Results Of Surgical Treatment Research Articles

Biportal Endoscopic Trans-Kambin Lumbar Interbody Fusion: Surgical Techniques and Treatment Outcomes

Objective: Lumbar interbody fusion with cages is a commonly used surgical solution for spinal conditions that do not respond to conservative management. Biportal endoscopic trans-Kambin lumbar interbody fusion (BE-KLIF) is a modern technique that offers several benefits over prior techniques, including early ambulation, reduced postoperative pain, and shorter hospital stays.Methods: This retrospective study enrolled 128 patients who underwent BE-KLIF between March 2018 and August 2022. The primary indications for surgery were segmental lumbar listhetic instability, failed decompression with neuroforamen stenosis, adjacent segment disease, and burst fracture of the lumbar vertebrae. The outcome measures included Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, and postoperative fusion status at 1 year after the procedure was graded using the Bridwell fusion grading scale.Results: BE-KLIF yielded significant improvements in patient outcomes. Successful fusion was achieved in 91.8% of segments. The mean ODI score was significantly lower at the 1-year follow-up than before the procedure. Similarly, VAS scores for leg and back pain significantly improved after the procedure. Seven early and 3 late postoperative complications were observed. The mean length of hospital stay was shorter for BE-KLIF than for the older transforaminal lumbar interbody fusion technique.Conclusion: BE-KLIF resulted in less bone removal, preservation of the facet joint, facilitation of a more oblique trajectory, and potential for larger cages with wider effacements compared with prior techniques. However, the technique lacks central and contralateral decompression. We recommend performing same-side unilateral laminotomy with bilateral decompression to provide central and contralateral decompression.

Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults

ObjectiveThe best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults.MethodsIn our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6–18 years; AG3, ≥ 18 years).ResultsSixty-two patients (median age 26.5 years, range 0–82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1–87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis.ConclusionsIn patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.

Surgery for Secondary Spontaneous Pneumothorax with Chronic Lung Diseases.

Secondary spontaneous pneumothorax (SSP) is occasionally observed in elderly patients suffering from diffuse lung diseases. The purpose of this study was to analyze the outcomes of surgical treatment of SSP patients with chronic lung diseases. In total, 242 patients who underwent surgery for spontaneous pneumothorax at Chiba University Hospital from January 2006 to October 2016 were included in this study. The patients' records were reviewed retrospectively for data on their background, surgical treatment, morbidity, mortality, and recurrence. Of the spontaneous pneumothorax cohort, primary spontaneous pneumothorax (PSP) accounted for 144 patients. Among the 98 patients with SSP, 57 cases were caused by chronic obstructive pulmonary disease (COPD) and 21 were caused by interstitial pneumonia (IP). The postoperative complication rate was 19.3% in the COPD group, 42.9% in the IP group, and 11.1% in the PSP group. The recurrence rate was 5.3% in the COPD group, 28.6% in the IP group, and 21.5% in the PSP group. The morbidity and recurrence were comparable between PSP and SSP cases with COPD, whereas these values were unfavorable in SSP cases with IP compared with PSP ones. Surgical intervention should be carefully considered in SSP patients with IP.

P433 Short-term outcomes of surgical treatment in primary ileocecal Crohn’s disease patients. Results of Crohn’s(urg) study, multicenter, retrospective, comparative analysis between indications for luminal and complicated phenotype

Abstract Background Recent evidence challenges the current standard of offering surgery to patients with ileocecal Crohn’s disease only when they present complications of the disease. Methods A retrospective, multicenter comparative analysis was performed including patients operated for primary ileocecal CD at 12 referral centers. Patients were divided in 2 groups, according to indication of surgery for inflammatory (ICD) or complicated (CCD) phenotype. Short-term results were compared. Patients operated on for primary isolated ileocaecal CD (last 50 cm of the terminal ileum and cecum), either for predominantly inflammatory phenotype or for complications of the disease (stricturing or fistulizing pattern), between January 2012 - December 2021 were considered eligible to participate in this study. Patients with previous abdominal procedures for CD, and patients who had activity of the disease in other intestinal segments other than the ileocaecal region at the time of surgery, were excluded from the study. Results 2013 patients were included, 291 (14.5%) in the ICD group. No differences were found between groups in time from diagnosis to surgery or in the levels of exposure to biologic drugs before indication of surgery. CCD patients had higher rates of low BMI, anemia (40.9 vs. 27%, p: &amp;lt; 0.001), and low albumin (11.3 vs. 2.6%, p: &amp;lt; 0.001). CCD patients had longer operations, lower rates of laparoscopic approach (84.3 vs. 93.1%, p: 0.001), and higher conversion rates (9.3 vs. 1.9%, p: &amp;lt; 0.001). CCD had longer hospital stay and higher postoperative complication rates (26.1 vs. 21.3%, p: 0.083). Anastomotic leakage and reoperations were also more frequent in this group. More patients in the CCD group required an extended bowel resection (14.1 vs. 8.3%, p: 0.017). In multivariate analysis, CCD was associated with prolonged surgeries (OR: 3.44, p: 0.001) and requirements of multiple intraoperative procedures (OR: 8.39, p: 0.030). Conclusion Indication of surgery in patients who present an inflammatory phenotype of CD was associated with better outcomes when compared to patients operated on for complications of the disease, without a difference between groups in time from diagnosis to surgery.

The Association of Tobacco Smoking and Level of Apoptosis in the Long Head of the Biceps Chronic Tendinopathy—An Immunohistochemical Study

Background: The substances present in cigarette smoke have a negative impact on cellular integrity and metabolism, can reduce blood flow to tissues, and can disrupt collagen synthesis. Ultimately this can lead to cell death, which clinically may result in impaired tendon healing and the onset of chronic tendinopathy. Within the shoulder, the exact association between the extent of apoptosis in the long head of the biceps (LHB) tendon and harmful factors like cigarette smoke remains unclear. Objectives: The purpose of this study was to investigate the connection between smoking, the degree of apoptosis in LHB tendinopathy, and the long-term outcomes of surgical treatment. Design: Observational, retrospective study. Methods: This study included 22 consecutive patients who had undergone arthroscopic biceps tenodesis or tenotomy for symptomatic LHB tendinopathy with or without concomitant rotator cuff tears (RCT). The intra-articular LHB tendon remnants were histologically examined by measuring the level of expression of apoptotic cell markers such as BCL2, cleaved caspase 3, and p53. Pre- and postoperative clinical outcomes were analyzed by collecting patient report outcome measures such as the American Shoulder and Elbow Surgeons (ASES) score and the Visual Analogue Scale (VAS) for pain. Results: The smokers group had a mean pack-year history of 13.12 (SD = 9.94), mean number of cigarettes per day of 14.77 (SD = 4.64), and a mean smoking duration of 16.38 (SD = 10.1) years. Among the smoking indexes, the number of cigarettes per day showed a positive correlation with Snyder classification (p = 0.0459, rho = 0.3682). Non-smokers and smokers did not show a statistically significant difference in the expression indexes of BCL2, cleaved caspase 3, or p53 (p = 0.4216, p = 0.5449, p = 0.5613, respectively). However, the cleaved caspase 3 expression index showed a negative correlation with the severity of rotator cuff lesions in the total population (p = 0.0193, rho = −0.4651). Conclusions: While apoptotic processes in the LHB tendon were observed, no significant association was found between tobacco smoking, the extent of apoptosis, and clinical outcomes. However, the expression of the apoptotic marker cleaved caspase 3 correlated with the severity of rotator cuff pathology. Furthermore, active smoker status was associated with worse clinical outcomes in terms of pain following LHB tenodesis or tenotomy.

Surgical Treatment of Abdominal Aortic Aneurysms. A Retrospective Study.

Introduction: Surgical treatment of abdominal aortic aneurysms poses a significant challenge in the field of vascular surgery, with numerous factors influencing operative technique and surgical outcome.&#x0D; This study aimed to assess the outcomes of open surgical treatment for patients with abdominal aortic aneurysms at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana and provide recommendations for improving outcomes.&#x0D; Material and Methods: A single-center, non-randomized, retrospective study of the results of open surgical treatment of abdominal aortic aneurysms in 206 patients from January 2008 to December 2015 was performed at the Vascular Surgery Service of University Hospital Centre “Mother Teresa” Tirana. The study only included patients with a histologically confirmed diagnosis of abdominal aortic aneurysm, while patients with ruptured abdominal aortic aneurysm were excluded.&#x0D; The study evaluated the incidence of abdominal aortic aneurysms, clinical and imaging findings of the disease (ultrasound, tomographic, and arteriographic), frequency of involvement of the iliac artery in the pathological process, and postoperative complications. Transabdominal access was the most commonly utilized, while retroperitoneal access was deemed the safest. No significant differences in recurrence rates were noted between the two approaches.&#x0D; Results: During the study period, 206 patients underwent surgery for AAA and met the inclusion criteria. Of these, 188 (91.3%) were male and 18 (8.7%) were female. The mean age of the patients was 67.8±5.7 years, with 67.7±5.9 years for men and 69±3.1 years for women. There were no statistically significant differences in age between genders (p&gt;0.05).&#x0D; Conclusion: In all other cases of abdominal aortic aneurysms, surgical treatment should be strongly recommended. Finally, given the clinical benefits of using surgical treatment of asymptomatic aneurysms to reduce mortality, it is necessary to conduct an economic assessment of the feasibility of abdominal aortic aneurysms screening in the population over 55 of the age of both sexes.&#x0D;  

Deep-learning-based diagnosis and grading of vesicoureteral reflux: A novel approach for improved clinical decision-making

Background/Aim: Vesicoureteral reflux (VUR) is a condition that causes urine to flow in reverse, from the bladder back into the ureters and occasionally into the kidneys. It becomes a vital cause of urinary tract infections. Conventionally, VUR’s severity is evaluated through imaging via voiding cystourethrography (VCUG). However, there is an unresolved debate regarding the precise timing and type of surgery required, making it crucial to classify VUR grades uniformly and accurately. This study’s primary purpose is to leverage machine learning, particularly convolutional neural network (CNN), to effectively identify and classify VUR in VCUG images. The aspiration is to diminish classification discrepancies between different observers and to create an accessible tool for healthcare practitioners. Methods: We utilized a dataset of 59 VCUG images with diagnosed VUR sourced from OpenI. These images were independently classified by two seasoned urologists according to the International Reflux Classification System. We utilized TensorFlow, Keras, and Jupyter Notebook for data preparation, segmentation, and model building. The CNN Inception V3 was employed for transfer learning, while data augmentation was used to improve the model’s resilience. Results: The deep-learning model attained exceptional accuracy rates of 95% and 100% in validation and training, respectively, after six cycles. It effectively categorized VUR grades corresponding to the global classification system. Matplotlib tracked loss and accuracy values, while Python-based statistical analysis assessed the model’s performance using the F1-score. Conclusion: The study’s model effectively categorized images, including those of vesicoureteral reflux, which has significant implications for treatment decisions. The application of this artificial intelligence model may help reduce interobserver bias. Additionally, it could offer an objective method for surgical planning and treatment outcomes.

Comprehensive Geriatric Assessment of Older and Oldest-Old Patients in the Perioperative Period. Russian Gerontology Research and Clinical Centre Experience

With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness.Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty).Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An  individual plan of  perioperative management was drawn up.Results. A  comparative analysis demonstrated statistically significant improvements in  functional status (based on  the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group.Conclusion: the management of  patients with frailty in  the perioperative period with the use of  CGA allows for preventive measures aimed at  maintaining functional, psycho-emotional status. Individual characteristics of  the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.

Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome

Abstract Background Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach's procedure and tendon transfers are not well described. The primary aim of this study was to report patient-reported functional outcome measures after surgery for VJS. Secondary aims were to report health-related quality-of-life scores, patient satisfaction, and complications Methods A single-center retrospective study was performed to identify patients who underwent surgical intervention for the management of VJS. Patient-reported outcomes were measured using the Patient-Rated Wrist and Hand Evaluation (PRWHE), Quick version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), EuroQoL 5-dimensions 5-Likert (EQ-5D-5L), and calculation of the Net Promoter Score (NPS). Results We report postoperative patient-reported functional outcome measures for 12 cases of VJS treated with distal ulna excision and extensor tendon transfer. The mean age was 69 years (range: 45–87 years; standard deviation [SD]: 14.1), and eight patients were females. Five patients had rheumatoid arthritis, and there was one case each of seronegative polyarthritis, ankylosing spondylitis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.) syndrome; the rest of the patients had osteoarthritis. At a mean of 53 months of follow-up, the mean PRWHE score was 34.5 (SD: 17.9), the mean QuickDASH score was 28.2 (SD: 18.6), and the mean EQ-5D-5L score was 0.71 (SD: 0.203). Ten patients were satisfied and the NPS was 42. Postoperatively eight patients had pain scores reported as none or mild, three as moderate, and one as severe. Two patients required further operations, both undergoing total wrist arthrodesis. Conclusion Although a degree of functional deficit persists after Darrach's procedure and tendon transfer for treatment of VJS, there are also high levels of patient satisfaction, a good NPS, and a low rate of operative reintervention. Level IV evidence.

The Outcome of Surgical Removal of Thyroglossal Cyst in Children; Experience of a Decade

Objective: To present postoperative outcome of surgical removal of thyroglossal cyst (TC) in children; single surgeon’s experience of a decade. Methodology:  This is a retrospective study of 10 children admitted at Northern Area Armed Forces Hospital, Hafer Al Batin, Saudi Arabia, with the diagnosis of TC between period of June 2011 to October 2021. All the patients were managed by single surgeon by surgical removal with an average follow up of 5 years. There were six males and six females. The diagnosis was confirmed on clinical examination and supported by ultrasound evaluation of upper neck midline swelling. Surgical excision was done by Sistrunk procedure under general anesthesia. The outcome of surgical treatment of thyroglossal cyst is evaluated post operatively during an average regular follow up of 5 years. Results: All the 10 children were operated by Sistrunk procedure during the period from June 2011 to October 2021 who were admitted with diagnosis of thyroglossal cyst. There were no associated anomalies. All the patients had excellent cosmetic outcome without any problem of wound infection. There is no recurrence of thyroglossal cyst in this series.  Conclusion: Sistrunk surgical procedure to treat thyroglossal cyst in children is safe, effective and feasible with good cosmetic results. It avoids recurrence of thyroglossal cyst and morbidity. We recommend Sistrunk operation as gold standard to treat children with TC.  

Video-assisted thoracoscopic surgery for non-cystic fibrosis bronchiectasis in children.

Pediatric bronchiectasis is a common respiratory disease in children. The use of video-assisted thoracoscopic surgery (VATS) for its treatment remains controversial. The objective of our study was to compare and analyze the clinical efficacy of thoracoscopic surgery and thoracotomy in the treatment of pediatric bronchiectasis and summarize the surgical treatment experience of VATS in children with bronchiectasis. Retrospective single-center cohort study. A retrospective analysis was conducted on the clinical data of 46 pediatric patients who underwent surgery with bronchiectasis at the Children's Hospital of Chongqing Medical University from May 2015 to May 2023. The patients were divided into two groups: the VATS group (25 cases) and the thoracotomy group (21 cases). Comparative analysis was performed on various parameters including basic clinical data, surgical methods, operation time, intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, length of hospital stay, incidence of complications, and follow-up information. There were no statistically significant differences between the two groups of patients in terms of age, weight, gender, etiology, duration of symptoms, site of onset, and comorbidities (p > 0.05). The operation time in the VATS group was longer than that in the thoracotomy group (p < 0.001). However, the VATS group had better outcomes in terms of intraoperative blood loss, transfusion status, postoperative pain, postoperative mechanical ventilation time, chest tube drainage time, and length of hospital stay (p < 0.05). The incidence of postoperative complications in the VATS group was lower than that in the thoracotomy group, although the difference was not statistically significant (p = 0.152). Follow-up data showed no statistically significant difference in the surgical treatment outcomes between the two groups (p = 0.493). The incidence of complications and mortality in surgical treatment of bronchiectasis is acceptable. Compared with thoracotomy surgery, VATS has advantages such as smaller trauma, less pain, faster recovery, and fewer complications. For suitable pediatric patients with bronchiectasis, VATS is a safe and effective surgical method.

Diagnostic challenges in low-grade central osteosarcoma.

Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder's grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome. Based on imaging, 35 of 49 patients (71.4%) exhibited malignant features. Overall, 40 of 49 patients (81.6%) had undergone a biopsy before en-bloc resection: 27 of 40 patients (67.5%) were diagnosed on the first biopsy, which was more accurate when carried out by open rather than needle biopsy (91.3% vs 35.3% diagnostic accuracy, respectively; p < 0.001). Of the 40 patients treated by en-bloc resection, surgical margins were wide in 38 (95.0%) and marginal in two (5.0%). Furthermore, nine of 49 patients (18.4%) underwent curettage (intralesional margin) without previous biopsy. All patients with a positive margin developed local recurrence. Distant metastases occurred in five of 49 patients (10.2%). The mean five-year overall survival (OS) and distant relapse-free survival (D-RFS) were 89.3% (SD 5.1%) and 85.7% (SD 5.5%), respectively. Univariate analysis showed that the occurrence of distant metastasis was a poor prognostic factor for OS (hazard ratio 11.54, 95% confidence interval (CI) 1.92 to 69.17; p < 0.001). Local recurrence was a poor prognostic factor for D-RFS (HR 8.72, 95% CI 1.69 to 45.0; p = 0.002). The diagnosis of LGCOS can be challenging because it may present with non-malignant features and has a low diagnostic accuracy on biopsy. If precisely diagnosed, LGCOS can be successfully treated by surgical excision with wide margins.

Long-Term Outcomes of Non-surgical versus Surgical Treatment for Carpal Tunnel Syndrome: An Observational Cohort Study

Background: Carpal Tunnel Syndrome (CTS) is a common condition that significantly impacts patients' quality of life and work productivity. While both non-surgical and surgical treatments are employed, there is a lack of consensus regarding the most effective management strategy.&#x0D; Objective: This study aims to compare the outcomes of non-surgical and surgical treatments for CTS, focusing on symptom severity, functional status, and patient satisfaction.&#x0D; Methods: This observational cohort study included 74 participants, with 37 in each treatment group (non-surgical and surgical). Demographic data, including age, gender, occupation, and hand dominance, were recorded. Clinical parameters assessed were duration and severity of CTS symptoms, previous treatments, and comorbid conditions. The non-surgical group underwent treatments like wrist splinting, NSAIDs, and physical therapy, while the surgical group underwent decompression surgery. Outcomes measured included frequency and severity of symptoms, impact on daily activities, and satisfaction with treatment outcomes. Data were analysed using descriptive statistics to compare between groups.&#x0D; Results: The average age was 50 ± 9 years in the non-surgical group and 52 ± 8 years in the surgical group, with a predominance of females in both. The non-surgical group showed higher frequency and severity of symptoms, with daily symptoms reported by 76.1% of patients, compared to 44.4% in the surgical group. Severity of pain was higher in the non-surgical group (5.8 out of 10) than in the surgical group (2.8 out of 10). Satisfaction with surgical outcomes was high, with all patients in the surgical group reporting satisfaction despite a 100% rate of postoperative complications.&#x0D; Conclusion: The study indicates that surgical treatment for CTS may be more effective in reducing symptom severity and improving patient satisfaction compared to non-surgical methods. However, the high rate of postoperative complications in the surgical group necessitates careful consideration and patient counselling regarding treatment choices.&#x0D; Keywords: Carpal Tunnel Syndrome, Non-surgical Treatment, Surgical Treatment, Patient Outcomes, Symptom Severity, Treatment Satisfaction

Surgical tactics for chest trauma accombined by flail chest

Thoracic trauma, often characterised as closed, comprises 23% to 56.9% of polytrauma cases.According to our research, flail chest in thoracic trauma occurs in approximately 7.9—8.9% of cases. The primary factors contributing to this instability are car accidents or falls from a height. Objective — to enhance the outcomes of surgical treatment for patients with flail chest by applying novel techniques for assessing the severity of injuries and implementing improved surgical tactics. Materials and methods. The study included a total sample of 123 patients who had flail chest. The participants were divided into 2 groups: the control group (n=56) and the comparison group (n=67). The ATS scale was used to assess the severity of the condition in the groups. The injury severity score was determined using a point‑based system and categorised as minor, severe, or extremely severe. The control group was additionally evaluated using the AdTS scale, while the perfusion index was measured. Results. The injury severity score determined using the AdTS scale and the perfusion index formed the basis of an algorithm for differential diagnosis that influenced the indication area and scope of diagnostic procedures. The choice of surgical tactics was based on the results of an additional examination and the injury severity score. For a minor injury, the full range of medical procedures was carried out. For a severe injury, a shortened list of procedures was prescribed. In the case of an extremely severe injury, care was provided using the principles of DCS technology. The chest stabilisation procedure was conducted using the suggested approach for assessing the severity of the injury: less traumatic operations were performed for severe injuries, while full‑scale operations were carried out for minor injuries. The selection of the method for stabilising floating segments was based on the established classification of chest instability. The stabilisation of flail chest was carried out either during the first or third phase of the DCS technology or after the patient had been brought out of a state of shock, in accordance with delayed indications. Conclusions. The application of the AdTS anatomical and functional scale and the determination of the perfusion index allowed for a rapid and objective evaluation of the injury severity score (minor, severe, and extremely severe). Additionally, these tools helped in identifying the appropriate diagnostic procedures and deciding on the method for stabilising the flail chest. The differential diagnostic programme implemented in the control group made it possible to reduce the examination time for patients with an extremely severe injury by 9.8±1.1 minutes. Implementing the proposed injury severity assessment and stabilisation tactics decreased the number of late purulent‑septic complications by 19.8% and mortality by 17.4% (from 38.8% to 21.4%).  

Comparative Assessment of Surgical Treatment Outcomes in Patients with Sacroiliac Joint Injury

stract The aim of the study is to evaluate the results of surgical treatment in patients with sacroiliac joint injury. Methods. An analysis of the results of surgical treatment of 60 patients with sacroiliac joint injury was conducted at the Center of polytrauma and orthopedic surgery of the State Public Healthcare Institution “Emergency Hospital” in Abai Region, the Trauma and Endoprosthetics Department of the State Public Healthcare Institution “Multispecialty City Hospital No. 1” in the city of Astana, and the “Shymkent City Clinical Hospital No. 1” from June 2019 to August 2022. Patients were divided into two groups. Patients in the control group underwent surgery using the standard technique, while patients in the experimental group underwent surgery using a device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries. The study was a randomized controlled trial by design. Results. The use of the device for minimally invasive locking osteosynthesis of sacroiliac joint injuries leads to a significant reduction in the length of hospitalization for all types of sacroiliac joint injuries regardless of the patient’s initial condition (p=0.001). Correlation analysis revealed a correlation between the observation group and patient pain assessment at 12 months (p=0.001). According to the Majeed Pelvic Score at 12 months, the maximum score in the experimental group was 98 points, while in the control group, it was 70 points. A satisfactory assessment on the Majeed Pelvic Score at 12 months was observed in 3 (10%) of patients in the control group and none in the experimental group. There were no unsatisfactory responses in both groups (significant differences were found, p=0.001). Conclusions. The use of the device developed by us for minimally invasive locking osteosynthesis of sacroiliac joint injuries reduces the length of hospitalization and the time to return to work (12 months in the control group and 8 months in the experimental group). The absence of pain in patients after 12 months in the experimental group was 26 (86.7%) and 20 (66.6%) in the control group. According to the Majeed Pelvic Score in the long term (3, 6, and 12 months), the frequency of excellent results increases from 13.3% to 90.0% in the experimental group and from 10% to 73.4% in the control group.

Outcomes of Treatment of Pectoralis Major Muscle Injury

Background. The incidence of injuries to the pectoralis major muscle (PMM) is steadily increasing, necessitating an assessment of outcomes of surgical treatment.&#x0D; Objective: to analyze the outcomes of surgical treatment for PMM injuries.&#x0D; Material and Methods. The study is based on the analysis of surgical treatment outcomes of 84 patients with PMM injuries who were hospitalized in the Department of Microsurgery and Reconstructive Surgery of the Upper Extremity at the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" from 2003 to 2023. The patients underwent a rehabilitation program and staged observation for up to 12 months after surgical intervention. The age of the patients ranged from 16 to 62 years; they were divided by age into three groups: up to 25 years, 25-40 years, and 41 years and older. Functional assessment of the PMM was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), The Score and Subjective Evaluation by Patients with a Pectoral Major Tear (SEPPMT), and the American Shoulder and Elbow Surgeons (ASES) scales at the time of admission, at 6 months, and at 12 months after the surgery.&#x0D; Results. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT and ASES scales preoperatively, patients with acute injuries had worse results than those with chronic injuries (p &lt; 0.001). At 6 months after surgical treatment, the group of patients with acute injuries showed significantly lower scores compared to the group with chronic injuries. At 12 months after surgical treatment, the group with acute injuries had significantly higher scores compared to the group with chronic injuries (p &lt; 0.001), though still corresponding to excellent and good results.&#x0D; Conclusions. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT, and ASES scales preoperatively and at 6 and 12 months after surgical treatment, patients who underwent surgery within two weeks after the trauma demonstrated better results. In cases of chronic injuries, the results were slightly worse, but still were close to good results.

COMPARATIVE ANALYSIS OF CONSERVATIVE AND SURGICAL TREATMENT OUTCOMES IN PATIENTS WITH DIAPHYSEAL HUMERUS FRACTURES

The frequency of diaphyseal humerus fractures varies from 1% to 5% of the total number of skeletal fractures in humans. A clear bimodal gender and age distribution of patients with fractures in the studied area has been established. The main methods of treatment for closed intra-articular humerus fractures are conservative functional and surgical treatment. Treatment of diaphyseal humerus trauma involves not only restoring the axis and length of the bone but also ensuring sufficient mobility of adjacent joints. The aim of the study was to conduct a comparative analysis of the outcomes of conservative and surgical treatment in patients with diaphyseal humerus fractures. The study involved 57 patients with diaphyseal humerus fractures aged from 19 to 83 years. The first clinical group comprised of 24 patients aged from 24 to 80 years who were treated using functional fixation devices. The second clinical group consisted of 33 patients aged from 19 to 83 years who were treated using surgical techniques, namely antegrade locked intramedullary nailing and cortical plate and screw osteosynthesis. Rehabilitation measures were initiated within the first two days for patients in the first group and in the early postoperative period for patients in the second group. The range of motion of adjacent joints was assessed using the CMS and MEPS scales. The use of surgical treatment techniques in combination with early rehabilitation measures, compared to conservative functional treatment, allows achieving significantly higher and statistically significant (p&lt;=0.01) functional outcomes of elbow joint mobility.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.&#x0D; The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.&#x0D; The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.&#x0D; Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.&#x0D; Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.&#x0D; We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.&#x0D; Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Evaluation of Liposuction as a Part of Abdominoplasty and Simultaneous Hernioabdominoplasty

Introduction. According to the estimates of many countries, liposuction comprises a sought-after aesthetic surgery, achieving a leading position among popular surgical interventions in recent decades. For instance, the records of the American Society of Plastic Surgeons show, that liposuction occupied the 4th place in 2020, 3rd — in 2019, and 2nd — in 2000. Liposuction is frequently included in other aesthetic surgeries. In 2019–2023 the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa, performed this surgical intervention an isolated operation, and as part of abdominoplasty, mammoplasty, brachioplasty, and face-lifting. Aim. To analyze the clinical data of the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa, on the experience of performing liposuction as a stage of the anterior abdominal wall correction in isolated abdominoplasty and simultaneous hernioabdominoplasty. Materials and methods. The study involved 56 patients: women with overweight or obesity, suffering from aesthetic and functional problems in the anterior abdominal wall associated with pregnancy and childbirth. Surgical treatment and outpatient follow-up were performed in the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa from 2019 to 2023. Group 1 of patients included 33 people who underwent abdominoplasty combined with liposuction, group 2 comprised 23 patients, who had hernioabdominoplasty with liposuction. Results and discussion. Liposuction refers to a technique for removing excess fat deposits and improving the contours of the anterior abdominal wall. Liposuction stands as the main component of surgical intervention on the anterior abdominal wall, simplifying the stages of detachment of the anterior abdominal wall and redistribution of the skin-fat flap. The complication rates in abdominoplasty with liposuction and hernioabdominoplasty with liposuction differ insignificantly. Conclusion. Liposuction as a part of abdominoplasty or hernioabdominoplasty contributes to the improvement of surgical treatment outcomes.

EXPERT AND CLINICAL ASSESSMENT OF DEFICIENCIES IN PROVIDING CARE TO PATIENTS WITH TRAUMATIC BRAIN INJURY AND HEMORRHAGIC STROKE DUE TO THE RUPTURE OF CEREBRAL ANEURYSM

Introduction. The relevance of conducting this study is determined by the necessity to create organizational conditions and optimize the clinical-diagnostic aspect of medical care for patients with traumatic brain injury (TBI) and acute stroke. This aims to improve patients' quality of life by enhancing the effectiveness of medical care provision in Ukraine. This improvement is based on identifying the causes and analyzing deficiencies in medical care for these conditions.&#x0D; The aim of the research is to investigate the specificity of deficiencies in providing medical care to patients with isolated traumatic brain injury and acute hemorrhagic stroke due to the rupture of cerebral arterial aneurysms based on a retrospective analysis of medical documentation, as well as the results of patient treatment in cases of discrepancies between clinical and forensic diagnoses concerning the primary, concomitant diseases, and their complications.&#x0D; Materials and methods. Clinical assessment of the results of providing care to patients with traumatic brain injury and stroke was conducted through a retrospective analysis of medical documentation of patients who were hospitalized with these pathologies. The applied methods include clinical and laboratory investigations of homeostasis and metabolism parameters, and instrumental techniques.&#x0D; Results. In the identified influence of the timing of the operation (within the first few days) and the breakthrough of blood in the subarachnoid space of the brain, including with intracranial hemorrhage as a result of a re-rupture of a cerebral arterial aneurysm, on the risk of lethal outcomes of surgical treatment, a rationale for searching ways to optimize therapeutic tactics in this category of patients was provided. This includes identifying defects and shortcomings in the organizational aspect of medical care.&#x0D; Conclusions. Based on the analysis and identification of the most informative factors influencing the results of surgical treatment of cerebral aneurysms, a prediction system has been developed that allows calculating the probability of its outcome. The application of the forecast is advisable to consider in the prevention and timely detection of possible deficiencies in providing medical care to patients with stroke.