Department Of Surgery Research Articles

Sleep Characteristics of Patients Admitted to Intensive Care Units after Major Abdominal Surgery

Purpose : The aim of this study was to investigate sleep parameters and architecture in patients admitted to the intensive care unit (ICU) on the day of abdominal surgery. Methods : A total of ten patients who underwent laparotomy under general anesthesia at the hepatopancreatobiliary surgery department of a general hospital in Busan, South Korea participated in this observational study. We measured total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep stages on their first night in the ICU using the WatchPAT300. Furthermore, we used nonparametric statistics to examine differences in postoperative sleep based on sedative administration. Results : The Median (IQR) TST for the participants was 399.50(263.80) minutes; the SE was 75.1 (30.4)%; the WASO rate was 27.8(30.6)%; and the WASO frequency was 5.50(8.50) times. Patients’ rapid eye movement (REM) sleep time was 114.31(87.88) minutes, with 55.8(11.9)% of N1, 18.2(5.3)% of N2, and 24.8 (11.7)% of N3 sleep stages. The sedation group had a longer TST (Z=-2.619, <i>p</i> =.008), higher SE (Z=-2.611, <i>p</i> =.008), lower WASO rate (Z=-2.611, <i>p</i> =.008), smaller number of WASOs (Z=-2.627, <i>p</i> =.008), and longer REM sleep (Z=-2.617, <i>p</i> =.008) compared to the non-sedation group. Conclusion : We observed a high rate of light sleep and awakenings during sleep in patients admitted to the ICU after surgery. Moreover, non-sedated patients lacked either deep or REM sleep. Sleep-improving interventions are needed for non-sedated surgical patients who are admitted to the ICU.

"The medicine is not something that interests me at all." Beliefs, health-related behaviors, and medication adherence in patients with symptomatic peripheral arterial disease

Abstract Background Despite evidence-based guidelines recommending secondary prevention with antithrombotics and lipid-lowering therapies, adherence to optimal pharmacological therapies remains suboptimal in patients with symptomatic lower extremity peripheral arterial disease (PAD), potentially contributing to excess morbidity and mortality. However, the behavioral factors and health beliefs underlying this behavior are still poorly understood. Purpose To explore the health-related behaviors and beliefs of patients with symptomatic PAD regarding secondary preventive therapy. Methods Using a qualitative design, we conducted individual semi-structured interviews with patients diagnosed with symptomatic PAD. Participants were recruited from four departments of vascular surgery in Denmark from December 2022 to January 2024. Data analysis was performed using framework analysis based on the six domains of the Health Belief Models1 (HBM) as analytical framework: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. The HBM is widely used for conceptualizing individual’s attitudes and beliefs to explain and predict health behaviours. Results Sixteen patients participated in the study: seven adherent and nine non-adherent patients. Based on the HBM components, the following findings emerged (Figure 1). Patients expressed low perceived awareness of the severity of PAD and its potential consequences, not recognizing PAD as a systemic condition associated with broader cardiovascular risk. The perception of PAD centered around the experience of excruciating leg pain and its impact on everyday life. This focus on symptoms affected the perceived benefits of secondary preventive therapies. Patients lacked knowledge about the importance and goal of treatment and did not link the secondary preventive therapy to PAD, often associating it only with other cardiovascular diseases. Barriers included inadequate understanding of the chronic progressive nature of PAD and its severity, experience and fear of side-effects, prescription confusion, pill burden, financial constraints, and allergies. Fear of recurring pain, complications, and early death served as strong internal adherence triggers. Paradoxically, despite expressing fear, some patients were only adherent to antithrombotic therapy, not assigning the same importance to statins. Other cues to action included practical arrangements as well as establishing a trusting patient-provider relationship and receiving comprehensive and logical explanations. Conclusions This study provided new perspectives on the multifaceted challenges hindering adherence to secondary preventive therapy among patients with symptomatic PAD. Notably, the insufficient knowledge regarding the chronic progressive nature of PAD and its cardiovascular implications, underscores the need for enhanced patient education and tailored interventions to ensure optimal secondary preventive therapy.Figure 1

Mid-regional pro-adrenomedullin is an independent predictor of cardiovascular outcomes in cardiac surgery, a prospective cohort study in 500 patients

Abstract Background MR-proADM (mid-regional pro-adrenomedullin) is a stable pro-peptide of Adrenomedullin, which is expressed in various cell types such as heart, lung, and renal tissue. It is a prognostic parameter for heart failure (HF) and sepsis as well as all-cause and cardiovascular (CV) mortality. Purpose Considering the characteristics of MR-proADM as a reliable biomarker for adverse events, we aimed to investigate the prognostic impact of MR-proADM in patients undergoing elective cardiac surgery. Methods We prospectively enrolled patients undergoing elective cardiac bypass and/or valve surgery at the department of cardiac surgery between May 2013 and August 2018. Blood samples were taken one day prior to surgery. MR-proADM was measured using an automated immunofluorescence assay. Patients were followed prospectively until endpoints were reached. The primary endpoint was the composite of hospitalization for heart failure (HHF) or CV mortality, the secondary endpoint was postoperative atrial fibrillation (POAF). The multivariate regression model was adjusted for age, sex, NT-proBNP, type of surgery, and CRP-level at baseline. Results A total of 500 patients (146 female [29.2%]; median age 69.8 years [IQR 60.6-75.5]) were followed over a median of 4.6 years (IQR 3.0–5.8). Valve surgery was performed in 214 (42.8%) patients, 160 (32%) underwent a bypass operation and 126 (25.2%) a combined valve and bypass surgery. The median MR-proADM value of the entire study population was 0.58 nmol/L (IQR: 0.44-0.79 nmol/L). Patients were stratified in risk categories based on their MR-proADM values (Low Risk ≤0.63nmol/L, Intermediate Risk 0.63-0.83nmol/L, High Risk >0.84nmol/L). Patients in the highest category presented with higher rates of diabetes mellitus (p <0.001), COPD (p <0.001), HF (p=0.009) and either bypass surgery (p=0.039) or the combination of bypass and valve surgery (p=0.008), compared to patients in the lowest tertile. We observed a significant increase in 5-year’s event rates for HHF/ CV Mortality in patients in higher risk groups (Low Risk 8.6% vs High Risk 37.7%, p <0.001, Figure 1). The adjusted Cox regression model found that MR-pro ADM was independently associated with a risk increase for HHF/ CV Mortality (adjusted HR of 4.45, 95% CI 2.55-8.09; p<0.001, Figure 2) comparing the High Risk to the Low Risk Group. A comparable risk increase could be observed in POAF, with an adjusted HR of 2.61 (High Risk Group vs Low Risk Group, 95% CI 1.46-4.67, p<0.001). Conclusion Within the prospective investigation, MR-pro ADM was found to be an independent predictor for HHF and CV mortality in patients undergoing cardiac bypass and/or valve surgery. Furthermore, there was a consistent predictive potential for POAF. In the era of personalized medicine, preoperative MR-pro ADM levels could help to identify patients at risk for serious adverse events, in order to apply intensified secondary prevention and reduce mortality and morbidity.

Association between Clinical Features and Risk Factors for Breast Cancer through a Cross-Sectional Study

Introduction: Breast cancer was responsible for 685,000 deaths worldwide in 2020. Approximately half of all breast cancers arise in women who have no identifiable risk factors other than their gender and age. Objectives: The goal of this study was to determine the association between clinical features and breast cancer risk factors. Methods: This cross-sectional study was conducted among 50 histologically confirmed breast cancer patients included by purposive sampling technique in the Surgery Department of Rangpur Medical College, Rangpur. Results: The presence of breast lump was significantly associated with the residence of patients (p value<0.011). The significant association between nipple retraction and family history may indicate a hereditary predisposition that affects the course of the disease (p value<0.031). Conclusion: This research provides insights into vital aspects of breast cancer within a particular demographic, under scoring the necessity for focused approaches to public health to address the discrepancies in breast cancer presentation and outcomes. J Bangladesh Coll Phys Surg 2024; 42: 321-328

Prevalence of tinnitus in temporomandibular joints disorder patients

BackgroundDisorders affecting the temporomandibular joint (TMJ), related structures, and the masticatory muscles are called temporomandibular disorders (TMD). The two most typical symptoms are mouth opening restriction and pain. Costen noted the connection between TMD and tinnitus in 1934. These conditions are brought about by the shared structures that connect the TMJ and the auditory apparatus (bones and muscles) through a shared innervation source and specific ligaments. Wright addresses Costen ideas, which suggest that otological symptoms of TMD could be caused by auriculotemporal nerve damage, Eustachian tube restriction, or other factors causing an incorrect intratympanic pressure adjustment.MethodsCross-sectional observation was regulated at Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University. The following are the inclusion criteria: patients with a TMD diagnosis and those older than 16 years old. The following conditions are excluded: neurological or oncological disorders, ear infection, and a history of face trauma.ResultsThe total number was 196 patients, 63.8% females and 36.2% males. A total of 76.5% had bilateral joint pain, and 21.9% had unilateral joint pain. While 70.4% had bilateral muscle pain, 18.9% had unilateral muscle pain. A total of 91.8% had mild tinnitus, while 8.2% had moderate tinnitus.ConclusionIn this study, 8.2% of patients complaining of tinnitus had severe tinnitus, while 91.8% had mild tinnitus.

Relative contribution of imaging techniques for the contemporary diagnosis of infective endocarditis: a single-center experience

Abstract Introduction In developed countries, the incidence of infective endocarditis (IE) is up to 6 cases per 100,000 individuals and in-hospital mortality rates are reported to reach 30%. The diagnostic recommendations for IE have been revised in the new ESC guidelines emphasizing the use of transesophageal echocardiography (TEE) and advanced imaging techniques (computed tomography [CT], magnetic resonance [MR], positron emission tomography [PET] and white blood cell scintigraphy [WBC-SPECT]). Aims This research aims to investigate the practical applicability of established clinical guidelines in a real-world population with suspected IE. Methods We reviewed the hospital database from 06/2021 to 06/2023 using the international classification of disease codification (ICD-10) for IE. Only patients admitted to Cardiology or Cardiac Surgery departments were included. Diagnosis of IE was defined according to the modified Duke criteria. Firstly, we identified individuals in whom diagnosis was performed by clinical presentation, blood cultures and transthoracic echocardiogram (TTE). Subsequently, we identified those who required further imaging diagnostic investigation. Results A total of 63 patients were included [mean age 64 ±14 years; 76% male (n=48)]. Native IE was diagnosed in 53 (84%) patients, prosthetic IE in 7 (11%) and cardiac implantable electronic devices-related IE in 3 (5%). A total of 26 (41%) patients had at least one predisposing risk factor, 48 (76%) presented with fever, 24 (38%) suffered an embolic event and 1 (2%) had an immunological phenomenon. Out of 49 positive blood cultures (78%), typical microorganisms consistent with IE were isolated in 25 (78%) of samples: 13 (34%) staphylococcus aureus, 10 (26%) oral streptococci, 9 (24%) enterococcus faecalis, 5 (13%) streptococcus gallolyticus and 1 (3%) HACEK group. Overall, in 22 (34%) patients, a definitive diagnosis of IE was established by means of clinical presentation, blood cultures and TTE. In the remaining, TEE was performed in 86% (n=36). Of those, a definite diagnosis was established in 52% (n=22). Brain and whole-body imaging upgraded the diagnosis from possible to definite in 3 (5%) patients. In the one patient in which a comprehensive clinical evaluation including TTE and TEE rejected IE, the diagnosis was ultimately established by means of PET. The median time from admission to the definite/possible diagnosis of IE was 6 (IQR 2-17) days. A total of 47 (75%) patients underwent surgery, with the most frequent indications being heart failure 46% (n=21) and uncontrolled infection 28% (n=13). Time from diagnosis to surgery was 10 (2-19) days, hospital length of stay was 45 (35-70) days and in-hospital mortality 21%. Conclusion Clinical presentation, blood cultures and TTE plus TEE established the definite or possible diagnosis of IE in most patients with suspected IE. Advanced imaging techniques allowed the establishment of definite diagnosis in only 6% of patients.

Pancreaticogastrostomy: A Safe and Effective Reconstruction Method After Pancreaticoduodenectomy: A Short Observational Study

Background: Pancreaticoduodenal resection is usually performed in patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla and occasionally for chronic pancreatitis.The mortality following pancreaticoduodenal resection has fallen and is now below 5% 1-6 .However, leakage from the anastomosis between pancreas and the jejunum has been and remains, one of the most worrying complications of the operation. The data from papers published in the last 8 years show that the incidence of pancreatic leak is 14% and the mortality of this complication 24%3,4,6-16 .Pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy in the reconstruction following Whipple's operation. Aim: The aim of the study was to observe pancreaticogastrostomy is a potentially safer alternative to pancreaticojejunostomy after pancreaticoduodenectomy. Methods: This prospective observational study was conducted at the Department of Surgery in Shaheed Suhrawardy Medical College Hospital, for One year (August 2021 to July 2022). Patients with a localised small carcinoma in the head of the pancreas, at the lower end of the common bile duct or at the ampulla, and occasionally for chronic pancreatitis admitted in the department of surgery were approached for inclusion in the study. Total 41 patients were selected according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients underwent pancreaticogastrostomy. Detail clinical and demographic history was taken along with thorough physical examination relevant investigations. All patients were evaluated preoperatively and post operatively at discharge, 1 month and 3 months. Outcome was assessed post operatively. Collected data were checked and analysed in SPSS 23. Results: Two patients died within 30 days of the operation (mortality 4.9%), one from perioperative haemorrhage and another from septicaemia due to a biliary infection, which may have resulted from preoperative transhepatic biliary drainage. Both operations were carried out for carcinoma of the head of the pancreas. One patient developed a biliary leak which closed in 6 days. A postoperative pancreatic leak occurred in one patient with carcinoma of the ampulla; the fistula closed after 5 mdays, and did not delay his discharge from hospital. This patient remains well 36 months after operation, although he has now developed mild diabetes.One other patient developed diabetes mellitus postoperatively. This woman had evidence of obstructive pancreatitis at operation. She died 6 months later of recurrent carcinoma of the head of the pancreas. One patient with chronic pancreatitis has uncontrolled steatorrhoea, with up to four bowel movements a day. Four other patients take regular pancreatic supplements together with H2 receptor antagonists in order to maintain normal defaecation. There has been no case of stomal ulceration. None of the patients were lost to follow-up. The median survival for patients operated on for carcinoma of the head of the pancreas was 13 months, and for patients with carcinoma of the bile duct, 14 months. Median survival of patients with ampullary carcinoma was 38 months. Conclusion: Seventy two percent of patients had good outcome after Pancreaticogastrostomy(PG). Significant relief in symptoms of pain were noted after PG. Further larger study is recommended to validate this findings. J Shaheed Suhrawardy Med Coll 2023; 15(1): 66-72

Efficacy of Autologous Platelet Rich Plasma For Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer (DFU) is a common complication of long standing uncontrolled diabetes mellitus. There are different types of treatment commonly practiced among the clinicians to treat DFU. Among them, autologous platelet rich plasma (PRP) application is getting popularity day by day throughout the western world. Methodology: It was a prospective, randomized, controlled study that was carried out among 40 DFU patients in the Department of Surgery, Dhaka Medical College Hospital. Among them, 20 patients were treated by autologous PRP and another 20 patients were treated by conventional method. They were followed up for 12 weeks period. Data collected from the participants were analyzed to compare the healing rate among two groups. Result: In PRP treated ulcers, healing rate was significantly faster and better in comparison to conventionally treated ulcers. After 10th weeks follow up, in PRP group 14 ulcers were completely healed whereas in control group,4 ulcers were completely healed. On the contrary, 3 ulcers in control group showed further deterioration. At the end of 12th weeks follow up, 19 ulcers in PRP group were completely healed whereas 13 ulcers in control group were completely healed. In PRP group no patient showed any complication during treatment, whereas in control group 7 patients experienced local complications. Conclusion: Treatment of diabetic foot ulcer with autologous platelet rich plasma results in faster and better ulcer healing in comparison to conventional treatment. PRP accelerates the healing rate and keep the ulcer area safe from external pathogens. Hence, autologous PRP is a better selection for DFU treatment. J Dhaka Med Coll. 2023; 32(1) : 38-42

Treatment Outcome of Surgery Followed By Corticosteroid Therapy For Idiopathic Granulomatous Mastitis

Introduction: Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic inflammatory breast condition that has been shown to have radiological and clinical similarities to breast cancer. In spite of the fact that the cause of IGM is unknown, various contributing variables have been identified, such as a reaction to chemical substances like OCP, viral disorders, autoimmune diseases, and an immunological response to milk leakage from the breast lobule. Although various methods have been used for IGM treatment (such as surgical excision, steroids, methotrexate, etc), no consensus currently exists regarding the ideal method of treatment. Due to its positive response to steroid treatment, it is hypothesized that IGM is an autoimmune disease and is well responds to corticosteroid therapy. The aim of this study is to observe the treatment outcomes of surgery and corticosteroid therapy in IGM. Materials and Methods: This quasi experimental study was conducted in Department of Surgery, Khulna Medical College Hospital from 8th August 2018 to 8th August 2019. Total 30 patients were enrolled and allocated in two groups a ratio of 1:1. In group-A there were 15 patients, received surgical treatment with corticosteroid therapy and group-B, 15 patients received only surgical treatment. A wide local excision (WLE) was done in surgical procedure to remove area of diseased unhealthy tissue with a margin of normal tissue. Corticosteroid therapy was given orally in the following regimen: 8 weeks of steroid therapy with prednisolone at 0.5mg/kg/day for 4 weeks and then tapered down slowly for 4 weeks. Then subsequent follow up conducted after 2 months and after 4 months of primary treatment to observe the treatment outcomes. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). A descriptive analysis was performed for all data. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. Unpaired student t-test was used to compare continuous variables. Chi-square test used to compare categorical data. A “p” value of <0.05 was considered as significant. Result was presented by tabulation and graphical presentation in the form of tables, pie chart, graphs, bar diagrams, histogram & charts etc. Result: Maximum numbers of patients (50.0%) were between 31-40 years age group, mean±SD age was 29.7±10.2 years. The left breast was affected in 16(53.3%) patients, right breast in 12(40.0%) patients and bilateral in 2(6.7%) patients. Included 30 patients were allocated in two groups. Among them in group-A there were 15 patients (Surgical treatment with corticosteroid therapy) and group-B, 15 patients (Surgical treatment alone). Wide local excision was performed in all patients. Concomitant corticosteroids therapy was used in selective group (group-A). Study shows that 22(73.3%) of the patients recovered completely (80.0% versus 66.7% in group-A and group-B respectively). There was a statistically significant difference (pd”0.05). Present study revealed that incidence of complications and recurrence rate was 8(26.7%) patients, among them 3(20.0%) were of group-A, while 5(33.3%) patients were group-B. Conclusions: Present study concluded that treatment outcomes of surgery, followed by corticosteroid therapy can be preferred at Idiopathic granulomatous mastitis (IGM) in the means of less early or late postoperative complication, resolution of symptoms with high accuracy rate to relief symptoms. J Dhaka Med Coll. 2023; 32(1) : 71-76

Outcome of Transanal suture haemorrhoidopexy and Stapled haemorrhoidopexy -A prospective observational study

Background: Transanal suture haemorrhoidopexy is the preferred treatment due to its low cost, less post operative complication and decreased chance of recurrence in grade II and grade III Hemorrhoids. Objective: To compare the post-operative outcome of transanal suture haemorrhoidopexy and stapled haemorrhoidopexy in patients with grade II and III haemorrhoids. Methods: This study was conducted in the Department of Colorectal Surgery, Shaheed Suhrawardy Medical College hospital over a period of one-year. Sixty-two patients with haemorrhoids were enrolled in this study according to selection criteria. Data were collected, compiled and tabulated according to key variables. Qualitative data were expressed as frequency with percentage and quantitative data as mean with standard deviation. Quantitative data were analyzed by student’s t-test and qualitative data by Chi-square test. Data were processed and analyzed by using software SPSS 22.0. For all analyses p-value <0.05 was considered statistically significant. Result: Mean age of the patients was 49.38 ± 7.17 years and 52.45 ± 6.17 years in Stapled hemorrhoidopexy and Trans anal suture hemorrhoidopexy group respectively (p>0.05). Males were predominant in both the two groups. In stapled hemorrhoidopexy group, grade of hemorrhoids was II (51.6%) and III (48.4%) whereas in Transanal suture hemorrhoidopexy group, grade of hemorrhoids was II (38.7%) and III (61.3%) (p>0.05). Operative time was lower in Stapled hemorrhoidopexy (26.93 ± 1.59 min) than Transanal suture hemorrhoidopexy (27.74 ± 1.63 min). Per operative bleeding was found more in stapled group. Most of the patients stayed in the hospital only one day in both the two groups. Only four patients in Stapled hemorrhoidopexy group and one patient in Transanal suture hemorrhoidopexy group stayed more than one day. Post-operative pain according to VAS was lower in Stapled hemorrhoidopexy group (1.90 ± 0.54) than Transanal suture hemorrhoidopexy group (2.09 ± 0.30) after 24 hours of the surgery. But there was no significant difference in pain after 7 days of surgery between the two groups. Post-operative complications were more in stapled hemorrhoidopexy than Trans anal suture hemorrhoidopexy, but not statistically significant. Recurrence (bleeding & prolapse) found more in stapled group than suture hemorrhoidopexy group. Treatment cost was significantly lower in trans anal suture hemorrhoidopexy. Conclusion: Based on this study, transanal suture hemorrhoidopexy showed less intra and post-operative hemorrhage, shorter duration of hospital stay, lower post-operative complications, and lower recurrence rate when compared to stapled hemorrhoidopexy. However, these differences were not statistically significant. The only statistically significant difference was in the operative cost, which was in favor of transanal suture hemorrhoidopexy. J Shaheed Suhrawardy Med Coll 2023; 15(1): 45-49

Association of Tobacco With Neck Node Metastasis In Supra-Glottic Carcinoma of Larynx

Background: Carcinoma larynx is one of the most common cancers in the head neck region. Mortality and morbidity in this disease is still high in spite of modern treatment modalities. Smoking and Alcohol is recognized as common predisposing factor for carcinoma larynx. Neck node metastasis increases the mortality twice than the primary alone. Most of the Laryngeal carcinoma patient with neck node metastasis are smoker in our country. Stopping the consumption of tobacco may reduce both mortality and morbidity of carcinoma larynx. Metastasis is more common in supra-glottic carcinoma of larynx. This study is carried to observe the association of tobacco with lymph node metastasis in supra-glottic carcinoma of larynx. Materials and Methods: This cross sectional study was conducted in Otolaryngology and head Neck surgery department of Dhaka Medical College and Mitford Hospital of Dhaka, Bangladesh from June 2013 to June2015 .212 cases of supra-glottic carcinoma age ranging from 35 year to 90 years (mean age 63.6 ±11.65) was included in this study. Results: Sixty two percent patients were diagnosed with cervical lymph node metastasis. 83.28% patients with nodal metastasis were above 60 years of age and 75.67% patients were manual worker.100% node positive patients were smoker. Smoking for longer period (>30yrs) and higher in number (>30 sticks/day) were found in advanced stage. Significant association was found between site, size, macroscopic features, cellular differentiation and demographic factors of patient with neck node metastasis in supra-glottic carcinoma larynx. Conclusion: As neck node metastasis significantly reduces prognosis so we must be more attentive towards factors that increase the chance of nodal metastasis to avoid the advancement of the disease. J Dhaka Med Coll. 2023; 32(1) : 51-56

A Project Model to Evaluate the Feasibility of the Cognizant Flow Source

This work discussed a project being steered in Cognizant, India for the design, development and implementation of Cognizant Flowsource. Flowsource is an AI-powered, incorporated full-stack platform that accompanies in the succeeding generation of engineering. The IT solution allows quicker innovation by integrating generative AI hooked on vital phases of the software development lifecycle (SDLC), allowing developers to concentrate on rich features and incomparable user experiences (cognizant.com). Initially the researcher applied the Critical Path Method (CPM) to evaluate the feasibility of the project and this was complemented later by developing a Project Evaluation Review Technique (PERT) model. The work also presented costs calculations to determine the applicability of the project. The research reports how the Flowsource development project is being managed by the operations department of the company and suggests alternative manners of solving problems identified in the development of the IT solution.

COMPARATIVE STUDY ON OUTCOME OF OPEN FISTULECTOMY VERSUS LIFT PROCEDURE FOR UNCOMPLICATED PERIANAL FISTULAS

Perianal fistulas, particularly trans sphincteric types, pose a significant challenge in terms of management, often requiring surgical intervention. Traditional open fistulotomy has been a common procedure, but newer techniques like the ligation of the intersphincteric fistula tract (LIFT) procedure are being explored for improved outcomes, particularly in terms of preserving continence. This study aims to compare the outcomes of open fistulotomy versus the LIFT procedure in patients with trans sphincteric perianal fistulas. Objective: To compare the clinical outcomes, healing times, recurrence rates, and continence status between patients undergoing open fistulotomy and those treated with the LIFT procedure for trans sphincteric perianal fistulas. Methods: A prospective comparative study was conducted in the General Surgery Department of Nishtar Medical Hospital, Multan, from May 2024 to August 2024. A total of 150 adult patients with trans sphincteric perianal fistulas were enrolled using consecutive sampling. The patients were randomly divided into two groups: Group A (n = 75) underwent the LIFT procedure, and Group B (n = 75) underwent fistulectomy. Postoperative follow-up was conducted weekly until wound healing and at three months after healing to assess pain scores, recurrence rates, healing time, and continence status. Statistical analysis was conducted using SPSS Version 25, with a significance level set at p < 0.05. Results: Among the participants, 6 patients (8%) in Group A and 8 patients (10.7%) in Group B experienced recurrent fistulas, showing no significant difference between the groups. Postoperative pain scores were similar between both groups. However, the healing time was significantly shorter in Group A (27.2 days) compared to Group B (48.1 days) (p < 0.05). Recurrence rates were higher in Group A (16%) compared to Group B (2.7%) (p < 0.05). Incontinence was observed in 10.7% of patients in Group B, while no incontinence was reported in Group A (p < 0.05). Conclusion: The LIFT procedure offers better outcomes in terms of continence preservation and shorter healing time compared to open fistulotomy in the management of trans sphincteric perianal fistulas. However, open fistulotomy showed lower recurrence rates. These findings suggest that the LIFT procedure may be preferable in patients for whom preserving continence is a priority, while open fistulotomy may be a better option in cases where recurrence prevention is the main concern.

Preliminary application results of laparoscopic assisted proximal gastrectomy λ-shaped double tract anastomosis

Objective: To share the results of laparoscopic assisted proximal gastrectomy λ- shaped modified double tract reconstruction. Method: This study retrospectively included 3 patients during January 2024 from the Department of Gastric Surgery at the First Affiliated Hospital of Nanjing Medical University using the λ-shaped modified double tract reconstruction. The procedure of the λ-shaped modified double tract reconstruction is as follows. After completing proximal gastrectomy, the jejunum is transected 15 cm from the Treitz ligament. A suture is made 18-20 cm from the distal jejunum to mark the esophagojejunal anastomosis site. A circular stapler anvil is inserted through the distal jejunum, and the remaining end of the jejunum is turned to the right. The circular stapler is pierced through the marked site for an esophagojejunal end-to-end anastomosis, which is reinforced with a barbed suture continuously. A 60mm linear stapler is used to close the remaining end of the jejunum. We then mark the gastric side of the gastrojejunal anastomosis with suture in the middle of the anterior wall of the residual stomach, and mark the jejunal side of the gastrojejunal anastomosis at a distance of about 2 cm and 8 cm from the residual end of the distal jejunum. We make an opening of about 0.5 cm and use a 60 mm linear stapler to perform anastomosis on the jejunal side of the anterior wall of the residual stomach according to the markings, so that the distance between the esophagojejunal anastomosis and the gastrojejunal anastomosis is 10-12 cm. The common opening is closed with barbed wire. About 50 cm below the esophagojejunal anastomosis, the small intestine opening is anastomosed side to side using a circular stapler and the common opening is closed. Return the jejunum into the abdominal cavity to complete the reconstruction of the λ-shaped double tract reconstruction. We analyzed the surgery and postoperative conditions, including surgery time, anastomosis time, intraoperative bleeding, tumor size and pathology, postoperative mobilization, passage of gas and water intake time, discharge time, postoperative complications, and postoperative gastrointestinal imaging to observe the passage of food through the gastric and intestinal loops. Results: Three patients successfully received laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction. The surgical time was 155 minutes, 240 minutes, and 160 minutes, respectively; The postoperative time for first ambulation was 20 hours, 18 hours, and 26 hours, respectively. The time for passage of gas was 59 hours, 83 hours, and 75 hours, respectively. The drinking time was 66 hours, 87 hours, and 90 hours, respectively. The postoperative discharge days were all 7 days. No surgical related complications occurred. On the 6th day and 3 months after surgery, gastrointestinal angiography was performed. The contrast agent passed smoothly through the jejunal loop and residual stomach jejunal loop, and both sides were unobstructed. No contrast agent was found to retrograde to the esophagojejunal anastomosis. Conclusion: Laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction is safe and feasible, as it improves the diversion of food through the residual stomach while ensuring anti-reflux effects.

The efficacy of preemptive multimodal analgesia in elderly patients undergoing laparoscopic colorectal surgery: a randomized controlled trial

Objective To evaluate the effectiveness of preemptive multimodal analgesiain elderly patients undergoing laparoscopic colorectal surgery. Methods A prospective randomized controlled study was conducted in the Department of Gastrointestinal Surgery of the Second Hospital of Hebei Medical University from January 2022 to December 2022. A total of 133 patients were included according to the criteria and randomly divided into preemptive analgesia (PRA) group (test group, 67patients) and postoperative analgesia (POA) group (control group, 66patients). Results The Visual Analog Scale (VAS)scores of PRA group 24 h, 48 h, and 72 h after operation were lower than those of POA group, and the difference was statistically significant, P < 0.001.The incidences of postoperative gastrointestinal dysfunction (POGD) and postoperative delirium (POD)in PRA group were 13.43% and 8.98%, respectively, which were significantly lower than those in POA group (31.82% and 24.24%), P < 0.05. The levels of IL-6 and IL-10 in PRA group after the operation were 17.54 ± 2.13 ng/L and 15.57 ± 1.71 ng/L respectively, which were lower than those in POA group (25.45 ± 2.95 ng/L and 23.45 ± 1.88 ng/L), P < 0.05. The level of acetylcholinesterase(AchE) was 56.34 ± 5.62 nmol/L in the POA group, which was significantly higher than that in the POA group (49.59 ± 5.52 nmol/L), P < 0.001. Conclusion Preemptive multimodal analgesia can reduce the incidence of POGD and POD in elderly patients undergoing laparoscopic gastrocolic surgery, improve the recovery process of postoperative gastrointestinal function, increase the concentrations of propionic acid and butyric acid in short chain fatty acids (SCFAs) and the number of beneficial intestinal bacteria.

Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome.

Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release. A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed. 20 patients met the inclusion criteria and underwent either laparoscopic (n = 3) or robotic (n = 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90-290) vs. 125 (80-254); p = 0.765), the median length of hospital stay (days: 4 (3-4) vs. 5 (3-6); p = 0.179) and intraoperative blood loss (< 50ml in both groups, p = 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200-765) vs. 167 (100-500), p < 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis. Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.

Perioperative Nutritional Support Case Study for a Patient Undergoing Gluteus Maximus Flap Transfer Surgery for Pressure Ulcer

Pressure ulcers are caused by prolonged pressure on local tissues, leading to continuous ischemia, hypoxia, and malnutrition, resulting in tissue necrosis. Patients with pressure ulcers often experience varying degrees of malnutrition due to gut flora imbalance and a hypercatabolic state. This paper documents the case of a patient with a sacral pressure ulcer admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Qinghai University on November 28, 2023. Clinical nutrition treatment began on the second day of admission, including dietary guidance and enteral nutrition intervention. The patient's nutritional status gradually improved, leading to a successful recovery. By reviewing the nutritional treatment process and clinical outcomes, this case study provides valuable insights into the nutritional management of pressure ulcer patients.

Distraction osteogenesis in the treatment of transverse malocclusions in children

Relevance. Malocclusions accounts for 37% to 89% of all maxillofacial conditions in children aged 3 to 18 across various regions of Russia. These malocclusions can present as isolated issues in a single plane or as combined anomalies across multiple planes. Jaw narrowing or underdevelopment is influenced by various endogenous and exogenous factors. The choice of treatment depends on the severity of the malocclusion. While literature indicates several effective methods for treating transverse malocclusions, some aspects remain insufficiently explored.Materials and methods. A statistical analysis was conducted on 271 patient records of individuals with transverse malocclusions who received treatment in the Department of Pediatric Maxillofacial Surgery at A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of the Russian Federation, between 2013 and 2023.Results. There was an almost equal distribution of patients by gender, with a noticeable increase in medical consultations from 2013 to 2023. The majority of surgically treated patients were between 15 and 17 years old. Isolated transverse malocclusions were significantly less common than cases combined with other pathologies, with mesial occlusion being the most frequent comorbidity.Conclusion. The findings demonstrate a significant need for surgical treatment in pediatric patients with transverse malocclusions through distraction osteogenesis. This underscores the importance of continually improving treatment methods for children, including enhancing diagnostics, refining treatment indications, optimizing distraction protocols, and adjusting treatment courses. These efforts aim to improve the quality of rehabilitation for children, ensuring better outcomes into adulthood and facilitating their social adaptation.

Analysis of long-term efficacy of CO2 laser partial excision of vocal folds for 599 cases in the treatment of vocal cord leukoplakia

Objective: To analyze long-term prognosis and influencing factors of recurrence in vocal fold leukoplakia treated by endoscopic cordectomy with CO2 laser. Methods: A retrospective review was conducted on 599 patients with vocal fold leukoplakia [566 males and 33 females, aged 17-84 years (median age 55 years)], undergoing endoscopic cordectomy by CO2 laser under general anesthesia at the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital, Capital Medical University, from January 2000 to December 2023. The study analyzed the clinical features, pathological grade, surgical methods, postoperative voice function, recurrence, malignant changes and analyzed the long-term efficacy and and its influencing factors. The patients were followed up for a duration of 6-249 months postoperatively, with a median follow-up time of 48 months. SPSS 20.0 software was used for statistical analysis. Results: Among the 599 patients, the histopathological grades included simple squamous cell hyperplasia in (n=264, 44.08%), mild dysplasia (n=96, 16.03%), moderate dysplasia (n=74, 12.35%), severe dysplasia(n=43, 7.81%), carcinoma in situ(n=35, 5.84%), and carcinoma in situ with microinvasion(n=87, 14.52%). The 3-year and 5-year overall recurrence rates were 12.91% and 16.00%, respectively. In patients with precancerous lesion, 3.91% of recurrences presented with an upgraded pathologic grade and 2.34% evolved into carcinoma. The risk of recurrence was higher in lesions involving the anterior commissure, larger lesions, significant reduction/absence of mucosal waves, neovascularization/suspected neovascularization, and pathology of dysplasia/carcinoma in situ/carcinoma in situ with microinvasion(F=44.76,21.54,11.55,8.78,23.20,respectively,P<0.05). Additionally, patients with recurrent disease exhibited higher reflux symptom index scores compared to those without recurrence. Exophytic lesion characteristics and the inability to cease smoking postoperatively were identified as independent risk factors for recurrence with an upgraded pathological grade, with odds ratios of 8.675 and 11.380 times greater than those with non-exophytic lesions and successful smoking cessation, respectively. At the 6-months postoperative assessment, patients who underwent subepithelial cordectomy (typeⅠ) demonstrated a statistically significant increase in fundamental frequency (t=-3.38, P<0.05), and while other voice acoustic parameters were not significantly different.Conversely, those who underwent transmuscular cordectomy (TypeⅢ) exhibited significant alterations in multiple voice acoustic parameters when compared to preoperative values (P<0.05). Furthermore, postoperative vocal fold adhesions developed in 84 patients with 13 of these individuals requiring surgical intervention for adhesion release. Conclusions: Lesions involving the anterior commissure, larger lesions, pathology of dysplasia/carcinoma in situ/carcinoma in situ with microinfiltration, significant reduction/absence of vocal fold mucosal waves, and neovascularization visible under NBI are indicative of an increased risk of recurrence, whereas exophytic lesions and the inability to cease smoking postoperatively significantly increase the risk of recurrence with elevated pathologic grade. Recovery of postoperative voice quality is procedure-dependent, underscoring the importance of surgical approach selection in the management of vocal fold leukoplakia.

Development of a diversity and inclusion taskforce in the department of surgery

Development of a diversity and inclusion taskforce in the department of surgery