Surgery Research Articles

Novel Minimally Invasive Surgical Approaches to Endometriosis and Adenomyosis: A Comprehensive Review

Endometriosis and adenomyosis are chronic gynecological conditions that significantly impact women’s quality of life, leading to symptoms such as pelvic pain, dysmenorrhea, and infertility. Despite ongoing research, a definitive cure for these conditions remains elusive, and treatment often focuses on managing symptoms. Minimally invasive surgery is considered the gold standard for surgical management, but novel surgical techniques are continuously being developed to enhance outcomes. These innovations aim to reduce disease recurrence, improve fertility rates, and provide better long-term symptom relief. In addition, techniques like robot-assisted laparoscopy (RAS) have revolutionized the treatment of complex cases, such as deep infiltrating endometriosis (DIE), offering improved precision and effectiveness. This review explores the latest advancements in surgical approaches, their clinical efficacy, and future directions, emphasizing the need for individualized multidisciplinary care to optimize patient outcomes.

UNVEILING THE VEIN

Cerebrospinal fluid (CSF)-venous fistula represents a formidable yet often overlooked neurosurgical dilemma. Despite its disabling consequences, it remains significantly underdiagnosed. This abstract sheds light on the clinical intricacies, diagnostic challenges, and therapeutic interventions associated with CSF-venous fistula. Early diagnosis is paramount, yet hindered by its rarity and diverse and often unspecific clinical presentations. The importance of heightened awareness among clinicians and radiologists for timely detection and management cannot be overstated. This presentation will draw upon a review of clinical cases operated in the Royal Hallamshire Hospital, supplemented by a concise surgical video which is focused on surgical technique and benefit of microscope mediated augmented reality.

Effectiveness and Personalized Approaches in the Correction of Gummy Smile: A Systematic Review of Orthodontic and Surgical Treatments

Background/Objectives: This systematic review seeks to assess the effectiveness of different orthodontic and combined orthodontic–surgical approaches for correcting gummy smile, with a focus on treatment efficacy, duration, and the potential for integrating various techniques. The objective is to offer evidence-based recommendations for the optimal management of gummy smile. Methods: A thorough search of the literature was conducted in the PubMed, Cochrane Library, Scopus, and Web of Science databases, covering publications from 1 January 1982 to 4 November 2024. Only randomized controlled trials involving adult human subjects with available full-text articles were included, while systematic reviews, editorials, case reports, and studies involving animals or in vitro experiments were excluded. Studies were selected based on their relevance to orthodontic or combined orthodontic–surgical treatments for correcting excessive gingival display (gummy smile), particularly in cases where residual growth does not impact treatment outcomes. The primary focus was on evaluating the efficacy of these interventions in improving smile aesthetics. Follow-up data were considered when available, though not required for inclusion. Results: The findings revealed that both orthodontic and surgical methods are effective in reducing gingival display. Orthognathic surgery offers lasting outcomes, particularly for patients with vertical maxillary excess, whereas orthodontic treatments, including the use of skeletal anchorage devices, are particularly effective for less severe cases. Minimally invasive approaches, such as botulinum toxin injections, provided temporary but promising results for patients reluctant to undergo surgery. Conclusions: Orthodontic and surgical techniques are viable options for treating gummy smile, with treatment choices depending on the condition’s severity. Future research, particularly long-term randomized studies, is required to further refine treatment protocols and improve patient outcomes.

ADVANCING PRECISION

Augmented reality (AR) technology is revolutionizing spine surgery, offering unprecedented intraoperative image guidance and enhancing patient safety, particularly in complex procedures. This presentation explores the expanding applications of AR in spinal surgery, highlighting recent technological advances that have transformed surgical practices. In addition to improving surgical precision and accuracy, AR provides real-time visualization of critical anatomical structures, aiding in navigation and decision-making during intricate spinal procedures. This presentation will delve into the benefits that AR brings compared to classical techniques, including enhanced visualization, improved spatial awareness, and reduced radiation exposure for both patients and surgical teams. By overlaying virtual information onto the surgeon’s view of the patient, AR facilitates a more intuitive understanding of complex spinal anatomy and pathology, leading to optimized surgical outcomes. Furthermore, this session will cover the diverse applications of AR in a range of spinal conditions operated in Royal Hallamshire Hospital, Sheffield, UK - including spinal tumors, calcified disc herniation, spinal CSF-venous fistula etc. By showcasing the benefits of AR technology across various pathologies, this presentation aims to underscore its transformative potential in advancing spinal surgical care.

USE OF AUGUMENTED REALITY IN TREATMENT OF PITUITARY MICROADENOMAS

Introduction Transsphenoidal surgery, performed using endoscopic or microscopic techniques, is a safe and effective method for treating neuroendocrine pituitary tumors, including microadenomas. However, the precise location of microadenomas can be challenging to determine, particularly in acromegaly patients, who often exhibit a reduced intracarotid distance. Augmented reality (AR), particularly through heads-up displays (HUD) integrated into surgical microscopes, has been predominantly utilized in transcranial approaches but shows potential in enhancing transsphenoidal procedures. Aim This study aims to present the surgical workflow, techniques, and outcomes associated with using AR in microscopic transsphenoidal surgery for pituitary microadenomas. Material and Methods All procedures were conducted at the Targu Mures Clinical Emergency Hospital’s Department of Neurosurgery between 2019 and 2024. A total of 15 cases were treated using AR-assisted techniques. While the surgical operative time was comparable to non-AR-assisted procedures, the preoperative setup was more time-consuming and required staging to optimize the surgical workflow. In all cases, surgeons successfully identified and resected the microadenomas without complications related to navigation accuracy. Conclusions The findings suggest that integrating AR into transsphenoidal surgery enhances anatomical understanding and precise localization of microadenomas, providing a valuable tool for neurosurgeons. However, AR cannot replace surgical expertise and clinical judgment.

MANAGEMENT OF EXTRAMEDULLARY INTRADURAL SPINAL TUMORS

Spinal tumors are relatively uncommon, accounting for approximately 5%–10% of all central nervous system tumors, with an estimated 70%–80% being located in the intradural extramedullary space. The most common intradural extramedullary tumors are schwannomas, followed by meningiomas. Other less common intradural extramedullary tumors include myxopapillary ependymomas. The clinical presentation of these tumors is often rather nonspecific, and clinicians must maintain a high index of suspicion when evaluating patients with chronic back pain. Approximately 50% of affected individuals experience nonspecific back pain, whereas radiating pain, motor deficits, and sensory loss often progress gradually. This study examines the surgical management of intradural spinal tumors treated in our department, focusing on surgical techniques Some of these benign lesions can pose a surgical challenge due to their location to spinal cord, tumor consistency (densely mineralized / calcified). Posterior approaches involving laminectomy while preserving facet joints are typically sufficient for the surgical resection of dorsal and dorsolateral tumors. In conclusion the total surgical removal of these tumors while preserving neurological function remains can pose a surgical challenge especially for those that are densely calcifed and situated anterolateral to spinal cord, but employing standard microsurgical techniques often makes these resections possible.

Is fascia lata a viable graft for MPFL reconstruction? An overview of surgical technique and scoping literature review

Lateral patellar dislocation is irrefutably one of the most common knee injuries, while subsequent medial patellofemoral ligament (MPFL) damage requires proper orthopedic care. Treatment of these injuries is regularly associated with the need for MPFL reconstruction surgery. This operation, often in combination with other procedures, can result very fruitful in restoring knee kinematics. There is a considerable variety of options for the orthopedic surgeon to choose from regarding graft selection when performing MPFL reconstruction surgery, including the semitendinosus tendon, the gracilis and others. Notwithstanding, utilizing the fascia lata as an autograft or allograft for MPFL reconstruction has emerged as a promising alternative. Perusing the existing literature, not any review paper could be found examining the efficacy of fascia lata as a MPFL reconstruction graft. As a result, a thorough search was conducted in various databases to investigate and explore the studies analyzing this type of MPFL reconstruction surgery. The number of papers scrutinizing this operation was exceedingly narrow. However, out of these studies it can be concluded that opting for fascia lata grafts when executing MPFL reconstruction surgery features some considerable advantages, involving similar biomechanics to the native MPFL, no hamstrings damage and quicker rehabilitation among others. This paper accentuates the requirement for considering fascia lata as a viable graft option in MPFL reconstruction surgery and the necessity for more pertinent research in order to attain more reliable inferences.

SURGICAL RESECTION OF A COMPLEX TUBERCULUM SELLAE MENINGIOMA ENCASING MAJOR ARTERIES

Introduction Though constituting only a minor proportion (1%) of sellar masses, suprasellar meningiomas pose a significant diagnostic challenge within the region of sellar and suprasellar tumors. Pituitary adenomas, at nearly 90% prevalence, dominate this anatomical region. Distinguishing these two entities is paramount, as both clinical presentation and, to some extent, biochemical profiles exhibit notable overlap. Accurate preoperative differentiation is critical due to the contrasting behaviors of these tumors. Meningiomas, with their robust vascularity supplied by dural and osseous arteries, present a heightened risk of intraoperative hemorrhage. Clinical Case A 53-year-old woman presented with a two-month history of worsening headaches and gradual vision loss. Neurological examination revealed only visual acuity decline. Her hormone profile showed elevated prolactin but lacked clinical features of prolactin excess, suggesting a possible prolactin-secreting pituitary macroadenoma. A contrast-enhanced MRI confirmed a significant sellar and suprasellar mass with homogeneous enhancement, extending to the right paramedian region and encasing the right internal carotid artery (ICA) at its critical segment involving the cavernous and supraclinoid portions. Furthermore, the right middle meningeal artery (M1) and anterior cerebral artery (A1) originated from this same location, highlighting the high surgical risk. Surgical resection was deemed necessary. The patient underwent a right pterional craniotomy, revealing a grayish, extradural soft mass lesion encasing the ICA bifurcation. Careful microsurgical dissection with basal devascularization was performed, followed by near-complete tumor removal using an ultrasonic aspirator to minimize damage to the encased arteries. Postoperative follow-up CT scan confirmed successful near-total tumor ablation. Conclusion This case underscores the critical role of meticulous preoperative diagnosis in managing complex sellar tumors. While pituitary adenomas dominate this region, suprasellar meningiomas, despite their rarity, demand a high index of suspicion. Overlapping clinical and biochemical presentations highlight the reliance on advanced imaging for accurate differentiation. The intricate vascularity of meningiomas, as exemplified by the encasement of critical arteries in this case, necessitates meticulous surgical technique with devascularization strategies. This successful near-complete tumor removal emphasizes the importance of such surgical expertise in navigating these diagnostically challenging sellar lesions.

Comparative Efficacy of Endoscopic Versus Open Surgical Techniques in the Management of Gastric Outlet Obstruction: A Systematic Review

Comparative Efficacy of Endoscopic Versus Open Surgical Techniques in the Management of Gastric Outlet Obstruction: A Systematic Review

Robotic minimally invasive inguinal hernia repair with the Dexter robotic system™: A prospective multicenter clinical investigation

Abstract Background Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) has been established with various robotic platforms. The Dexter robotic system is an open platform consisting of a sterile surgeon’s console, two robotic instrument arms, and one robotic endoscope arm. This study aimed to confirm the perioperative and early postoperative safety and clinical performance of the Dexter system in patients undergoing primary transperitoneal inguinal hernia repair. Methods The primary objectives of this multicenter study conducted at three centers in France, Germany, and Switzerland were to document the successful completion of rTAPP procedures and the occurrence of serious adverse events (Clavien–Dindo grades III–V), device-related events up to 30 days post-surgery. The procedures were performed by three surgeons with varying levels of experience in robotic systems. Results 50 patients with a median age of 62.5 years (IQR 51.0–72.0) and BMI of 25.1 kg/cm2 (IQR 23.5–28.7), respectively, underwent inguinal hernia repair (33 unilateral, 17 bilateral). All surgeries were successfully completed using three standard laparoscopy trocars. There were no conversions to open surgery, intraoperative complications or device deficiencies. The median skin-to-skin operative time was 50 min (IQR 45–60) for unilateral hernias and 96 min (IQR 84–105) for bilateral hernias. The median console time was 30 min (IQR 26–41) for unilateral and 66 min (IQR 60–77) for bilateral hernias. Twenty-six patients were discharged on the day of surgery, and 22 on postoperative day 1. Conclusion This study confirmed the use of the Dexter system in rTAPP was feasible and safe in multicenter cohorts, with operative times consistent with the literature on other robotic platforms. Our data demonstrated the accessibility of this new robotic approach, even when adopted by surgeons new to robotics. The Dexter system emerged as a valuable device in the hernia repair toolkit for both experienced robotic surgeons and those new to the field.

OGC SO39 - The OUTLIVE Study - Oesophageal and JUncTional Cancer ELectIVE Surgery Morbidity and Mortality at 90-Day: A TUGS Multinational Audit

Abstract Background Oesophageal cancers are among the most common types of cancer and have a high mortality rate. Todate, oesophagectomy remains the gold standard treatment. However, considerable heterogeneity in the literature fails to generate a truly representative picture of short-term outcomes associated with these procedures. Method This multinational global audit includes all consecutive adults with clinically documented primary oesophageal malignancy undergoing elective surgery with curative intent. The study'sstudy's primary objective was to assess the 90-day mortality and morbidity rates in this population. Data was collected through a standardised dataset, and a descriptive analysis was employed. For analysis purposes, the patients were classified depending on the surgical procedure they underwent (laparoscopic, open, hybrid, converted and robotic surgery). Results A total of 622 individuals were analysed, most male [462 (74%)], with a mean Charlson Comorbidity Index of 4.30. The most common procedure was laparoscopic surgery [222 (35.7%)], followed by open surgery [198 (31.83%)]. 31 (5%) of the procedures reported an intraoperative complication, but more common in open procedures [11 (5.6%)]. 318 (51%) patients suffered postoperative complications within 90 days of surgery. The reoperation rate was 9.3%. McKeown staged procedure, compared to Ivor Lewis, had more infective complications [19% vs 11%, p=0.007] and a higher conversion to open procedures [69 (11.1%)]. 34 (11%) patients died because of a surgical complication. Conclusion No significant differences were found between the number of patients with at least one complication and the surgical approach. Nevertheless, robotic-assisted minimally invasive oesophagectomy (RAMIE) presented with the lowest complication, reoperation, and mortality rates. McKeown three-stage surgery also presented with worse clinical outcomes compared to Ivor Lewis procedures. Further studies and randomised control trials comparing different procedures in the field of elective oesophagectomy are needed to expand our knowledge in this field and guarantee the best outcomes for our patients.

HPB SO25 - The impact of chest physiotherapy on post-operative recovery from open liver surgery: A quality improvement project

Abstract Background The incidence of postoperative pulmonary complications (PPCs) after open liver surgery is high. Risk factors include age, body mass index, ex- or current smoker, and chronic lung disease. Early postoperative chest physiotherapy (CP), an essential part of any enhanced recovery protocol (ERP), can reduce PPCs, length of stay and healthcare costs. This study evaluated the uptake of CP after open liver surgery and resultant outcomes, following a quality improvement (QI) intervention. Method The project design involved two audit cycles: cycle 1 (C1) and cycle 2 (C2), each of five months duration, of consecutive patients undergoing open liver surgery, before and after a QI intervention (intensive preoperative patient education, poster campaign, increased engagement with physiotherapists regarding the importance of timely CP. Patients undergoing laparoscopic resections were excluded. Outcome measures included whether patients received postoperative CP at all, if so on which post-operative day (POD), for what duration, patient location, incidence of PPCs, and the length of postoperative stay. Statistical analysis was performed using (r 4-4.1) software, using the Chi-squared or Fisher’s Exact test. Results Despite more smokers/ex-smokers in C1(24%) versus C2(8%,p=0.04), only 18/50(36%) C1 patients received CP on POD1, versus 20/36(57%) in C2(p=0.07). Sixteen(32%) C1 patients received no postoperative CP, versus 7(19%) in C2(p=0.19). There were non-significant decreases in PPCs in C2(8%), versus C1(20%)(p=0.13). Three of four patients developing pneumonia in C1, and both those in C2, had no POD1 CP. Wards with higher physiotherapist:patient ratios had more POD1 CP: in C1 12/19(63%)[6/31(20%), p=0.001], and C2 14/15(93%)[6/20(30%) p=0.0001]. Median hospital stay was unchanged (4 days). Conclusion This QI project shows that even with an established enhanced recovery programme, the provision of postoperative chest physiotherapy is not universal. However, it can be improved with an education programme for both healthcare workers and patients.

OGC SO23 - Audit on Enhanced Recovery After Surgery (ERAS) in Oesophago-gastric Resections for Cancers

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols, have been designed to guide clinicians in managing patients post-operatively, reducing hospital stay, complications and readmissions. Our trust’s ERAS protocol includes guidance on oral intake initiation, drain, catheter and epidural removal, investigation frequency, medications required on discharge and early mobilization. However, implementation of ERAS protocols in complex oncological surgery can be challenging, due to the multiple factors included and increasing complexity. We aimed to assess the compliance of ERAS implementation in a high volume resectional oesophago-gastric unit, and subsequent impact on morbidity. Method A retrospective review of all patients who underwent oesophago-gastric resections during March-April 2024 was performed. Patients were included if they completed an oesophagectomy, or subtotal/total gastrectomy resection for cancer. Electronic records and medical notes were reviewed and compared to all aspects of the trust’s ERAS protocol. The adherence percentage to the protocol was calculated. Results 20 patients underwent surgery. 85% started their oral diet on time per ERAS protocol. Adherence to ERAS was lowest for epidural (52.6%, 95% within 24-hours of target), catheter (55%, 90% within 24-hours of target), apical (55.6%, 100% within 24-hours of target), basal (53.8%, 85.7% within 24-hours of target), and abdominal drain removals (81.8%, 90.9% within 24-hours of target). All patients mobilized within four days post-op, with 65% achieving daily mobilization. VTE prophylaxis was prescribed for all, and discharge medication adherence ranged from 86.7% to 100%. The mean hospital stay was 9 days post-oesophagectomy, with a 3.2% emergency department return rate. Conclusion Implementation of an ERAS protocol is feasible in complex oesophago-gastric cancer surgery. Effective involvement and training of allied health, specialist pain services and the whole surgical team can decrease morbidity and length of stay in oesophagectomy, while avoiding excess emergency department presentations. Ongoing training and feedback of allied health, pain services, and surgical team at all levels is important to ensure adequate compliance.

Comprehensive Pain Management in Total Joint Arthroplasty: A Review of Contemporary Approaches

Background: Total hip and knee arthroplasties are among the most effective and widely performed procedures in modern medicine, providing substantial benefits to patients with end-stage osteoarthritis. These surgeries have transformed the treatment of degenerative joint disease, significantly enhancing functionality and quality of life for patients. Despite considerable advancements in surgical techniques and postoperative care, managing postoperative pain remains a major challenge, impacting both clinical recovery and patient satisfaction. The persistence of postoperative pain as a barrier to recovery underscores the need for improved pain management strategies. Methods: A comprehensive narrative review of the literature was conducted, focusing on the physiological mechanisms underlying surgical pain, the role of anesthesia techniques, and the development of multimodal pain management approaches used in total joint arthroplasty. This review emphasizes the components of modern multimodal strategies, which combine multiple pharmacologic and non-pharmacologic methods to address the various mechanisms of postoperative pain. Results: Current pain management strategies employ a dynamic, multimodal approach that covers the perioperative period. These strategies aim to optimize pain control while minimizing side effects. They incorporate a range of methods, including nerve blocks, non-opioid analgesics, opioids, and non-pharmacologic techniques such as physical therapy. However, evidence regarding the efficacy and optimal combinations of these interventions varies widely across studies. Conclusions: This variation has led to inconsistent pain management practices across institutions. To standardize and improve care, this paper presents the authors’ institutional pain management model, offering a potential framework for broader application and adaptation in the field of joint arthroplasty.

Dorsolateral Transdural Surgical Management of Spontaneous Intracranial Hypotension From Ventral Dural Cerebrospinal Fluid Leaks: Case Series and Technical Report

BACKGROUND and OBJECTIVES: Spontaneous intracranial hypotension is an uncommon but debilitating condition that commonly involves positional headaches and vertigo. One cause is cerebrospinal fluid (CSF) leakage from ventral dural defects from calcified spinal discs. Patients can undergo epidural blood or fibrin glue patches as treatment; however, in cases where the leak does not resolve, surgical repair of the dural tear may be warranted. We aim to describe a case series and technical notes for these patients. METHODS: Patients with spontaneous intracranial hypotension because of myelography-confirmed ventral dural defect from calcified thoracic disc, who were treated surgically between June 2020 and March 2024, were included in the study cohort. Demographic information, clinical course, and postoperative outcomes were collected. The surgical technique was also described based on an illustrative case. RESULTS: Twelve consecutive patients underwent surgery between June 2020 and March 2024 with postoperative records. The median age at the time of surgery was 41.5 years (range: 28-58 years). Male patients comprised 50% of the cohort. Dural defects were spread throughout the thoracic spine in the cohort. While all patients reported positional headaches, other symptoms included vertigo, pulsatile tinnitus, and neck pain. Median length of follow-up time was 6.5 weeks. There were no surgical complications or permanent neurologic deficits. All patients had radiologic cure of their leaks with absence of extradural CSF on postoperative MR imaging. Ten patients (83.3%) had complete resolution of spontaneous intracranial hypotension-related symptoms. Two patients did suffer from rebound headaches postoperatively. CONCLUSION: The dorsolateral transdural surgical approach is a safe and effective method to repair type 1 CSF leaks caused by ventral dural defects. Our case series of 12 patients did not involve any surgical or immediate postoperative complications, and all patients had radiologic resolution of their leaks with relief of positional headaches. Two patients experienced continued headaches after treatment.

HPB SO78 - A Novel Application of ISGPS Guidelines for Calculating Pancreatic Fistula Rates Post-Distal Pancreatectomy

Abstract Background Post-operative pancreatic fistula (POPF) remains a major cause of morbidity and mortality following distal pancreatectomy and there is continual debate regarding the optimal peri-operative practice. The impact of drain displacement on outcome is poorly understood and limited information is documented on how the ISGPS guidelines are used to determine a clinically significant POPF. This study aims to assess the POPF and drain displacement rate at our institution and identify factors predicting a clinically significant POPF. We have proposed an algorithm to standardise the interpretation of the ISGPS guidelines. Method Case records of patients undergoing left sided pancreatectomy at our institution from January 2019 to January 2024 were analysed to assess the incidence of biochemical and clinically significant POPF using ISGPS criteria. Post operative CT scans were reviewed to record drain displacement with respect to the pancreatic stump. Continuous data was represented as mean +/- SD or median(IQR) depending on normality. Appropriate statistical tests were used for comparison of continuous and categorical variables (alfa error of 5%). Receiver operating characteristic curves were performed to assess the suitability of drain fluid amylase level as a predictor of clinically significant POPF. Results A total of 56 patients qualified for analysis. There was no difference between the clinically insignificant and significant groups with respect to age, gender, BMI, pathology and surgical technique (open/laparoscopic, splenic preservation, stump reinforcement). The clinically significant group had higher day three and peak drain amylase levels. The day of peak drain amylase was significantly later in this group. The drain displacement rate was 41% and did not differ significantly between the two groups. A day 3 drain fluid amylase level of 1120(U/L) had a 74% sensitivity of predicting a clinically significant POPF. Conclusion The ISGPS guidelines do not provide explicit criteria for stratifying the grade of POPF. We propose an algorithm to standardise the interpretation of these guidelines. Drain displacement did not impact POPF rate allowing for small sample size. Day 3 fluid amylase level is a useful predictor of clinically significant POPF. Program permission yes

Effective Ayurvedic Treatment of Pilonidal Sinus using Udumber Ksheer Sutra: A Case Study

ABSTRACT Pilonidal sinus, also known as “jeep bottom,” is common among people who sit a lot, such as cab drivers. It mostly affects men and young adults and is associated with thick hair. Surgical techniques are available for treatment, but the condition has a relatively high recurrence rate. The Kshara Sutra method described in the Sushruta Samhita offers a minimally invasive treatment option. Pilonidal disease is estimated to affect about 26 out of every 100,000 persons, with around 0.7% of people affected. This study focuses on the diagnosis and treatment of patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra. The Kshara Sutra is a minimally invasive, cost-effective technique with a low recurrence rate for treating pilonidal sinus. Udumber Ksheer Sutra management has also proven to be beneficial as a curative therapy for the pilonidal sinus.

Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency

Purpose: To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD). Methods: Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes. Results: Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23–0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes. Conclusions: This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.

BN SO62 - Laparoscopic technique for right sided paraduodenal hernia repair: A clinical study and surgical insights

Abstract Background Paraduodenal hernias can present significant diagnostic and therapeutic challenges, with up to 50% potentially leading to bowel obstruction. A minimally invasive approach to repairing these defects offers reduced morbidity and quicker recovery. This report highlights the feasibility and safety of laparoscopic repair of a right-sided paraduodenal hernia. Method A 19-year-old female presented with persistent postprandial bilious vomiting and a long history of forceful regurgitation 10-30 minutes after eating. The preoperative evaluation, surgical technique and operative outcomes are detailed. Results Preoperative evaluation included magnetic resonance imaging, computed tomography and a barium swallow, revealing an incidental finding of the duodenojejunal flexure and most jejunal loops on the right side of the abdomen. A right paraduodenal hernia was diagnosed during laparoscopy. After delineating and reducing the hernia laparoscopically, the sac was obliterated by opening up the posterior aspect over the inferior vena cava. The repair was completed by suturing the hernia orifice and plicating the duodenum. The patient's symptoms resolved postoperatively, with no intraoperative or immediate postoperative adverse outcomes reported. Scheduled outpatient follow-up showed satisfactory resolution of symptoms. Conclusion The laparoscopic repair of the right paraduodenal hernia was successfully performed, leading to the resolution of the patient's symptoms. This case underscores the importance of considering laparoscopic approaches for managing complex and rare hernias, especially when cross-sectional imaging modalities do not clearly identify the cause of symptoms. The laparoscopic technique offers significant advantages, including reduced pain and faster recovery.

Otoplasty and Ear Reconstruction Complications

AbstractProminauris, often known as prominent ears, is one of the most frequent congenital deformities of the head and neck. Therefore, otoplasty has gained significant popularity and is now one of the most performed procedures in the field of facial plastic surgery.Reconstructing and correcting ear abnormalities remains a challenging procedure in facial plastic and reconstructive surgery. These deformities, whether congenital or acquired, have a substantial influence on patients' lives and inflict psychological harm. Addressing the deformity and tissue loss will improve the overall quality of life.Throughout history, various surgical techniques have been reported for treating external ear abnormalities. While most of these surgeries are considered safe, a comprehensive preoperative evaluation and understanding of the different techniques and risks can minimize potential complications.