Operative Indications Research Articles

Intravenous Locoregional Anesthesia: An Alternative of Choice in a Country with Limited Resources (Abidjan- Cote d'Ivoire)

Background: ALRIV, a simple, reliable, inexpensive and easily reproducible technique, is still little practised in sub-Saharan Africa. The objective of this study is to describe our practice in order to popularize this anesthetic technique.
 Methods: This was a prospective and descriptive study covering a 12-month period. All patients admitted for surgical management of upper limb except the arm and lower limb except the thigh were included. The parameters studied were epidemiological, clinical, therapeutic, anaesthetic and evolutionary.
 Results: We selected 73 patients out of 675 (10.81%). The majority of the patients were seen in the framework of a regulated surgery against only 13.69% in emergency. The operative indications were: removal of osteosynthesis materials (52.05%), limb osteosynthesis (43.83%) and phlegmon evacuation (4.10%). The double tourniquet technique was used in (93.15%). Lidocaine 0.5% was used at a dose of 0.5ml/kg. The average duration of the procedures was 57.28 minutes. Postoperatively, all our patients received multimodal analgesia. In the postoperative monitoring room, 64.38% of patients did not experience any discomfort or pain.
 Conclusion: ALRIV is a simple technique of peripheral local anaesthesia that is easy to teach, consistently effective and inexpensive.

Role of hysteroscopy in evaluation of recurrent pregnancy loss

Objective: to detect the uterine abnormalities missed in U/S scan and HSG using hysteroscopy, in females presenting with recurrent pregnancy loss &to study hysteroscopic therapuatic potential to that pathology. Methodology: prospective cohort study, conducted in obstetrics & gynecology department of, Beni-suef University Hospital.on one hundred women with recurrent 1st &2nd trimester pregnancy loss recruited for hysteroscopy .A rigid fiberoptic 2.7mm, 0 and 30 degrees angled hysteroscopy along with an operative channel for grasping forceps or scissors were used for both diagnostic and operative indications. The findings, and different types of abnormalities, comparison between<or=3 &>3 cosecutive miscarriage as regarding hysteroscopic findings &impact of the procedure on management were recorded. Results: In this study In the normal hysteroscopy group, 24women (29.3%) achieved a successful ongoing pregnancy without additional treatment, 49 (59.8%) had recurrent miscarriages again, and 4(5%) had persistent secondary infertility .In women who needed and had hysteroscopic correction of a SUA, the number of successful ongoing pregnancies was significantly higher 13 (72.2%) vs (29.3%) in normal group and the number of new abortions significantly was lower than in those who had no pathology 3(16.7%)vs (59.8%) with statistically significance between the 2 groups (p value = 0.002).

Are patients with limited English proficiency less likely to undergo parathyroidectomy for primary hyperparathyoidism?

BackgroundDespite meeting operative indications for primary hyperparathyroidism (PHPT), many patients never undergo parathyroidectomy. We hypothesized that patients with limited English proficiency (LEP) would be less likely to undergo parathyroidectomy than English-proficient (EP) patients. Study designWe retrospectively analyzed patients with PHPT from an institution-wide registry who met operative criteria between 2010 and 2018. The cohort was stratified by English proficiency. Univariate associations between sociodemographic and clinical factors with parathyroidectomy were assessed. A multivariable logistic regression model was created to assess independent predictors of parathyroidectomy. ResultsAmong a cohort of 1,104 patients, 262 (24%) underwent parathyroidectomy. LEP patients (n = 135, 12%) were significantly younger (mean age 62 vs. 69, p < 0.001), more likely non-white race and ethnicity (p < 0.001), and less likely to have private insurance (p < 0.001). After adjusting for covariates, non-English and non-Spanish preferred language was an independent negative predictor of undergoing parathyroidectomy (OR 0.46, 95% CI 0.21–0.95, p = 0.037). ConclusionsLimited English proficiency may be an independent barrier to appropriate surgical management of PHPT. Systems-level and disease-specific interventions are needed to address this disparity faced by patients with LEP.

What is the best way for an inexperienced surgeon to learn total ankle arthroplasty?

BackgroundPrevious reports on the learning curve of total ankle arthroplasty (TAA) revealed that inexperienced surgeons should be more careful about operative indications and procedures during the learning curve period. Patients who underwent surgery with inexperienced surgeons may be associated with inferior clinical outcomes, such as frequent complications. This study aimed to evaluate the effect of the participation of experienced surgeons as assistants on the results of TAA performed by inexperienced surgeons. MethodsSurgeons whose experience in performing TAA included less than 15 ankles were defined as inexperienced surgeons; on the other hand, those whose experience included more than 20 ankles were defined experienced surgeons in this study. Thirteen ankles operated by inexperienced surgeons, with an experienced surgeon who participated as an assistant, were assigned to the inexperienced group. Fifteen ankles operated on by an experienced surgeon were assigned to the experienced group. TNK Ankle (Kyocera, Kyoto, Japan) was used for all experiments.The coronal and sagittal alignments and the size of the tibial component relative to the tibial shaft were measured. Preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were used for clinical assessment. ResultsThere were two malleolar fractures during the operation in both groups, and there were no cases of revision surgery. There were no significant differences in the coronal and sagittal tibial component alignment and size between the groups. The JSSF and SAFE-Q improved. There were no significant differences between groups, except for the preoperative JSSF score. ConclusionsDuring the learning curve period, careful surgical indications and surgeries are desired. However, we found that when experienced surgeons participated as assistants, favorable results could be expected even when inexperienced surgeons performed the surgery. Level of evidenceⅢ

Violation of Water-Electric Exchange in Patients with Nospecific Ulcerative Colitis Before Total Colectomy

Abstract: Inflammatory diseases of the colon - ulcerative colitis and Crohn's disease are an urgent surgical problem. The paper presents an analysis of surgical interventions for ulcerative colitis and Crohn's disease over the past 12 years based on the materials of the First Republican Clinical Hospital in Izhevsk. Indications for one-stage and multi-stage radical operations for nonspecific ulcerative colitis and Crohn's disease have been developed. The indications for emergency, urgent and planned indications for inflammatory diseases of the large intestine have been clarified. Performing radical multi-stage operations for ulcerative colitis and Crohn's disease can reduce mortality, improve treatment outcomes, prognosis and quality of life. Keywords: inflammatory diseases of the colon, ulcerative colitis, Crohn's disease.

Indications and Results of Nephrectomys at the Urology Department of Zinder National Hospital (HNZ)

Aim: To describe the indications and results of nephrectomy in the urology department of the National Hospital of Zinder (HNZ). Materials and methods: This is a retrospective, descriptive and analytical study over a period of six years on patients followed in the urology department of the National Hospital of Zinder. During this period, 33 indications for nephrectomy were made. The clinical and Para clinical parameters, the operative indication and postoperative data were studied. Results: 33 patient records were collected. Men (20) were more represented 61%. The average age of our series was 31.47 years with extremes of 3 to 60 years. Lumbar mass was the most common reason for consultation with 36% of cases, followed by lumbar pain (30%). All our patients had an ultrasound of the urinary tract which highlighted the lesion and the organ concerned. The Uro-Scanner completed the Para clinical assessment in 25 cases, i.e. 75.75%. % Nephrectomy was indicated for Hydronephrosis with destruction of the renal parenchyma in 76% of cases and for Renal tumor in 24% of cases. Simple nephrectomy was the most represented technique (25 cases) and extended nephrectomy concerned 8 cases. Peroperatively, a pleural breach was noted in 3 patients (9.09%) and a peritoneal breach in 5 others (15.15%). Postoperatively, two patients presented with parietal infection (6%), four patients (12%), present renal failure with créatinin betwen 455 µmol/l to 646 µmol/l, and two patients (6%) died. Conclusion: Benign pathologies, especially obstructive, of the urinary tract leading to destruction of the renal parenchyma and therefore to nephrectomy. As reported in many developing countries, they were the most frequent indication in our study.

Infra-Temporal and Pterygo-Palatine Fossae Tumors: A Frontier in Endoscopic Endonasal Surgery-Description of the Surgical Anatomy of the Approach and Report of Illustrative Cases.

Infratemporal and pterygopalatine fossae (ITF and PPF) represent two complex paramedian skull base areas, which can be defined as jewelry boxes, containing a large number of neurovascular and osteomuscular structures of primary importance. They are in close communication with many craniofacial areas, such as nasal/paranasal sinuses, orbit, middle cranial fossa, and oral cavities. Therefore, they can be involved by tumoral, infective or inflammatory lesions spreading from these spaces. Moreover, they can be the primary site of the development of some primitive tumors. For the deep-seated location of ITF and PPF lesions and their close relationship with the surrounding functional neuro-vascular structures, their surgery represents a challenge. In the last decades, the introduction of the endoscope in skull base surgery has favored the development of an innovative anterior endonasal approach for ITF and PPF tumors: the transmaxillary-pterygoid, which gives a direct and straightforward route for these areas. It has demonstrated that it is effective and safe for the treatment of a large number of benign and malignant neoplasms, located in these fossae, avoiding extensive bone drilling, soft tissue demolition, possibly unaesthetic scars, and reducing the risk of neurological deficits. However, some limits, especially for vascular tumors or lesions with lateral extension, are still present. Based on the experience of our multidisciplinary team, we present our operative technique, surgical indications, and pre- and post-operative management protocol for patients with ITF and PPF tumors.

Females Do Not Have Increased Adverse Events After Combined Carotid Endarterectomy and Cardiac Operations Despite Greater Abundance of Symptomatic Carotid Disease in This Female Cohort

Despite numerous reports of female patients having more adverse events after vascular procedures, the impact of birth sex on adverse outcomes following combined carotid endarterectomy (CEA) and cardiac operations has not been reported. The objective of this project was to define the event rate using an institutional data warehouse. We hypothesized that women undergoing combined carotid and cardiac operations would be more likely than men to have postoperative adverse events. We identified patients by Current Procedural Terminology codes and performed a retrospective cohort study of patients who underwent CEA and cardiac operations (coronary artery bypass grafting with or without valve or isolated valve operations) in a simultaneous or staged fashion between 2007 and 2020. Patient comorbidities, operative indications, symptomatic status, and postoperative outcomes were abstracted via chart review. Late deaths, defined as deaths that occurred after initial 30-day postoperative period, were obtained from the National Death Index. The primary exposure variable was male or female birth sex. Fisher’s exact test with a P value of less .05 used to test for significance. We identified 134 patients (40.3% female) who underwent combined CEA + cardiac operations. Most (105) of the cardiac operations (105) were coronary artery bypass grafts, 16 were coronary artery bypass grafts + valve, and 13 were valve operations. Women were more likely to present with symptomatic carotid disease (women 19% vs men 6%; P < .05) (Table). The mean time between staged carotid and cardiac operations was 3.8 ± 3.3 days. There was one myocardial infarction (MI) in a male patient after CEA in the staged cohort and one MI in a female patient after synchronous group. There were two postprocedural strokes in male patients, both after staged cardiac operation and neither involved the CEA distribution. There were five perioperative deaths related to the cardiac operation. There were 14 late deaths with an average time to late death of 1272 ± 721 and 1248 ± 1219 days for women and men, respectively, after the CEA (Table). In our institutional database, women comprised 40% of patients undergoing combined carotid and cardiac operations. We found that women were more likely to have symptomatic carotid disease, but they did not have a greater risk of MI, stroke, or death (perioperative or late) compared with men. There were few adverse events suggesting that CEA is safe in women and men undergoing cardiac operations. We conclude that female sex does not increase the risk of adverse events in this challenging cohort of vascular patients.TablePatient comorbidities, operative indications, and outcome metricsFemaleΜaleP value(n = 54)(n = 80)Comorbidities Age (average)66.1 ± 8.668.2 ± 7.9- Diabetes26 (48%)39 (49%)1 Average A1c7.1 ± 1.87.5 ± 1.9- Hypertension47 (87%)73 (91%).57 Hyperlipidemia41 (76%)59 (74%)1 Renal dysfunction8 (15%)23 (29%).09 Average body mass index33.0 ± 8.230.3 ± 7.1- Tobacco exposure31 (57%)54 (68%).32Operative indications Symptomatic carotid10 (19%)5 (6%).048a Symptomatic heart28 (52%)35 (44%).382 Symptomatic for both3 (6%)1 (1%).302 Staged operation32 (59%)42 (53%).482 Synchronous operations22 (41%)38 (48%).482Outcomes MI1 (2%)1 (1%)1 Stroke0 (0%)2 (3%).515 Postoperative death2 (4%)3 (4%)1 Late deatha6 (11%)8 (10%)1MI, Myocardial infarction.Data are presented as percentage (x/n) or mean ± standard deviation.aP < .05.bDeaths captured via data warehouse query of the National Death Index. Open table in a new tab

Reintervention Following Outpatient Peripheral Artery Disease Procedures: Trading Convenience for Value?

Peripheral artery disease (PAD) represents a high volume, high-cost burden on the healthcare system. The Centers for Medicare and Medicaid Services has developed the Bundled Payments for Care Improvement-Advanced program, in which a single payment is provided for all services to be administered in a postsurgical 90-day episode of care. Factors associated with 30- and 90-day reinterventions after PAD interventions would represent useful data for both payors and stake holders. We conducted a national cohort study of adults 65 years and older in the Vascular Quality Initiative and Centers for Medicare and Medicaid Services linked dataset who underwent an open, endovascular, or hybrid revascularization procedure for PAD between January 1, 2010, and December 31, 2018. Procedures for acute limb ischemia and aneurysm indications were excluded. The primary outcome was 90-day reintervention and 30-day reintervention was a secondary outcome. Covariates of interest included demographic, comorbidities, and patient and facility level characteristics. Multivariable Cox regression was used to determine the association between patient- and facility-level characteristics and the risk of 30- and 90-day reinterventions. Among 42,429 patients (71.3% endovascular, 23.3% open, and 5.4% hybrid), median (interquartile range) age was 74 years (interquartile range, 69-80 years), 58.9% were male, and 84.3% were White. Chronic limb-threatening ischemia was the operative indication in 56.4%; 42.8% of the procedures were completed in the outpatient setting (40.3% outpatient, 2.5% office-based laboratory). More than 70% of procedures for chronic limb-threatening ischemia were completed as an inpatient, while 60% of the claudication interventions were done as an outpatient. The 30-day reintervention rate was 5.5% and the 90-day reintervention rate was 14.5%. Compared with inpatient procedures, PAD interventions completed in the outpatient or office-based laboratory setting had significantly higher 30- and 90-day reintervention rates (ref, inpatient; outpatient 30-day reintervention: hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.62-2.24]; outpatient 90-day reintervention: HR, 1.41; 95% CI, 1.25-1.60); office-based laboratory 30-day reintervention: HR, 3.54; 95% CI, 3.17-3.94]; office-based laboratory 90-day reintervention, HR, 2.09; 95% CI, 1.82-2.41) Open and hybrid approaches demonstrated lower risk of reintervention compared with endovascular procedures at 30 and 90 days and, compared with aortoiliac disease, all other anatomic segments of disease were associated with higher 90-day reintervention but no difference was noted at 30 days (Table). Although outpatient PAD interventions may be convenient for patients and providers, the outpatient setting is associated with a significant risk of subsequent 30- and 90-day reintervention. Additional work is needed to understand how to improve the longevity of outpatient PAD interventions.TableMultivariable analysis of factors associated with 30- and 90-day reinterventionsCovariate30-Day reintervention90-Day reinterventionAdjusted hazard ratio95% confidence intervalAdjusted hazard ratio95% confidence intervalStandard demographics Age 70-74 vs 65-690.950.891.020.990.951.04 Age 75-79 vs 65-690.950.841.090.950.881.03 Age 80-84 vs 65-691.000.841.190.950.861.05 Age ≥85 vs 65-690.990.911.080.880.820.94 Female vs male0.760.690.830.870.820.92 Non-White vs White1.050.931.191.050.971.14Comorbidities BMI ≥30 vs BMI <300.950.871.030.930.890.98 Coronary artery disease0.990.881.121.101.041.15 Congestive heart failure0.990.891.090.940.890.99 Chronic obstructive pulmonary disease1.040.971.131.081.011.16 Diabetes mellitus1.030.941.141.050.991.10 ESRD on dialysis1.461.311.631.381.261.50 Hypertension1.070.931.241.090.981.22 Microvascular disease1.010.901.141.010.921.11 Current smoker vs nonsmoker1.130.991.300.980.911.06 Prior smoker vs nonsmoker1.080.971.201.010.941.08Patient-level characteristics Ischemic rest pain vs claudication1.171.011.361.101.001.20 Tissue loss vs claudication1.110.991.241.070.991.15 Femoropopliteal vs aortoiliac1.050.911.211.241.151.35 Tibial vs aortoiliac0.930.771.111.311.191.45 Aortoiliac + any outflow vs aortoiliac1.140.961.351.381.251.51 Femoropopliteal + tibial vs aortoiliac1.030.821.301.341.171.54 Prior LER0.930.851.020.990.941.04 Ambulation with assistance vs ambulatory1.121.011.241.080.981.18 Wheelchair/bedridden vs ambulatory0.880.731.060.870.790.96 Homeless vs home0.000.000.000.430.111.67 Nursing home vs home0.880.681.140.820.730.91Facility-level or operative characteristics Office/clinic vs inpatient3.543.173.942.091.822.41 Outpatient vs inpatient1.901.612.241.411.251.60 Hybrid vs endovascular0.440.340.580.740.650.85 Open vs endovascular0.460.380.560.780.690.89 Year of procedure 2013-2015 vs 2010-20121.020.781.321.120.981.27 Year of procedure 2016-2018 vs 2010-20120.930.671.291.040.901.20 Distance to care 5-10 miles vs <5 miles1.030.941.131.020.951.11 Distance to care >10-20 miles vs <5 miles1.000.881.140.980.901.07 Distance to care >20-40 miles vs <5 miles1.070.921.251.040.941.15 Distance to care >40-60 miles vs <5 miles1.070.911.271.050.941.18 Distance to care >60 miles vs <5 miles0.860.661.120.960.841.11BMI, body mass index; LER, lower extremity revascularization; ESRD, end stage renal disease.All variables in the table are included in the model. 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Racial Disparities in Treatment Indications and Outcomes for Limb Ischemia

Studies suggest that the Affordable Care Act of 2014 has improved access to vascular care and vascular outcomes among patients suffering from peripheral arterial disease. We sought to examine the racial disparities that exist in patients with peripheral arterial disease who have undergone lower extremity bypass (LEB) or a peripheral vascular intervention (PVI) using the Vascular Quality Initiative database. The Vascular Quality Initiative infrainguinal and PVI datasets were queried for patients receiving elective and urgent LEB or PVI between 2016 and 2021. Patients undergoing interventions emergently or for aneurysm were excluded. The primary outcome was major adverse limb event (MALE; defined as any vascular reintervention or above ankle amputation) and MALE-free survival at 1 year. Standard statistical methods were used as appropriate. A total of 19,490 LEB and 90,532 PVIs were included in this analysis. Black patients present at a younger age when compared with non-Hispanic Whites and are more likely to have diabetes, hypertension, end-stage renal disease, and higher rates of prior amputation (Table). Black patients are more likely to present with chronic limb-threatening ischemia rather than claudication, and in an urgent setting (FigureF). Postoperative outcomes were similar except for higher rates of amputations among Black patients for both LEB (14.2% vs 9.4%; P < .001) and PVI (23.1% vs 20.6%; P < .001). Black patients are at higher risk of 1-year MALE for LEB (15.4% vs 13%; P < 0.001) and PVI (16.8% vs 12.3%; P < 0.001). Even after adjusting for confounding variables and accounting for interactions with indications, Black patients had a higher risk of 1-year MALE for LEB with a hazard ratio (HR) 1.33 (95% confidence interval [CI], 1.13-1.43; P < 0.001) and PVI (HR, 1.18; 95% CI, 1.05-1.32; P = .004). Other major determinates of 1-year MALE on multivariate Cox regression included chronic limb-threatening ischemia (LEB HR, 1.28; 95% CI, 1.13-1.43; P < .001 and PVI HR, 1.79; 95% CI,1.69-1.91; P < .001) and presenting in an urgent setting (LEB HR, 1.12; 95% CI, 1.01-1.23; P = .019 and PVI HR, 1.1; 95% CI, 1.03-1.15; P = .001). Compared with non-Hispanic Whites, Black patients present with more advanced vascular disease and in an urgent setting regardless of the operative indication. Black patients are also at significantly higher risk of 1-year MALE. Despite many advances in more accessible care through Affordable Care Act of 2014, our observations suggest that Black patients still have significantly worse outcomes owing to significant prevailing barriers to vascular care in this patient population.TableBasic demographics of lower extremity bypass (LEB) and peripheral vascular intervention (PVI) by raceFactorLEBPVINHWBlackHispanicOthers/unknownP valueNHWBlackHispanicOthers/unknownP value13055 (67.0%)3013 (15.5%)875 (4.5%)2547 (13.1%)66,911 (73.9%)14,577 (16.1%)5284 (5.8%)3760 (4.1%)Gender Male9196 (70.4%)1857 (61.6%)537 (61.4%)513 (69.8%)<.00141,502 (62.0%)7650 (52.5%)3022 (57.2%)2428 (64.6%)<.001 Female3859 (29.6%)1156 (38.4%)338 (38.6%)222 (30.2%)25,409 (38.0%)6927 (47.5%)2262 (42.8%)1332 (35.4%)Age, mean (SD)67.4 (10.4)64.7 (10.3)66.5 (10.9)66.9 (11.3)<.00169.2 (10.8)66.2 (11.3)67.8 (11.8)68.9 (11.2)<.001BMI in kg/m2, mean (SD)27.6 (5.9)27.2 (6.3)27.6 (5.5)26.7 (5.5)<.00128.1 (6.5)28.2 (6.9)27.9 (6.1)26.9 (7.9)<.001Hypertension11,508 (88.5%)2788 (93.3%)796 (91.5%)645 (88.2%)<.00158,287 (87.8%)13,453 (92.8%)4784 (91.3%)3266 (87.3%)<.001Diabetes6454 (49.5%)1728 (57.4%)662 (75.8%)457 (62.3%)<.00134,257 (51.2%)9394 (64.5%)4102 (77.7%)2433 (64.8%)<.001End-stage renal disease601 (4.6%)411 (13.6%)95 (10.9%)71 (9.7%)<.0014391 (6.6%)2947 (20.2%)993 (18.8%)631 (16.8%)<.001Coronary artery disease4356 (33.4%)834 (27.7%)272 (31.2%)242 (33.0%)<.00124,519 (36.7%)4475 (30.7%)1787 (33.8%)1314 (35.0%)<.001Congestive heart failure2419 (18.5%)628 (20.9%)181 (20.7%)121 (16.5%).00413,419 (20.1%)3722 (25.6%)1096 (20.8%)713 (19.0%)<.001Chronic obstructive pulmonary disease4105 (31.5%)652 (21.7%)154 (17.6%)177 (24.1%)<.00119,649 (29.4%)3105 (21.3%)857 (16.2%)711 (18.9%)<.001Prior leg artery bypass, endarterectomy, PVI10,446 (80.1%)2248 (74.6%)702 (80.2%)505 (19.8%).00934,489 (51.6%)7520 (51.6%)2753 (52.1%)1640 (43.7%)<.001Prior amputation587 (4.5%)233 (7.7%)65 (7.4%)32 (1.2%)<.00110,189 (15.2%)3618 (24.8%)1490 (28.2%)715 (19.0%)<.001Indications Claudication3433 (27.1%)521 (17.8%)146 (17.1%)159 (22.6%)<.00131,095 (48.0%)4945 (35.0%)1638 (31.9%)1414 (38.8%)<.001 Chronic limb-threatening ischemia9244 (72.9%)2399 (82.2%)708 (82.9%)543 (77.4%)33,652 (52.0%)9172 (65.0%)3499 (68.1%)2226 (61.2%)Smoking status Never1509 (11.6%)526 (17.5%)259 (29.6%)196 (26.7%)<.00112,342 (18.5%)3911 (26.9%)2088 (39.5%)1310 (34.9%)<.001 Prior6260 (48.0%)1188 (39.5%)396 (45.3%)267 (36.4%)32,062 (48.0%)5813 (39.9%)2124 (40.2%)1465 (39.0%) Current5276 (40.4%)1295 (43.0%)219 (25.1%)270 (36.8%)22,457 (33.6%)4838 (33.2%)1069 (20.2%)978 (26.1%)Admission status Elective11,010 (84.5%)2486 (82.7%)679 (77.7%)532 (72.5%)<.00159,103 (88.4%)12,493 (85.8%)4355 (82.5%)3191 (84.9%)<.001 Urgent2026 (15.5%)521 (17.3%)195 (22.3%)202 (27.5%)7757 (11.6%)2062 (14.2%)921 (17.5%)569 (15.1%)Aspirin9851 (75.6%)2209 (73.4%)657 (75.3%)496 (67.6%)<.00149,368 (73.8%)10,509 (72.1%)3741 (70.8%)2604 (69.3%)<.001Antiplatelets4659 (35.7%)1123 (37.3%)377 (43.2%)206 (28.1%)<.00130,070 (45.0%)6613 (45.4%)2518 (47.7%)1446 (38.5%)<.001Statins10,242 (78.6%)2366 (78.6%)719 (82.4%)583 (79.4%).06350,882 (76.1%)11,059 (75.9%)4099 (77.6%)2860 (76.1%)0.071Anticoagulation3033 (23.3%)551 (18.3%)154 (17.6%)139 (18.9%)<.00113,413 (20.1%)2339 (16.1%)879 (16.6%)623 (16.6%)<.001ACE inhibitors/ARBs6953 (53.3%)1526 (50.7%)506 (58.0%)404 (55.0%)<0.00135,751 (53.4%)7523 (51.6%)2881 (54.6%)1942 (51.7%)<.001Volume of surgeries per center Low3057 (23.4%)798 (26.5%)294 (33.6%)165 (22.4%)<.00116,341 (24.4%)3293 (22.6%)1528 (28.9%)1329 (35.3%)<.001 Medium6600 (50.6%)1683 (55.9%)393 (44.9%)344 (46.8%)33,668 (50.3%)7473 (51.3%)3003 (56.8%)1949 (51.8%) High3398 (26.0%)532 (17.7%)188 (21.5%)226 (30.7%)16,902 (25.3%)3811 (26.1%)753 (14.3%)482 (12.8%)ACE, Angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; BMI, body mass index; NHW, non-Hispanic Whites; PVI, peripheral vascular intervention; SD, standard deviation. 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Turnbull-Cutait abdominoperineal pull-through operation: The Cleveland Clinic experience in the 21st century.

The Turnbull-Cutait pull-through procedure (TCO) restores intestinal continuity in the setting of chronic pelvic sepsis, colorectal anastomotic leak, complex pelvic fistulas and technical challenges related to complicated rectal cancer. The aim of this study was to evaluate the outcomes of the TCO for salvaging complex pelvic conditions and to compare it to hand-sewn immediate coloanal anastomosis (CAA). This is a retrospective single-institution study where we searched a prospectively maintained database to identify patients who underwent the TCO. Patient demographics, operative indications and outcomes were analysed. TCO success was defined as maintenance of intestinal continuity and being stoma-free. Kaplan-Meier analysis was employed for stoma-free survival analysis. A total of 81 patients with TCO and 129 patients with CAA were included. The TCO success rate was 69% at a median of 1.4 years' follow-up with 25 (31%) patients ending up with a permanent stoma compared to 22 (17%) in the CAA group with a median follow-up of 4 years (P=0.03). The Kaplan-Meier cumulative incidence of TCO success at 1, 3 and 5 years was 79%, 60% and 51%, respectively, compared to 91%, 81% and 73% after CAA. The TCO has a high success rate for patients with complex pelvic conditions who may be facing a permanent stoma as their only option.

Simultaneous combined endoscopic endonasal and transcranial surgery for giant pituitary adenomas: Tips and traps in operative indication and procedure

ObjectivesThis retrospective analysis of patients treated with endoscopic endonasal transsphenoidal surgery (ETSS) alone or simultaneous combined surgery investigated imaging features suitable for surgical methods and pitfalls in simultaneous combined surgery for giant pituitary adenoma. Patients and methodsTen patients with giant pituitary adenoma treated by ETSS alone or simultaneous combined endoscopic endonasal and transcranial surgery were enrolled. By analyzing tumor imaging features on magnetic resonance imaging (MRI), operative findings and clinical outcomes, we examined types of imaging features suitable for each surgical method. ResultsFour patients received ETSS alone and six patients underwent simultaneous combined endonasal and transcranial surgery. Four patients treated by ETSS alone and three patients treated by combined surgery had high resection rates and good outcomes. The remaining three patients with combined surgery achieved partial resection and visual deterioration in one patient. MRI features suitable for ETSS included an enlarged sella, upward tumor extension, and round surface, whereas those for combined surgery included normal/enlarged sella, anterior and/or unilateral tumor extension, and a multilobulated surface. Tumors extending extensively bilaterally or upward and encasing neurovascular structures could not be effectively resected even under combined surgery. ConclusionBoth ETSS alone and simultaneous combined endonasal and transcranial surgery showed good results for giant pituitary adenoma when the surgical methods matched suitable imaging features. Tumors with unilateral or anterior extension and a multilobulated surface were maximally resected without neurological deficit by combined surgery, but tumors showing extensive multi-directional extension and full encasement of neurovascular structures were not effectively resected even with combined surgery.

Pre-Anaesthetic Consultation at the National Hospital of Zinder: Epidemiological Aspect and Fate of those Consulted

Introduction: The pre anesthetic consultation is the essential element of the continuity of peri and post interventional care. In fact, it gathers all the information concerning the pre, per operative anesthetic period. For any patient whose condition requires anesthesia, the health structures must provide a preanesthesia consultation. General objective: To highlight the importance of a preanesthetic consultation through the profile and prognosis of the patients as well as the operative indications recorded. Patients and method: This was a prospective and descriptive study conducted over a period of six months from January 1 to June 30, 2021 in the anesthesia and intensive care unit of the national hospital of Zinder. Patients consulted by a surgeon, scheduled for surgery and having a preoperative workup were included. Age, sex, history, ASA class, anesthetic technique, operative indication and outcome of the patent were the variables studied. The data analysis was done by Excel. Results: During the study 401 patients were registered with a sex ratio of 3.6%. The mean age was 42 years with extremes from 02 months to 84 years. Medical history represented 08.72% including hypertension (68.57%) and diabetes (11.42%). ASA II class represented 73.81% (n= 296) and ASA I class 26.18% (n= 105). General anesthesia was the chosen technique in 63.34% (n=254) versus 36.5% (n=147) for spinal anesthesia. Hernia and restoration of digestive continuity were the main surgical indications with respectively 17.45% (n=70) and 10.47% (n=42) followed by benign prostatic hypertrophy for 10.47% (n=42). Visceral surgery occupied the first place with 21.19% (n=85) followed by urology with 15.96% (n= 64). The per and post operative evolution was generally favorable, no case of death was recorded. Conclusion: The pre-anaesthetic consultation remains the essential element of the continuity of pre- and post-anaesthetic care. It should be popularized in health structures with high-risk patients.

Paediatric quality-of-life following adenotonsillectomy: an evaluation of T14 paediatric throat disorder quality-of-life outcomes according to operative indication.

Adenotonsillectomy is the most common surgical intervention for obstructive sleep apnoea (OSA) or recurrent tonsillitis. The Paediatric Throat Disorder Quality of Life Outcome (T14) questionnaire is a validated tool completed by parents to compare the outcome of surgery by measuring the pre- and postoperative scores. This study was undertaken to evaluate the quality-of-life outcome in children undergoing surgical intervention for recurrent tonsillitis and/or OSA. This was a prospective, uncontrolled study of 117 children who underwent adenotonsillectomy and tonsillectomy at a single tertiary ear, nose and throat department. An analysis of pre- and postoperative T14 paediatric throat disorder quality-of-life outcomes was undertaken at 12 months. Of the 117 children, 105 were included in the study sample; 75 with recurrent tonsillitis, 8 with OSA and 22 with both tonsillitis and OSA. All children had an improved T14 score postoperatively. The greatest change in pre- and postoperative T14 score was observed in the tonsillitis and OSA combined group (mean change -29.36, p<0.001). However, an improvement in T14 score was also noted in the tonsilitis (-24.453, p<0.001) and OSA groups (-14.25, p<0.001). This study found a statistically significant improvement in the T14 quality-of-life score at 12 months postoperatively in children undergoing adenotonsillectomy. This demonstrates improved parental perception of their child's symptoms for all operative indications of adenotonsillectomy.

The Occurrence and Relationship of Postoperative Seizure and de novo Epilepsy after Craniotomy Surgery: A Retrospective Single-Center Cohort Study

ObjectivePostoperative seizures and epilepsy are common complications of craniotomy. In this study, we aimed to investigate the characteristics of seizures and epilepsy after craniotomy.MethodsA total of 293 consecutive craniotomy surgeries were analyzed. Infratentorial surgeries, epilepsy surgeries, surgeries using the same approach conducted for the same patients, and the cases with incomplete clinical data were excluded. A total of 211 surgeries were included in this study. We evaluated the following clinical characteristics in all patients: sex, age, preoperative epilepsy, use of preoperative antiseizure medication (ASM), indication for operation, early postoperative seizure (EPS), delayed postoperative seizure (DPS), and postoperative de novo epilepsy. The day of onset of EPSs was defined as within 7 days post-surgery, and the day of onset of DPSs was defined as later than 7 days and less than 60 days post-surgery.ResultsTwenty-eight patients were previously diagnosed with epilepsy. Nine patients had EPSs (4.3%), and 10 patients had DPSs (4.7%). Seven cases of EPSs and six cases of DPSs were observed in 183 patients without previous epilepsy (3.8% and 3.3%, respectively). Three of the seven patients with EPSs (42.9%) and all six patients with DPSs (100%) developed de novo epilepsy. Postoperative de novo epilepsy was observed in 9 (4.9%) of the 183 patients without epilepsy. EPSs and DPSs were significant risk factors for epilepsy (p < 0.01). The odds ratios of EPSs and DPSs for the development of epilepsy were 12.71 (95% confidence interval [CI]: 3.94–112.80; p < 0.01) and 22.88 (95% CI: 5.38–55.72; p < 0.01), respectively. ASM was administered prophylactically to 51 patients. The prophylactic use of ASMs did not prevent EPSs or postoperative de novo epilepsy.ConclusionEPSs and DPSs occurred in 4.3% and 4.7% of the patients, respectively, after craniotomy. Postoperative de novo epilepsy occurred in 4.9% of patients. This study revealed that EPSs and DPSs were risk factors for de novo epilepsy. Previous epilepsy was not a significant risk factor for EPSs. The prophylactic use of ASMs did not prevent EPSs or de novo epilepsy.

What Is the Effect of Inguinal Hernia Operations on Sexual Functions?

Objective: The study aimed to evaluate sexual function before and after inguinal hernia surgery using a standard, internationally approved, patient-administered questionnaire.Methods: 57 male inguinal hernia cases operated with the Lichtenstein hernioplasty technique were prospectively included in the study. Patients who agreed to participate in the study had the IIEF (International Index of Erectile Function) scoring system form consisting of 15 questions filled in preoperatively, during the first and sixth months after surgery. Patients' age, BMI, comorbidity, employment status, hernia type, hernia size, and single or bilateral hernia were recorded. The relationship between these variables was evaluated by statistical analysis.Results: A statistically significant difference was found in terms of erectile function, sexual desire, intercourse function, and overall satisfaction, when the preop-postop first month, preop-postop sixth month, and postoperative first month-postop six-month scores were compared (p < 0.05).Conclusions: Pain and swelling due to an inguinal hernia can negatively affect the sexual functions of the patient, and most of the patients benefit from this after the surgery. Sexual dysfunction may be one of the indications for an inguinal hernia operation.

Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia

Objective: To share 4 techniques that decrease the rate of postoperative hypocalcaemia and save recurrent laryngeal nerve with a good cosmetic outcome. Method: The research included all consecutive patients of thyroidectomy (hemi and total thyroidectomy) during 4-year practice. The techniques included (1) elevation of a circular flap after 4 cm collar incision. (2) Ligation of the pedicles (middle first-vein, inferior last-artery). (3) Sharp dissection of the parathyroid glands. (4) Sharp and blunt dissection and exposing the nerve in all of the patients. Result: The total numbers of patients were 2399. At least 1 symptom of hyperthyroidism was found in 1271 patients (53%). The main indication for operation was multinodular goiter and compression symptoms in 1331 (55.5%) patients, followed by thyrotoxicosis in 598 (25%) patients and malignancy in 402 (16.8%) patients. The most common operations were total thyroidectomy in 1880 (78.4%) patients, followed by thyroid lobectomy in 495 (20.6%) patients and completion thyroidectomy in 24 (1%) patients. Among all patients, 4 (0.16%) patients developed permanent voice change. Seven (0.3%) patients developed permanent hypocalcemia. Conclusion: This study offers a set of surgical techniques that reduced the risks of complications of thyroidectomy to a minimal range.

An Anatomical Method for Rib Disconnection During Posterior Costotransversectomy for Paravertebral Access to the Ventral Thoracic Spine

Posterior costotransversectomy in the thoracic spine is commonly used for degenerative diseases, tumors, trauma, and other operative indications. It involves resection of the rib head after the ligamentous complexes have been disconnected from the transverse process and lateral vertebral body. The current literature provides only vague descriptions of the steps involved in rib disconnection with respect to posterior costotransversectomy. Through cadaveric studies and in vivo application, a stepwise method for rib disconnection is described. This manuscript is the first to outline an anatomical method for rib disconnection during costotransversectomy.

Reproductive disorders in women of reproductive age who have undergone urgent surgery on the reproductive organs

The objective: to analyze the long-term reproductive effects in women who after emergency gynecological surgery. Materials and methods. A retrospective analysis of the reproductive outcomes after urgent surgical operations (after 2 years) was performed in 300 gynecological patients aged 19 to 42 years. Results. A retrospective analysis showed that 69,3% of women who underwent emergency gynecological surgery had a history of gynecological diseases, but 30,7% of patients were not observed by a gynecologist. Before surgery, menstrual disorders were diagnosed in 42,0 % of patients, pathology of the lower genital tract – 19,7%, inflammatory diseases of the pelvic organs – 7,7 %. 8,2 % of women had gynecological operations before, 13,9 % – reproductive losses, and 11,1 % persons were examined and treated for infertility. The predominant method of surgical intervention in this cohort of patients was open laparotomy (59,7 %), laparoscopic intervention was performed in 40,3 % of cases. The most common indications for surgery were damage tubal pregnancy, ovarian apoplexy, complicated ovarian formation. Morphological verification of intraoperative findings showed that most often indications for operations were serous ovarian tumors (38,7 %), follicular tumors (22,4 %), complicated endometrioid and dermoid cysts (22,4 %), corpus luteum cysts with hemorrhage (9,2 %), paraovarian cysts (7,1 %). Rehabilitation postoperative therapy was performed for a limited number of patients (31,7 %), which could not but affect the state of reproductive health of women – an increase in the incidence of pain (42,0 %; p&lt;0,05) and chronic pelvic pain (42,3%) in the absence of such before surgery, as well as infertility (from 11,1 % to 22,5 %; p&lt;0,05). Conclusions. The lack of pathogenetically intra- and postoperative measures after urgent surgical interventions leads to increase the frequency of reproductive dysfunction, which requires the development and improvement of differentiated rehabilitation therapy and secondary prevention according to the nosology that caused urgent surgical operatrion.

Arthroscopically Assisted Humeral Head Decompression for Avascular Necrosis: Lateral Cortical Perforation Technique

AbstractAvascular necrosis (AVN) of the humeral head is debilitating condition that, when left untreated, can progress to humeral head collapse and end-stage arthritis of the glenohumeral joint. Core decompression is widely regarded as a first-line surgical treatment for early-stage AVN, and when performed on the appropriate patient, core decompression is an effective treatment for improving symptoms and preventing progression and humeral head collapse. This article discusses operative indications and presents a relatively simple and effective arthroscopic method for core decompression of humeral head avascular necrosis.