Open Repair Research Articles

Functional outcomes in anterior talofibular ligament repair with anchoring screw: Two case series

Background: The Anterior Talofibular Ligament (ATFL) functions to resist plantarflexion and anterolateral translation of the talus. Lateral ankle sprains account for 85% of all ankle sprains and are most common in athletes. ATFL injury is the most common ankle ligament injury, accounting for 35.6% of the total patients with ligament injuries. Case Report: The first patient, a 39 year old man with a diagnosis of ATFL injury, had a history of falling with the outside of his right leg supported when he fell. Physical examination of the right ankle revealed tenderness in the posterolateral region, pain during dorsiflexion and plantarflexion, positive anterior drawer examination and positive talar tilt. The second patient, a 19 year old male with the same history and injury location on the right ankle. Physical examination showed a similar condition to the first patient. MRI examination of both patients showed ATFL injury. Both patients underwent open repair of the right ATFL (Brostrom technique) with anchoring screws, post-operative care, and evaluation one year after surgery. Discussion: Surgery is taken to prevent repeated ruptures, especially in cases of ligament tears. The Brostrom technique is an anatomical repair with end-to-end repair from the final ATFL tear to the distal anterior fibula. Both patients demonstrated normal foot and ankle function, with a score of 100 based on the American Orthopedic Foot Ankle Association (AOFAS). Conclussion : Brostrom open repair with Anchoring Screw is an effective procedure in returning the patient's function to its previous level as assessed based on the AOFAS score after a year after surgery.

Variation in care in individuals hospitalised with abdominal aortic aneurysm in nine high-income countries: a cross-sectional cohort study

Abstract Background Abdominal aortic aneurysms (AAA) can be safely repaired using either endovascular aneurysm repair (EVAR) or open repair when intact, but after rupture morbidity and mortality are extremely high. Treatment patterns and outcomes for intact AAA are likely to differ between countries due to differences in AAA screening policies, health system capacity and payment approaches, and other factors, such as demographics and lifestyle, but are poorly studied. Methods We conducted a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalised for with an intact AAA and repair procedure in the same admission between 2011 and 2019 in nine countries (US, Canada, England, Denmark, Netherlands, Switzerland, Taiwan, South Korea and Israel) using population-representative administrative data. We investigated age-sex standardised (to the 2019 US population) repair rates (open repair or EVAR) and health system performance measures, including hospital length of stay (LOS), 30-day readmission, and all-cause mortality (30 days and 1 year). Results The number of intact AAA hospital admissions between 2011 and 2019 ranged from 1,290 in Israel to 199,764 in the US. The rates of intact AAA repair per 1000 population varied between countries and over time, from 0.11 per 1000 (South Korea) to 0.69 per 1000 (US) in 2011 and from 0.14 per 1000 (Taiwan) to 0.57 per 1000 (the Netherlands) in 2019. Most countries saw a decline in the rate of AAA repair over the study period. The proportion repaired using open repair vs EVAR also varied widely across the countries. In the US, Israel and Taiwan open repair was used in 11% or fewer cases whereas in the remaining countries we observed open repair in 25.1 % (South Korea) to 56.7% (Denmark) of cases. (Figure 1) Mortality was generally higher following open repairs compared to EVAR in all countries. In 2019, following EVAR, 30-day mortality varied from 0.6% (8.1% at 1 year) in South Korea to 2.3% (11.7% at 1 year) in Israel and following open repair varied from 2.9 (4.4% at 1 year) in England to 7.6% (15.1% at 1 year) in the US. (Figure 2) Mean hospital LOS in 2019 ranged from 2.5 days (US) to 12.2 days (South Korea), following EVAR and from 9.1 days (Taiwan) to 21.5 days (South Korea) following open repair. The 30-day readmission rate in 2019 ranged from 8.1% (US) to 31.8% in Israel following EVAR and from 11.4% (US) to 22.2% (South Korea) following open repair. Conclusions We observed substantial between-country variation in surgical approaches, mortality, and health system performance measures for AAA. Further research is needed to understand and plan optimal, evidence-based AAA screening and treatment strategies.Rates of EVAR and open repairAdjusted 30-day all-cause mortality

Comparison of open and hybrid endovascular repair for aortic arch: a multi-Centre study of 1052 adult patients.

We aimed to evaluate early and late outcomes by comparing open total arch repair and endovascular arch repair using proximal landing zone analysis in a multicentre cohort. From 2008 to 2019, patients treated surgically for aortic arch disease at six centres were included, excluding cases with type A aortic dissection, additional aortic root replacement, and extensive aortic aneurysm. In all patients and populations with proximal landing zone 0/1 (N = 144) and 2 (N = 187), early and late outcomes were compared using propensity score matching. A total of 1052 patients, including 331 (31%) and 721 (69%) undergoing endovascular arch repair and open total arch repair, respectively, were enrolled. After propensity score match (endovascular arch repair, 295, open total arch repair; 566), no significant difference was observed in in-hospital mortality rate (endovascular arch repair, 6.8%, open total arch repair, 6.2%; p = 0.716). Open total arch repair was associated with a lower risk of all-cause death (log-rank test; p = 0.010, hazard ratio 1.41 [95% confidence interval: 1.17-1.71]). The incidence of aorta-related death was higher in endovascular arch repair (Gray test; p = 0.030, hazard ratio; 1.44 [95% confidence interval; 1.20-1.73]). When compared to endovascular arch repair with proximal landing zone 0/1, open total arch repair was associated with lower risks of all-cause death (log-rank test; p < 0.001, hazard ratio; 2.04 [95% confidence interval; 1.43-2.90]) and aorta-related death (Gray's test; p = 0.002, hazard ratio; 1.67 [95% confidence interval; 1.25-2.24]). There was no difference in the risk of all-cause death (log-rank test; p = 0.961, HR; 0.99 [95% confidence interval; 0.67-1.46]) and aorta-related death (Gray's test; p = 0.55, hazard ratio; 1.31 [95% confidence interval; 1.03-1.67]) between endovascular arch repair with proximal landing zone 2 and open total arch repair. Open total arch repair was considered the first choice based on early and late results; however, endovascular arch repair may be a useful option if the proximal landing zone is limited to zone 2.

Exercise intolerance at hospital discharge as a predictor for readmission and mortality after aortic aneurysm repair

Abstract Background As procedures of aortic aneurysm repair have advanced, an increased number of surgeries performed for older patients and those with comorbidities and low activities of daily living. Conversely, since these patients frequently suffer from difficulty returning to their daily activities after the surgery, physical function is considered an important indicator for risk classification and treatment effect evaluation. However, in patients following aortic aneurysm repair, the association between physical performance and clinical outcomes is not thoroughly evaluated. Purpose We aimed to clarify whether physical function at hospital discharge predicted clinical outcomes, including readmission rates and mortality, in patients following aortic aneurysm repair. Methods This was a single-centre cohort study. We included the patients admitted to a tertiary hospital to undergo surgery or endovascular repair for aortic aneurysm and who received cardiovascular rehabilitation during hospitalisation. As patient characteristics during hospitalisation, age, sex, body mass index (BMI), urgent or standby surgery, surgical type (open repair or endovascular), and comorbidities were obtained from medical records. We also reviewed 6-minute walk distance (6MWD) as physical function at hospital discharge, and 6MWD &amp;lt;300 m was defined as exercise intolerance. The primary and secondary endpoints were readmission and death for all causes, respectively. The multivariate Cox regression analysis was used to examine whether exercise tolerance predicted the endpoints. Results The 365 patients were studied for analysis. Exercise intolerance was observed in 107 patients (29.3 %). During the median follow-up period of 2.3 years, readmission and mortality for all causes occurred in 161 (44.1 %) and 39 (10.7 %), respectively. After adjusting for patient characteristics, including age, sex, BMI, urgent or standby surgery, and surgical type, exercise intolerance defined by 6MWD &amp;lt;300 m was significantly associated with higher mortality (adjusted hazard ratio [aHR]: 2.21, 95% confidence interval [CI]: 1.05–4.66, Figure 1-A) and readmission rates (aHR: 1.63, 95% CI: 1.13–2.34, Figure 1-B). Conclusions In patients following aortic aneurysm repair, exercise intolerance at hospital discharge independently predicted readmission and death for all causes. Our findings suggest that physical function after the aortic aneurysm repair is a useful predictor for patient risk classification and an indicator for treatment effect evaluation.

Establishment and validation of a prediction model for the outcome of rheumatic mitral valve repair surgery based on transthoracic echocardiography

Abstract Background The outcome of mitral valve repair over replacement in degenerative diseases has been recognized, but the patient selection of mitral valve repair in rheumatic diseases are still controversial. At present, there is a lack of comprehensive evaluation methods for rheumatic mitral valve disease, which cannot guide the selection of patients before surgery. Purpose The aim of this study was to establish a comprehensive evaluation method and innovative indicators for rheumatic mitral valve disease using transthoracic echocardiography, and to establish a model for predicting the outcome of rheumatic mitral valve repair. Methods This prospective, multicenter, observational cohort study included 167 patients who underwent rheumatic mitral valve surgery in 4 centers from 2022 to 2023. Each enrolled patient underwent a comprehensive transthoracic echocardiography evaluation and measured 94 ultrasound indicators, mainly covering leaflets, annulus, subvalvular apparatus, and atrial and ventricular function. The main endpoint event was the failure of mitral valve repair (including switching to replacement after repair, and moderate to severe stenosis or regurgitation during follow-up after repair). Patients were randomly assigned to the modeling and validation groups at a ratio of 7:3. In the modeling group, LASSO regression was used for variable selection, and logistic regression was used for modeling. A nomogram was drawn and a webpage rating calculator was created. In the validation group, model comparisons were conducted using the C-statistic and Net Reclassification Index (NRI). Results 112 patients (67.1%) underwent mitral valve repair with satisfactory results, 47 patients (28.1%) ultimately underwent mitral valve replacement, and 8 patients (4.8%) found moderate to severe mitral stenosis or regurgitation during follow-up after repair. Three indicators, including mitral valve orifice area, leaflet calcification score, and anterior leaflet-annulus angle, were selected through LASSO regression. No collinearity was found between the three indicators, and they were ultimately included in the logistic regression model. The C statistics in the modeling group and validation group were 0.846 and 0.958, respectively, indicating that the constructed model has satisfactory predictive ability. Compared to the Wilkins score, the proportion of correctly classified items increased by 19.8%, significantly better than the Wilkins score. Finally, a nomogram was drawn based on the model, and a web rating calculator was created to guide clinical decision-making. Conclusion This study explored a comprehensive evaluation method and innovative indicators for rheumatic mitral valve disease by transthoracic echocardiography, established and validated a model for predicting the outcome of repair surgery, and had certain guiding significance for doctors to choose suitable patients for rheumatic mitral valve repair.Validation of the predictive modelNomogram

Changes in mitral and tricuspid valve morphology after surgical repair of pectus excavatum

Abstract Background The effect of pectus excavatum (PE) on cardiac morphology and function has been reported previously. The right heart chamber size and cardiac output improved after the surgical correction of PE. However, the effect on the mitral and tricuspid valve has not been investigated. Purpose Our purpose was to investigate the morphological changes in the tricuspid and mitral valve after PE surgery. Methods We enrolled 25 patients who underwent Nuss surgery for PE repair. The inclusion criteria were 1) aged 15 years or older, 2) Haller Index of more than 5.0, and 3) transesophageal echocardiography (TEE) during PE surgery. We measured RV size and the sphericity index of tricuspid and mitral valve using 3D echocardiography before and after the elevation of the sternum. The sphericity index was calculated as the ratio of anterior-posterior (AP)/medial-lateral (ML) dimeter for the mitral valve (MV) and septal-lateral (SL) / AP dimeter for the tricuspid valve (TV). Results Mean age was 26±11 years, and 28% was female. The Haller index was 6.9 ± 2.8. All patients had normal left ventricular and right ventricular function evaluated with transthoracic echocardiography. The chamber diameter of the base and mid in RV increased after the elevation of the chest. The AP and SL dimeter were enlarged after the elevation of the chest in the TV, and the sphericity index of TV did not change. On the other hand, AP diameter increased but ML diameter was constant in the MV, and the sphericity index of MV increased after the elevation of the chest. Therefore, the annulus size was increased but the morphology was not changed in the TV. Unlike the TV, the morphology of MV annulus became close to circular from flat shape. In several patients, trivial mitral regurgitation was observed after elevation of chest, and possibly affected by the morphological change of the MV annulus. Conclusions The surgical repair for pectus excavatum effected not only right ventricular morphology but also on the tricuspid and mitral valve. The annulus change was different between the tricuspid and mitral valve.

Biological effects of radiation exposure in patients treated with X-ray guided endovascular aortic repair

Abstract Background X-ray guided cardiovascular interventions such as endovascular aortic repair (EVAR) expose patients and operators to significant amounts of repeated ionising radiation over a long period of time. The biological effect of such protracted radiation exposure is poorly understood. We have previously demonstrated a higher incidence of dicentric chromosome (DC) aberrations in high-volume endovascular interventionalists and differences in acute DNA damage in lymphocytes between individuals following in vitro irradiation. Studies suggested a higher incidence of cancer in patients who underwent EVAR compared with those who have had open aneurysm repair, but the evidence is inconclusive. Further work is required to evaluate the biological radiation risk of X-ray guided cardiovascular interventions. Purposes We aimed to examine radiation-induced genome instability from patients after complex EVAR. We also aimed to investigate the intrinsic response of each patient to radiation using biomarkers of acute DNA damage following in vitro irradiation of their blood and to correlate this response to the expression of radiation-responsive genes. Methods Lymphocytes were isolated from patients after complex (branched/fenestrated) EVAR and non-irradiated controls. DC, a type of chromosomal aberration caused by radiation exposure were enumerated. γ-H2AX, a marker of acute DNA damage/repair, was measured by immunofluorescence after in vitro irradiation at 0.2 Gy and 1 Gy, along with the expression of the radiation-responsive genes FDXR, CCNG1, P21 and PHPT1 using qPCR. Results 17 patients (82% male, median age 73[59 – 85years]) and 16 controls (56% male, median age 68[53 – 83years]) were recruited. The mean incidence of DC was 3.782 (95% CI 3.13 - 4.43) and 0.898 (95% CI 0.48 -1.32) per 1000 cells for patients and controls, respectively (P&amp;lt;0.0001). Patients had higher background of γ-H2AX foci than unexposed controls, (0.7056, 95% CI 0.316 - 1.10) vs (0.241 95% CI 0.077 - 0.405) per cell, P&amp;lt;0.05. FDXR expression was most increased following irradiation (P&amp;lt;0.0001), reaching a mean 13.1-fold and 11.4-fold increase at 4-hour and 24-hour time-point, respectively, but this upregulation was not significantly different between the two groups. Conclusion We have shown an increased frequency of chromosomal aberrations in patients after complex EVAR, a biological finding that may support a propensity to developing malignancies. Patients also have higher basal DNA damage/repair (γ-H2AX) activity. Expression of ferredoxin reductase, FDXR gene could be a potential radio-responsive biomarker to provide personalised biological dosimetry information for clinical monitoring. Our study further underlines the long-term radiation risk of X-ray guided cardiovascular interventions and the potential of biological assays that may guide personalised care.

Experimental Studies of Corrosion Resistance of Welded Seams of Steel Structures with a High Sulfur Content in Surface Layers Using Modern Methods of Modeling

Analysis of literature sources and empirical data indicate a variety and a large volume of experimental material, which often characterizes the uncertainty and contradiction of information regarding the effect of sulphur and manganese on the corrosion behaviour of steels obtained using traditional methods. This leads to the need to search for new, alternative methods for its effective analysis. The task of assessing and predicting the corrosion properties of structural steels is a key one in the general problem of managing the operational reliability of welded metal structures and equipment for the chemical, metallurgical, oil and gas, mining and other industries. The possibilities of its solution consist of using new information technologies, a component of which is intelligent means of information processing, such as artificial neural networks (ANN). The use of ANN makes it possible to create qualitatively new hardware and software that significantly expand the classes of emerging problems and increase the efficiency of analysis and forecasting. In the process of long-term operation of metal structures in many industrial industries, the metal is in direct contact with sulfur-containing agents at high temperatures. This leads to the saturation of the surface layer of the metal with sulfur with a concentration of up to 0.6%, which further makes it impossible to carry out repair and welding operations due to the formation of hot cracks. It was found that adding metallic manganese into the electrode coating in an amount of 20-25% significantly increases (4-5 times) the resistance against the formation of hot cracks. Sulfur content in the deposited metal has the opposite effect on the appearance of hot cracks. So, with a sulfur content of 0.042% and more, the resistance of the metal against the formation of hot cracks decreases sharply. It is shown that an increase in the content of metallic manganese in the electrode coating significantly reduces the content of dissolved sulfur in the deposited metal. Moreover, this tendency is typical for steels with different sulfur content in the surface layers and with different service life. For example, for steel with a service life of 20 years, the initial sulfur content in the surface layer of the metal (up to 1 mm) was about 0.52%. Adding metallic manganese in the coating of electrodes in an amount of 20-25% made it possible to reduce the sulfur content in the deposited metal to 0.03-0.045%, i.e. 12.6-17.3 times. In addition, the corrosion rate decreases with an increase in the content of metallic manganese in the electrode coating. The lowest corrosion rate for all steels involved in the research was established at 20-25% manganese content in the coating.

Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report

Acute Large Bowel Obstruction Post Umbilical Hernia Repair Surgery: A Case Report

Monocytes perturbation implicated in the association of stress hyperglycemia with postoperative poor prognosis in non-diabetic patients with Stanford type-A acute aortic dissection

ObjectivesThe study aimed to investigate the interaction of intraoperative stress hyperglycemia with monocyte functions and their impact on major adverse events (MAEs) in acute aortic dissection (AAD) patients who underwent open repair surgery.MethodsA total of 321 adults who underwent open surgery for AAD at two tertiary medical centers in China were enrolled in the study. The primary endpoint was defined as the incidence and characteristics of perioperative stress hyperglycemia. The secondary endpoints included the incidence of postoperative MAEs, postoperative monocyte counts and inflammatory cytokine expression. Multi-logistic, linear regression and receiver operating characteristic (ROC) curve analyses were used to establish relationships between intraoperative time-weighted average glucose (TWAG), day-one postoperative monocyte counts, serum inflammatory cytokines and postoperative outcomes. In addition, in vitro experiments were conducted to evaluate changes in the inflammatory features of monocytes under high glucose conditions.ResultsIntraoperative hyperglycemia, as indicated by a TWAG level over 142 mg/dL, was associated with elevated postoperative monocyte counts and inflammatory cytokines, which correlated with extended intensive care unit (ICU) stays and worsened outcomes. In vitro, high glucose treatment induced mitochondrial impairment in monocytes, increased the release of inflammatory cytokines and the proportion of classical monocytes from AAD patients.ConclusionsIntraoperative stress hyperglycemia, in combination with day-one postoperative monocyte counts, were clinically significant for predicting adverse outcomes in AAD patients undergoing open repair surgery. Elevated glucose concentrations shaped the inflammatory features of monocytes in AAD by impairing mitochondrial functions.Graphical abstractHigh glucose-driven mitochondrial functional impairment mediates a more pronounced monocytic inflammatory state in Stanford type-A AAD.

Outcome of mini open anterolateral rotator cuff repair by suture anchor

Background: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments. Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated. Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p&lt;0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p&lt;0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p&lt;0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients. Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies.

A Systematic Review of Renal Perfusion in Complex Abdominal Aortic Aneurysm Open Repair

Introduction: This systematic review aims to analyze the current literature regarding 30-day mortality and postoperative acute kidney disease (AKI) in complex abdominal aortic aneurysms (cAAAs), which included juxtarenal aortic aneurysm (JAA), suprarenal aortic aneurysm (SRAA), and type IV thoracoabdominal aortic aneurysm (TAAA) open surgery (OS), to evaluate the impact of renal perfusion on AKI and to try to define which is the best way to perform it. Methods: A literature search in PubMed and Cochrane Library was performed, and articles published from January 1986 to January 2024 reporting on JAA, SRAA, and TAAA type IV open surgery management were identified. Multicenter studies, single-center series, and case series with ≥10 patients were considered eligible. Comparisons of outcomes of patients who underwent OS for complex abdominal aortic aneurysms (cAAAs) with or without perfusion of the renal arteries were analyzed when available. The titles, abstracts, and full texts were evaluated by two authors independently. The primary outcomes included AKI and 30-day mortality rates. The new-onset dialysis rate was considered a secondary outcome. Results: A total of 295 articles were evaluated, and 21 were included, totaling 5708 patients treated for cAAAs with OS. The male patients totaled 4094 (71.7%), with a mean age of 70.35 ± 8.01 and a mean renal ischemia time of 32.14 ± 12.89 min. Data were collected and analyzed, at first in the entire cohort and then divided into two groups (no perfusion of the renal arteries—group A vs. selective perfusion—group B), with 2516 patients (44.08%) who underwent cAAAs OS without perfusion of the renal arteries and 3192 patients (55.92%) with perfusion. In group B, four types of renal perfusion were reported. Among the 21 studies included, 10 reported on selective renal perfusion in cAAA OS, with several types of fluids described: (1) “enriched” Ringer’s solution, (2) “Custodiol” (Istidine-tryptophan-ketoglutarate or Custodiol HTKsolution), (3) other cold (4 °C) solutions (i.e., several combinations of 4 °C isotonic heparinized balanced salt solution containing mannitol, sodium bicarbonate, and methylprednisolone), and (4) warm blood. Thirty-day mortality for patients in group A was 4.25% (107/2516) vs. 4.29% (137/3192) in group B. The reported incidence of AKI and new onset of dialysis was, respectively, 22.14% (557/2516) and 5.45% (137/2516) for group A and 22.49% (718/3192) and 4.32% (138/3192) for group B. A total of 579 patients presented with chronic kidney disease (CKD) at admission across all studies, which included 350 (13.91%) in group A vs. 229 (7.17%) in group B. Acute kidney injury, 30-day mortality, and new-onset dialysis rate were reported in four subgroups: (1) In the “Ringer” group, 30-day mortality was 2.52% (3/113), AKI affected 27.73% (33/119) of patients, and the new-onset dialysis rate was 2.52% (3/113). (2) In the “Custodiol” group, 30-day mortality was 3.70% (3/81), AKI affected 20.17% (24/81) of patients, and the new-onset dialysis rate was 2.46% (2/81). (3) In the “cold solutions” group (i.e., NaCl and mannitol), 30-day mortality was 4.38% (130/2966), AKI affected 21.81% (647/2966) of patients, and the new-onset dialysis rate was 4.48% (133/2966). (4) In the “Warm blood” group, 30-day mortality was 3.85% (1/26), AKI affected 53.84% (14/26) of patients, and the new-onset dialysis rate was 0% (0/26). Conclusions: This systematic review highlights the lack of standard definitions for AKI, CKD, and the type of renal perfusion. Despite similar results in terms of AKI and 30-day mortality, renal perfusion seems to be protective of the new-onset hemodialysis rate. Moreover, Custodiol appears to have lower rates of AKI and hemodialysis than the other perfusion types. A prospective randomized controlled trial to perform further subgroup analysis and research the various types of renal perfusion may be necessary to identify possible benefits.

Effectiveness of 2 Lip Taping Techniques in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial.

This trial was designed to test the efficacy of 2 lip taping methods in modifying the maxillary arch dimensions (MADs) of infants with bilateral cleft lip and palate (BCLP) before lip repair surgery. Parallel-group randomized clinical trial. The trial was conducted at 3 centers in Baghdad city. Thirty-six nonsyndromic infants with BCLP. The eligible infants were randomly assigned to either the first experimental group that received a conventional horizontal tape (3 M Steri strip-1/4 inch) or the second experimental group that received a custom-made tape made of Steri strips and orthodontic extra oral elastics. All of the included infants in both groups had rubber base impressions taken for them at the start of treatment (T1) and right before surgical lip repair (T2). A desktop scanner was used to scan each of the generated models, creating digital models that could be used for outcome evaluation. Virtual MAD measurements were performed by a blinded assessor on the generated digital models both before (T1) and after (T2) treatment. At T2, both groups showed statistically significant changes in all measured MADs, with a mean difference ranging from 1.36 to 2.95 mm for the conventional taping group and from 1.46 to 7.96 mm for the custom-made one. The comparison of the 2 groups revealed both statistically and clinically significant differences with a P value <.05. The custom-made taping demonstrated more constriction in maxillary arch in terms of changes, which could provide easier surgical manipulation for the cleft parts. Lip taping appears to be an efficient technique for modifying the MADs in infants with BCLP.

List-Based Threshold Accepting Algorithm with Improved Neighbor Operator for 0–1 Knapsack Problem

The list-based threshold accepting (LBTA) algorithm is a sophisticated local search method that utilizes a threshold list to streamline the parameter tuning process in the traditional threshold accepting (TA) algorithm. This paper proposes an enhanced local search version of the LBTA algorithm specifically tailored for solving the 0–1 knapsack problem (0–1 KP). To maintain a dynamic threshold list, a feasible threshold updating strategy is designed to accept adaptive modifications during the search process. In addition, the algorithm incorporates an improved bit-flip operator designed to generate a neighboring solution with a controlled level of disturbance, thereby fostering exploration within the solution space. Each trial solution produced by this operator undergoes a repair phase using a hybrid greedy repair operator that incorporates both density-based and value-based add operator to facilitate optimization. The LBTA algorithm’s performance was evaluated against several state-of-the-art metaheuristic approaches on a series of large-scale instances. The simulation results demonstrate that the LBTA algorithm outperforms or is competitive with other leading metaheuristics in the field.

Tabular review of contemporary open surgical repair experiences for treatment of thoracoabdominal aortic aneurysms.

Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is one of the most challenging operations due to extensive surgical dissection and exposure, risk of complications and need for reconstruction of the aorta and its branches. In the last two decades, endovascular techniques have evolved and now are considered a viable alternative to open surgical repair in patients with suitable anatomy. Regardless of which technique is selected, open or endovascular, reduction of postoperative morbidity and mortality requires large clinical volume, optimal patient selection and a multidisciplinary team that can take care of the surgical, anesthetic, critical care and postoperative issues that occur after these operations. The aim of this article is to summarize the clinical data on open surgical repair of thoracoabdominal aortic aneurysms in a schematic tabular format.

Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study.

Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used as a minimally invasive alternative to open surgical repair to treat patients with thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to evaluate aortic-related mortality (ARM) and aortic aneurysm rupture after FB-EVAR of TAAAs. Patients enrolled in 8 prospective, nonrandomized, physician-sponsored investigational device exemption studies between 2005 and 2020 who underwent elective FB-EVAR of asymptomatic intact TAAAs were analyzed. Primary end points were ARM, defined as any early mortality (30 days or in hospital) or late mortality from aortic rupture, dissection, organ or limb malperfusion attributable to aortic disease, complications of reinterventions, or aortic rupture. Secondary end points were early major adverse events, TAAA life-altering events (defined as death, permanent spinal cord injury, permanent dialysis, or stroke), all-cause mortality, and secondary interventions. A total of 1109 patients were analyzed; 589 (53.1%) had extent I-III and 520 (46.9%) had extent IV TAAAs. Median age was 73.4 years (interquartile range, 68.1-78.3 years); 368 (33.2%) were women. Early mortality was 2.7% (n=30); congestive heart failure was associated with early mortality (odds ratio, 3.30 [95% CI, 1.22-8.02]; P=0.01). Incidence of early aortic rupture was 0.4% (n=4). Incidence of early major adverse events and TAAA life-altering events was 20.4% (n=226) and 7.7% (n=85), respectively. There were 30 late ARMs; 5-year cumulative incidence was 3.8% (95% CI, 2.6%-5.4%); older age and extent I-III TAAAs were independently associated with late ARM (each P<0.05). Fourteen late aortic ruptures occurred; 5-year cumulative incidence was 2.7% (95% CI, 1.2%-4.3%); extent I-III TAAAs were associated with late aortic rupture (hazard ratio, 5.85 [95% CI, 1.31-26.2]; P=0.02). Five-year all-cause mortality was 45.7% (95% CI, 41.7%-49.4%). Five-year cumulative incidence of secondary intervention was 40.3% (95% CI, 35.8%-44.5%). ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related. Late all-cause mortality rate and the need for secondary interventions were 46% and 40%, respectively, 5 years after FB-EVAR. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02089607, NCT02050113, NCT02266719, NCT02323581, NCT00583817, NCT01654133, NCT00483249, NCT02043691, and NCT01874197.

Ventral hernia repair with permanent mesh for non-Hispanic black versus white patients: access and post-operative outcomes in the era of robotic surgery.

Robotic ventral hernia surgery may provide better patient outcomes. Whether it is provided equitably based on race remains unknown. We examined whether patients from the Abdominal Core Health Quality Collaborative who were Black had equitable access to robotic surgery for ventral hernia repair with permanent mesh compared to white counterparts from 2013 to 2023. We performed propensity-score matching to address confounding and then chi-squared testing to examine access to robotic, laparoscopic, and open approaches. Secondary outcomes included 30-day readmissions, complications, and death and 1- and 2-year hernia recurrence and quality of life measured by HerQLes Summary and PROMIS Pain T-Scores analyzed with chi-squared, Fisher exact, and Wilcoxon testing. 2397 patients identified as Black, and 21,900 identified as white. Our propensity-score matched cohort included 2374 Black patients and 7122 white. Black and white groups had the same rates of laparoscopy (15% vs 15%). Patients who identified as Black were more likely to undergo robotic surgery (36% vs 32%). Open approach was 49% for Black and 53% for white (p = 0.005). For 30-day complications, we found Black patients were more likely to experience reoperation (2% vs 1%, p = 0.005) and less likely surgical site infection (1% vs 2%, p < 0.001). Hernia recurrence scores and perceived abdominal health based on HerQLes were not statistically significantly different. At 2years, absolute reported T-Scores were higher for Black patients (median 40 (IQR 31-49) vs 36 (31-46), p = 0.031). This is the first large-scale study examining access to robotic surgery, complications, and quality of life measures. We found patients who identified as Black were more likely than white counterparts to undergo robotic surgery, but they were more likely to require reoperation and had higher pain scores. Our data suggest equitable access still may not translate to equitable patient outcomes.

Ultrasound Therapy as a Treatment for Valvular Aortic Stenosis: A Review.

Calcific aortic stenosis is the most common form of aortic stenosis, and offers a poor prognosis in affected patients. Current treatment methods for aortic stenosis, including open surgical aortic valve repair and transcatheter aortic valve replacement, are invasive, and require the patient to undergo open-heart surgery with cardiopulmonary bypass. Ultrasound therapy offers a potential solution for patients ineligible for traditional surgical treatment. Noninvasive ultrasound therapy allows for decalcification of aortic valves without open sternotomy or cardiopulmonary bypass. This article reviews the use of ultrasound therapy for aortic stenosis, including this newer method of noninvasive ultrasound therapy.

Pneumaturia and Colonic Bleeding Post-Inguinal Herniorrhaphy: A Case Report

Introduction: A 51-year-old male was seen complaining of pneumaturia and bowel complaints, including blood per rectum. The patient related a history of an open left inguinal hernia repair utilizing a Kugel mesh ten years before. Case Presentation: Cystoscopy and colonoscopy demonstrated a hemorrhagic mass due to a prosthetic mesh protruding into the bladder and colon. Following colonoscopy and cystoscopy, a large inflammatory mass involving both the colon and urinary bladder was resected, which contained a rolled-up “tubular” mesh structure. After primary repair of the urinary bladder and placement of a Foley catheter, the sigmoid colon and mesh were resected, and the colonic anastomosis was completed. Outcome: Postoperatively, the patient progressed well with normal colon and bladder function after the removal of the Foley catheter. Discussion: Historically, the patient demonstrated the risk of major multiorgan surgical complications of a newer inguinal hernia repair technique, which may occur even a decade or more after the initial surgical correction and is, therefore, presented.

Sensory assessment of intramuscular quadratus lumborum block at the L2 level in open inguinal hernia repair patients

BackgroundThe effectiveness of the quadratus lumborum block (QLB) for postoperative pain management depends on the injection pathway used. There is limited research on the block area produced by intramuscular injection of local anesthesia in the quadratus lumborum muscle. This study aimed to determine the cutaneous sensory blockade area produced by an intramuscular quadratus lumborum block (QLBi) at the L2 level.MethodsTwenty patients aged 18–60 years with ASA grade I-II and a BMI of 18–30 kg/m2 who were scheduled for open inguinal hernia repair with mesh underwent ultrasound-guided QLBi injection of 20 ml of 0.5% ropivacaine. The cutaneous sensory blockade area was measured by applying a cold stimulus 1 h after the block and then measured every hour after surgery until the sensation returned to normal. The duration of a blockade is defined as the time it takes for all affected areas to fully regain normal sensation following a blockade. Pain scores (numeric rating scale, NRS) were recorded at 2, 4, 8, 12, and 24 h after surgery. Adverse reactions to QLBi were recorded 24 h after surgery.ResultsAll 20 patients had reduced or lost cold sensation areas. The greatest extent of cold sensation reduction occurred at T7 (10%), and the least amount of cold sensation reduction occurred at L3 (10%). The block level covered T8 (20%), T9 (30%), T10 (45%), T11 (90%), T12 (95%), L1 (100%), and L2 (15%). Eighteen patients experienced areas of sensory loss, with the highest range at T11 and the lowest at L2. The duration of the blockade was 8.9 ± 3.8 h, with a maximum of 24 h and a minimum of 5 h. One patient experienced quadriceps weakness after surgery.ConclusionQuadratus lumborum block of intramuscular pathway can produce effective cutaneous sensory blockade, which can be used for postoperative analgesia of indirect inguinal hernia operation, and may also be beneficial to analgesia of other lower abdominal operations. However, the best method needs further confirmation to determine specific anesthesia methods for various operations.Chinese clinical trial registryJune 2, 2018; ChiCTR1800016457.