale. Volume of bleeding, pre and postoperative hematocrit, surgeon’s satisfaction by likert scale and duration of the surgical procedure were evaluated. Data was analyzed by SPSS v21 and P&lt;0.05 was significant. Results: Demographic parameters were not different among three groups. The surgical field quality at 15th minute was grade I-II in 25, 68.75 and 75 percent of the patients in the control, intravenous and oral groups, respectively. And also, no patients in the intervention groups and 42% of the patients in the control group were in grade IV. At 15 minute following surgery, there was a significant difference between the tranexamic groups and the control group (P = 0.002). at 30th minute 25, 50 and 56% of the patients in the control intravenous and oral groups, respectively were in grade I-II and difference was significant (P = 0.003). But at 45th minutes quality of surgical field was not different significantly (P = 0.163). The intraoperative average bleeding was 95.46, 94.32 and 190.64 ml for intravenous, oral and control patients that difference was significant (P = 0.001). The satisfaction of the surgeon was higher in the intravenous and oral TXA groups than the control group (P = 0.012). In comparison to the control group, the tranexamic group's surgical time were considerably lower (P 0.001). Hematocrits and drug side effects did not differ significantly among groups. Conclusion: Systemic tranexamic acid (intravenous or oral) during endoscopic sinus surgery enhances surgical field quality, decreases intra-operative hemorrhage, and shortens operation duration.

Comparison of robot-assisted vs. traditional laparoscopic sacral colpopexy for pelvic organ prolapse: Outcomes and quality of life

Background Pelvic organ prolapse is a prevalent condition affecting women of varying ages and ethnicities globally. The prevalence of pelvic organ prolapse is substantial, with estimates suggesting that up to 50% of parous women may experience some degree of prolapse during their lifetime. Objective This retrospective evaluation aimed to compare the outcomes of robot-assisted sacral colpopexy (RASC) and traditional laparoscopic sacral colpopexy (LSC) in the treatment of pelvic organ prolapse, focusing on surgical outcomes, postoperative pain, quality of life, complications, and recurrence rates. Methods A total of 138 patients treated for pelvic organ prolapse and undergoing sacral colpopexy from December 2021 to December 2023 were included in the study. The patients were categorized into two groups based on the procedure utilized: RASC or LSC. Demographic characteristics, surgical outcomes, postoperative pain scores, quality of life, complications, and recurrence rates were compared between the two groups. Results The demographic characteristics of the study population demonstrated comparable baseline profiles for the RASC and LSC groups. RASC was associated with shorter surgery duration, lower intraoperative blood loss, shorter operative time for apical prolapse repair, and significantly lower postoperative pain scores at 24, 48, and 72 h postoperatively compared to LSC. Additionally, patients undergoing RASC demonstrated significantly better quality of life across various domains compared to those undergoing LSC. There were no statistically significant differences in the incidence of complications between the two groups. Furthermore, the RASC group demonstrated consistently lower recurrence rates at 1, 2, and 5 years postoperatively compared to the LSC group. Conclusion Robot-assisted sacral colpopexy offers potential advantages over traditional laparoscopic sacral colpopexy in the treatment of pelvic organ prolapse, with favorable surgical outcomes, reduced postoperative pain, improved quality of life, comparable complication rates, and lower recurrence rates. These findings support the consideration of RASC as a promising surgical approach for addressing pelvic organ prolapse and provide valuable insights for informing clinical decision-making and refining the approach to pelvic organ prolapse treatment.

Vitrectomy With Short-Term Perfluorocarbon Liquid Tamponade for Retinal Detachment With Inferior Retinal Breaks and Proliferative Vitreoretinopathy.

Purpose: To assess and compare the results of pars plana vitrectomy (PPV) with short-term perfluorocarbon liquid (PFCL) tamponade and combined PPV with scleral buckling to treat rhegmatogenous retinal detachment (RRD) with inferior retinal breaks complicated by proliferative vitreoretinopathy (PVR). Methods: The medical records of patients who had vitreoretinal surgery for RRD with inferior retinal breaks complicated by PVR were reviewed. Group 1 had PPV with PFCL, and Group 2 had PPV with scleral buckling. Silicone oil tamponade was used in all cases of PPV with scleral buckling. The anatomic and functional outcomes and duration of surgery were compared between the 2 groups. Results: Group 1 comprised 48 eyes and Group 2, 36 eyes. No statistically significant differences were found in the demographic and baseline clinical characteristics between the groups (P > .05). The mean (±SD) duration of the initial surgery was 42.82 ± 15.25 minutes (range, 25-65) in Group 1 and 81.46 ± 37.48 minutes (range, 45-115) in Group 2. The difference was significant (P < .001). At the end of the follow-up period, recurrent RD occurred in 3 eyes (6.2%) in Group 1 and 2 eyes (5.5%) in Group 2, with no significant difference (P > .05). There was no significant difference between the groups in the mean best-corrected visual acuity or mean intraocular pressure at 6 months (P > .05). Seven eyes (14.5%) in Group 1 had anterior chamber cells and flares after the initial surgery. The inflammation resolved with topical steroid application. Conclusions: The results of PPV with PFCL are similar to those of PPV with scleral buckling for managing RRD with inferior retinal breaks complicated by PVR. Favorable anatomic and functional outcomes are maintained.

Utility of Surgical Apgar Score in Predicting Post-operative Complications After Whipple Procedure in Pancreatic Cancer Patients

AbstractAn intraoperative 10-point Surgical Apgar Score, based on estimated blood loss, lowest mean arterial pressure, and lowest heart rate, was developed and validated for predicting postoperative complications in patients undergoing vascular and general surgeries. We sought to estimate the ability of this metric to predict major postoperative complications in patients with pancreatic cancer undergoing the Whipple procedure. This is a prospective, observational, single-centre study involving adult patients undergoing the Whipple procedure, at a major tertiary cancer centre. All eligible patients undergoing Whipple surgery in our institute between March 2018 and October 2021 were included in the study. Demographic data, clinicopathological characteristics, comorbidities, intraoperative variables, and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest heart rate, and lowest mean arterial pressure. All the patients were followed up till 30 days postoperatively. Descriptive statistics and univariate and multivariate analyses were used as appropriate. The occurrence of major postoperative complications represented the primary outcome. A total of 253 patients were analyzed. The mean duration of surgery was 436 min. On statistical analyses, the occurrence of major postoperative complications was significantly associated with SAS ≤ 4 (OR = 8.00, 95% CI = 3.78–16.93, p = 0.000), use of intraoperative vasopressor (OR = 2.247, 95% CI = 1.312–3.846, p = 0.003), and body mass index (BMI) (OR = 1.074, 95% CI = 1.010–1.142, p = 0.022). However, we did not find any significant association between other demographic variables like age, comorbidities, duration of surgery, and preoperative s. albumin with the occurrence of postoperative complications. Lower SAS (≤ 4) is the most powerful predictor of postoperative complications in pancreatic cancer patients undergoing Whipple surgery. The score provides a simple and immediate means of measuring and communicating patient outcomes, using data routinely available in any setting.

Arcuate eminence distance to temporal bone outer table in the middle fossa repair of superior canal dehiscence.

To investigate the influence of arcuate eminence's distance to temporal bone outer table (AE-OT) on surgical outcomes following the middle fossa repair of superior canal dehiscence (SCD). We conducted a cohort study of consecutive repairs at a center between 2011 and 2022. AE-OT was measured on temporal bone CT imaging. Surgical outcomes were assessed with established metrics including Symptom Resolution Score (SRS), rate of Overall Symptom Improvement (OSI), and change in low-frequency air-bone gap (ΔLF-ABG) from pre- to post-surgery. Multivariable regression models assessing surgical outcomes were constructed with AE-OT as the primary predictor. Models adjusted for patient demographics, medical and surgical history, and follow-up duration. A total of 402 repairs were included. Mean AE-OT was 27.1mm (SD 2.1, range 20.8-33.9). Every mm increase in AE-OT was independently associated with a 14% reduction in odds of OSI (aOR 0.86, 95% C.I. [0.75, 0.98]) and a 4-point decrease in SRS (adj. β - 4.0 [- 6.9, - 1.1]) among frank dehiscences. AE-OT was also not associated with operative duration and ΔLF-ABG among both frank dehiscences and near dehiscences. Longer AE-OT predicted poorer symptomatic response but similar operative duration and audiometric improvementamong frank SCDcases.

Comparative Efficacy of Three Methods of Lumbar Interbody Fusion for Lumbar Degenerative Diseases in a Tertiary Public Hospital.

To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in the treatment of degenerative diseases of the lumbar spine. The data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 cases had Endo-PLIF, 36 patients received MIS-TLIF, and 43 cases underwent modified-TLIF. We compared several parameters among the three groups: operative duration; intraoperative blood loss; latent blood loss; intraoperative radiation dose; visual analog scale (VAS) score; Oswestry Disability Index (ODI); anterior protrusion angle of the intervertebral space; postoperative ambulatory time; postoperative duration of hospital stay; complications. The prevalence of interbody fusion was observed at follow-up. The operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified-TLIF (P <0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P <0.05). The VAS score and ODI of the three groups were satisfactory, but the low-back pain of patients in the Endo-PLIF group and MIS-TLIF group was less than that in the modified-TLIF group (P <0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the three groups (P >0.05). All three operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.

Preoperative skin asepsis in bovine surgery: an outcome-blinded 3-arm randomized clinical trial under non-sterile operating room conditions

BackgroundSurgical site infections (SSI) following clean abdominal surgery in cattle pose significant economic and welfare concerns. Preoperative skin asepsis aims to minimize microbial load over the surgical field before and throughout surgery to minimize its risk. While chlorhexidine (CHX) and povidone-iodine (PVI) are commonly used antiseptics for this purpose, our study introduces the so far unexplored use of octenidine (OCT) in veterinary surgery.MethodsWe compared in a single-center, prospective, randomized, outcome-blinded, 3-arm trial the effectiveness of an OCT-based protocol to CHX- and PVI-based protocols. Cattle aged 2 years or older, needing a clean standing flank laparotomy (e.g., exploratory laparotomy, right flank omentopexy, left flank abomasopexy), were eligible. Exclusion criteria comprised skin abnormalities, recent antibiotic use, or debilitating conditions with systemic involvement or distant site infections. Patients were randomized 1:1:1 with concealed allocation using unique identifiers. Skin bacterial reduction (immediate [IRF] and delayed [DRF] reduction factors), SSI rate, and wound scores were evaluated. Wound scores were rated on a 0 to 6 scale, considering the presence and severity of discharge and swelling.ResultsOut of 373 assessed cattle, 126 were included and randomized: PVI (n = 42), CHX (n = 41), OCT (n = 43). All protocols significantly reduced bacterial counts, with PVI exhibiting lower IRF. No significant differences were observed in DRF. The summer season and duration of surgical procedures had a negative impact on IRF and DRF in all groups, respectively. Nine of 118 patients (7.6%) with complete follow-up developed SSI. Higher wound scores were associated with development of SSI. Wound scores ≥3 at day 10 postoperatively predicted SSI with high sensitivity and specificity. Microbial flora in SSI included typical skin bacteria and opportunistic pathogens.ConclusionAll protocols met minimum FDA standards in reducing bacterial colonization. While limited by sample size and single-center design, this study confirms the OCT-based protocol as a valuable option for preoperative skin asepsis in clean abdominal bovine surgery.

Factors influencing surgical site infections and health economic evaluation in patients undergoing robot-assisted radical resection for colorectal cancer.

To investigate the incidence and factors influencing surgical site infections (SSIs) in patients undergoing robot-assisted radical resection for colorectal cancer and assess their health and economic impact on the patients and hospital. This retrospective case-controlled study comprised patients who underwent robot-assisted radical resection for colorectal cancer at a tertiary hospital in China. Information about baseline characteristics, perioperative details, postoperative SSI incidence, hospitalization costs, and follow-up was collected. Univariate and multivariate analyses were performed to identify the independent risk factors for SSI. Propensity score matching was used to evaluate the health and economic impacts of SSI on the patients and the hospital. The overall incidence of colorectal SSI in 546 patients undergoing robot-assisted radical resection for colorectal cancer was 11.72% (64/546). Intraoperative blood loss, duration of operation, preoperative absolute lymphocyte count, preoperative and postoperative serum albumin levels, tumor location, gender, history of radiotherapy or chemotherapy, surgical wound classification, and preoperative hypoalbuminemia levels were associated with SSI. Rectal cancer, male gender, and class 3 or 4 surgical wounds were identified as independent risk factors for postoperative SSI. SSI prolonged the hospital stay by 6.60 days, increased the patient's direct costs by 31,669.88 CNY, increased the economic burden by 3,262.38 CNY, and caused an indirect economic loss of 50,546.79 CNY for the hospital. Patients undergoing robot-assisted radical resection for colorectal cancer are at a high risk for SSI. SSI can prolong postoperative hospital stays and increase the economic burden for patients and hospitals.