Results Of Repair Research Articles

Analysis and long-term outcomes of spontaneous cerebrospinal otorrhea repair via the middle cranial fossa approach

Background The incidence of spontaneous CSF otorrhea is increasing and knowledge about treatment management is growing. Objectives To analyse the cases operated via the middle cranial fossa approach (MCFA) for spontaneous CSF otorrhea in our clinic and to evaluate the long-term surgical results in the light of the literature. Methods Demographic data, presenting complaints, complications, hearing outcomes, recurrence rates and long-term success of patients operated with MCFA between 2012 and 2022 in our tertiary care centre were evaluated. Results The mean age of the 12 patients who met the inclusion criteria was 58.3 ± 13.4 years. Hearing loss and ear fullness in five patients and persistent otorrhea after ventilation tube insertion in three patients were the most common symptoms. The mean body mass index (BMI) was 35.03 ± 3.39. More than one defect was detected in seven patients. No perioperative or postoperative complications were observed in any patient. The mean airway hearing threshold (ASH)±SD was 40.6 ± 13 preoperatively and 24.4 ± 6.3 postoperatively, a statistically significant decrease (p = 0.003). The mean follow-up period was 80.8 ± 32.5 months and no recurrence was observed in any patient. Conclusion Our experience and results support the use of MCFA in the repair of spontaneous CSF otorrhea as safe, highly successful, and beneficial.

Cystocele and rectocele repair with native tissue layers: definition of the technique.

To investigate the outcomes of central cystocele and rectocele repair using natural tissue layers. To describe a novel technique (Dogan technique). This is a retrospective cohort study. Between January 2021 and January 2023, patients who had central cystocele and rectocele higher than stage1 were included in the study. The Pelvic Organ Prolapse Quantification (POP-Q) score was used to determine the degree of the prolapsus. All cystocele and rectocele repair surgeries were performed by the same physician. The patients' voiding habits were assessed using ICIQ-SF and OAB-V8. Sexual function results were assessed with FSFI questionnaire before and after the operation. Transperineal ultrasonography was performed to examine mobility of the anterior and posterior compartments. Total of 36 patients were diagnosed with grade 2 and above central cystocele (19, 52%) and rectocele (n = 17, 48%). After the operation the anatomical cure of anterior and posterior compartments was achieved for all patients in the two-years follow-up. According to voiding habits before the surgery, there were symptoms of stress urinary incontinence (SUI),urge urinary incontinence (URGE), both SUI and URGE, and no incontinence at the patients; 7 (36.8%), 14 (73.7%), 5 (26.3%), 3 (15.7%) respectively. Of those URGE patients (n = 5/14, 35.7%) incontinence symptoms were mixed-type. After the cystocele operation, significant improvement was seen in their voiding problems according to the ICIQ-SF and OAB-V8 questionnaires (p < 0.05). As well as significant improvement was found in sexual function according to the FSFI questionnaire (p < 0.05).

Comparison of Partial Endoscopic vs Surgical Fundoplication after Hiatal Hernia Repair.

The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery. Following IRB approval, a prospectively maintained anti-reflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication. The primary endpoint was QoL scores at 2, 6, and 12 months from surgery with attention to bloating and dysphagia scores. Secondary endpoints were PPI use, 30-day outcomes, OR time and costs, re-operation within 1 year. The three groups were compared using analysis of variance for continuous variables and Pearson's Chi-square test for categorical variables. P-values < 0.05 were considered indicative of statistical significance. Demographics between groups were similar except for age, PPI use, and presenting symptoms. There was no difference between the three groups with regards to post-operative QoL scores, PPI use, dysphagia, or bloating. All three types of fundoplication are associated with significant improvement of all symptom types and 65-80% of patients are no longer using a PPI at 12 months. There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications and there are no differences in dysphagia or bloating between the three types of fundoplication. Long term data is necessary to see if either technique provides superior control of symptoms while minimizing dysphagia and bloating.

Impact of Sex-Related Differences in Infrarenal Aortic Neck Morphology on Outcomes of Endovascular Aneurysm Repair for Similar-Sized Aortic Aneurysm

Objectives: This study aimed to evaluate whether gender-related anatomical differences in proximal aortic neck morphology affect the feasibility and outcomes of endovascular aortic aneurysm repair (EVAR) in women with abdominal aortic aneurysms (AAA). Methods: This study performed a retrospective analysis of patients electively treated by EVAR for infrarenal AAA between January 2019 and December 2023. Demographics, anatomical characteristics, and stent graft details were analyzed. The primary endpoint was technical success. Secondary endpoints included freedom from aortic and neck-related reinterventions, endoleak rate, and freedom from aneurysm-related mortality during follow-up. Technical aspects, including adherence to the instructions for use (IFUs), were retrospectively analyzed. Results: One-hundred-seventeen patients (fifty-six females; mean age 76.2 ± 5.3 years) underwent elective EVAR for AAA. Demographics and comorbidities were homogeneous across genders. Female patients (Group A) demonstrated a higher prevalence of hostile proximal aortic neck features, including neck length &lt; 10 mm and angulation &gt; 60° (p = 0.009, p = 0.029, respectively) and a higher frequency of off-label EVAR procedures (28.6% vs. 11.5%; p = 0.034). The overall technical success rate was 98.3%, with no significant differences between genders in terms of stent graft selection, use of suprarenal fixation, or incidence of type 1–3 endoleaks. The median follow-up period was 35.2 ± 12.7 months, showing comparable rates of neck-related reinterventions, open conversions, and aneurysm-related mortality between genders. Notably, off-label EVAR was identified as an independent risk factor for type 1A endoleaks, reinterventions, and aneurysm-related mortality (p &lt; 0.00001, p &lt; 0.0001, and p = 0.001, respectively). Conclusions: Female patients undergoing EVAR often present with hostile proximal aortic neck features and are treated at an older age than males. Despite these differences, technical success rates and mid- to long-term outcomes were comparable between genders, with no variation in stent graft selection or suprarenal fixation use. Effective procedural planning, device selection, and surgical expertise appear to mitigate historical gender-related anatomical challenges. Further large-scale studies are needed to confirm whether anatomical factors alone drive outcomes, irrespective of gender.

Knotless Versus Knotted Suture Anchors for Labral Repair of the Hip: A Systematic Review of Clinical and Biomechanical Outcomes.

Arthroscopic labral repair of the hip is successfully performed with increasing frequency using either knotless or knotted suture anchors, each with its own risks and benefits. To examine biomechanical and clinical outcomes for labral repair of the hip based on the use of knotted or knotless suture anchors. Systematic review; Level of evidence, 4. A search was performed to retrieve clinical and biomechanical studies examining the use of knotless or knotted suture anchors for arthroscopic labral repair of the hip. The studied outcomes included functional outcome scores such as modified Harris Hip Score (mHHS) and Hip Outcome Score Activities of Daily Living, biomechanical outcomes, failure mechanisms, and complications such as revision/reoperation and conversion to total hip arthroplasty (THA). A total of 47 articles met inclusion criteria for analysis (5 articles examining biomechanical outcomes and 42 reporting clinical outcomes). Included patients (N = 6185) who underwent hip labral repair had a mean age of 33.0 ± 8.5 years and follow-up time of 43.8 ± 18.4 months. The knotless group (n = 2719) had a mean preoperative mHHS of 63.3 ± 4.1 and postoperative mHHS of 86.3 ± 2.8 at a mean follow-up time of 47.2 ± 16.1 months. The knotted group (n = 2600) had a mean preoperative mHHS of 69.5 ± 8.3 and postoperative mHHS of 88.8 ± 5.5 with a mean follow-up time of 44.8 ± 18.1 months. The most common reason for failure of knotless anchors in biomechanical studies was suture breakage or pullout, and for knotted anchors it was anchor pullout. Of the articles reporting on revisions and/or conversion to THA after labral repair, the knotless group had 225 reoperations (8.1%) and 123 cases of conversion to THA (4.4%). The knotted group had 101 reoperations (6.2%) and 31 cases of conversion to THA (1.9%). Arthroscopic management of labral repairs of the hip using either knotless or knotted suture anchors appears to be both safe and effective in reducing pain and improving function. Biomechanical evaluation suggests differing failure mechanisms in knotted versus knotless anchors. The rates of revision and conversion to THA are low overall, irrespective of knotted or knotless anchors.

Analysis of the therapeutic efficacy of arthroscopic repair of the subscapularis tendon combined with coracoplasty

The aim of this study was to analyze the outcomes of arthroscopic subscapularis tendon repair combined with coracoplasty in the treatment. The study involved 80 patients (46 males, 34 females; aged 33 to 73 years), who underwent arthroscopic repair for subscapularis tears (type I, II, and III) presenting symptoms of anterior shoulder pain and tenderness. Subcoracoid impingement was defined as a coracohumeral distance of less than 6 mm on preoperative magnetic resonance imaging, with a follow-up of was at least two years. The patients were divided into two groups: Group A underwent coracoplasty, while Group B did not. The postoperative functional outcomes of the two groups were compared and analyzed using an independent sample t-test. The patients’ prognosis was assessed pre- and postoperatively using the University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, and Visual Analog Scale (VAS)pain score. Postoperatively, primary wound healing was successful in all patients, with no systemic or localized shoulder joint infections or brachial plexus nerve injuries. Both groups showed improvements in overall functional outcomes after surgical intervention. At the 24-month follow-up, all evaluated parameters in both groups demonstrated improvements compared to preoperative values (P < 0.05). The functional scores significantly increased in both groups post-surgery compared to preoperative values (p < 0.01). When comparing the two groups using an independent sample t-test, the p-values for all indicators, except forward flexion range of motion, were below 0.01. The statistical analysis indicated that patients in Group A had better recovery outcomes than those in Group B, except for forward flexion. The results suggested that subcoracoid impingement syndrome could potentially be a significant precursor to subscapularis tendon injuries. It is noteworthy noting that the combined approach of subscapularis tendon repair and coracoplasty showed superior therapeutic efficacy compared to isolated subscapularis tendon repair when subscapularis tendon injuries were associated with subcoracoid impingement.

T-branch by partial deployment technique in the endovascular repair of complex aortic and thoracoabdominal aneurysms with narrow or severe angulated para-visceral aorta.

The partial deployment technique (PDT) is an unconventional option of T-branch deployment to allow target arteries (TAs) cannulation/stenting from the upper arm access, in case of narrow (NPA: <25mm) or severely angulated (APA: >60°) aorta. Aim of this study was to report outcomes of the endovascular repair of complex aortic (c-AAAs) and thoracoabdominal (TAAAs) aneurysms by T-branch and PDT. All consecutive patients underwent urgent endovascular repair of c-AAAs and TAAAs by T-branch (Cook-Medical, Bloomington, IN, US) and PDT from 2021 to 2023 were analyzed. Technical success (TS), 30-days mortality, TAs-instability within 30-days and 1-year as well as reinterventions were assessed as primary endpoints. Time of intraoperative pelvic/lower limb ischemia, spinal cord ischemia (SCI) and perioperative stroke were assessed as secondary endpoints. Thirty-three cases were analyzed. There were 6(18%) type I endoleaks in failed EVAR, 9(28%) juxta/para-renal aneurysms, 6(18%) post-dissection and 12(36%) degenerative TAAAs, respectively. The median para-visceral aortic lumen diameter was 23(IQR:19-27) mm and 10(30%) cases had APA. Out of 128 TAs, 111(87%) were cannulated/stented with distally captured aortic graft. The median time of pelvic/lower limb ischemia was 120 (IQR:90-150) minutes. TS was achieved in all patients. One (3%) patient suffered SCI and there were no cases of stroke. An asymptomatic renal artery occlusion was detected at postoperative imaging which was recanalized by thrombus-aspiration/relining. This was the only case of TAs-instability (1/128-0.8%) and reintervention (1/33-3%) within 30-day. Two (6%) patients died within 30-days. Median follow-up was 14(IQR:6-22) months. One (3%) case of bilateral renal artery occlusion occurred at 6-months. No superior mesenteric artery or celiac trunk events occurred, with an overall TAs-instability rate of 2% (3/128). Eighteen (55%) patients completed the radiological follow-up at 1-year with no new case of TAs-instability. Freedom from TAs-instability was 91% at 1-year. T-branch by PDT seems to be safe and effective in the management of c-AAAs/TAAAs with NPA or APA. Results were satisfactory in terms of TS and mid-term TAs-instability, suggesting a possible enlargement of the anatomical feasibility criteria for outer branches in urgent cases.

Favorable 30-day outcomes of initial open inguinal hernia repair with local anesthesia among frail patients.

Open inguinal hernia repair (OIHR) can be conducted under either general anesthesia (GA) or local anesthesia (LA). Despite a lack of evidence supporting improved perioperative outcomes, GA is the predominant anesthesia type used in OIHR. Frailty is defined as a clinically recognizable state of age-related increased vulnerability. This study aimed to compare the 30-day perioperative outcomes of frail patients undergoing OIHR with either GA or LA. Patients who underwent initial OIHR were identified in the ACS-NSQIP database from 2005-2021. Patients with a Modified Frailty Index (mFI)≥2 were included. Patients were divided based on GA or LA administered. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients undergoing OIHR under GA or LA. Among 20,129 frail patients who underwent initial OIHR, 13,473 had GA, and 3686 had LA. The 30-day mortality rates for LA and GA were low. However, frail patients who underwent LA had a lower risk of bleeding (aOR 0.282, P=0.04), superficial surgical site infection (aOR 0.450, P=0.03), and discharge not to home (aOR 0.792, P<0.01). In addition, frail patients who underwent LA had shorter operation time (58.42±25.26 vs 67.60±37.17 mins, P<0.01) and a shorter length of stay (0.45±2.30 vs 0.57±2.96 days, P<0.01). Although GA is the dominant anesthesia use (4:1) in OIHR among frail patients, LA emerges as a safe alternative to GA for these patients, offering potential benefits such as reduced complications and increased day-case surgery volume, which may be associated with decreased healthcare costs.

Ultrasound-Guided Repair of the Anterior Talofibular Ligament With or Without Gould Augmentation Is Safe and Improves Clinical Outcomes for Chronic Lateral Ankle Instability: A Case Series of 49 Patients.

We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective is to assess the safety and clinical outcomes of ultrasound-guided ATFL repair with or without augmentation. Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized post-operative rehabilitation protocol. The primary outcome was the complication rate in 49 subjects. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 non-athletes) after excluding 21 subjects with such concomitant injuries that could affect clinical course. These included (1) Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months. The overall complication rate was 2.0% with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ± 2.1 at baseline to 1.3 ± 1.6 (p < 0.001, student's t-test). FAOS increased from 74.7 ± 11.9 to 93.4 ± 8.1 (p < 0.001). JSSF scale increased from 56.9 ± 15.1 to 90.9 ± 10.2 (p < 0.001). All 20 athletes returned to sports at a pre-injury level, and their SAFE-Q sports activity scores increased from 40.7 ± 17.6 to 90.6 ± 0.2 (p < 0.001). Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months. V.

Comprehensive Management of Coarctation of the Aorta; Modern Approaches and Updated Strategies for Adolescents and Adult

In adolescents and adults with coarctation of aorta (CoA), whether it manifests as native CoA or recurrent CoA, transcatheter CoA intervention has emerged as widely accepted alternative to surgery. Rapid advancements in techniques and refinement of stent technology have driven a significant paradigm shift in clinical practice. This manuscript offers detailed review of the current management strategies for CoA, with particular focus on adolescents and adults. It provides updated insights into current indications for intervention, procedural tips and techniques, and addresses both immediate and long-term outcomes of CoA repair in adults. Through this comprehensive review, we aim to highlight the evolving landscape of CoA management and the benefits of modern interventional approaches.

Surgical Outcomes of Lateral Ulnar Collateral Ligament Reconstruction Versus Repair for Posterolateral Rotatory Instability of the Elbow: A Systematic Review and Meta-analysis.

The aim of surgical treatment for posterolateral rotatory instability (PLRI) of the elbow is to restore the integrity of the lateral ulnar collateral ligament (LUCL), with ligamentous reconstruction being the preferred option for recurrent symptomatic PLRI. However, there is no clinical evidence demonstrating the superiority of reconstruction versus repair. Treatment options currently depend on the cause of the LUCL injury and surgeon preference. To review studies comparing surgical outcomes of LUCL reconstruction versus repair in treating PLRI of the elbow. Systematic review; Level of evidence, 4. This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was conducted on PubMed, Medline (via EBSCO), ProQuest, and ScienceDirect databases using the following keywords: "(lateral ulnar collateral ligament reconstruction)" OR "(lateral ulnar collateral ligament repair)" AND "(outcome)." Excluded were studies in languages other than English, those that included terrible triad injury, transolecranon fracture, radial head arthroplasty involvement, associated procedures, animal studies, and biomechanical studies. A total of 193 studies were identified after the initial search. The primary outcome measure was the Mayo Elbow Performance Score, which was compared between studies using a random-effects model. Overall, 20 studies (N = 646 patients) were included, with 445 of 646 patients (68.8%) in the LUCL reconstruction group and 201 of 646 patients (31.1%) in the LUCL repair group. All injuries in the included studies were traumatic. The LUCL reconstruction group had a longer follow-up period compared with the LUCL repair group (72.05 ± 43.51 vs 36.86 ± 21.19 months, respectively). The postoperative range of motion arc was similar in both the repair and reconstruction groups (135.02°± 15.33° vs 133.60°± 8.84°, respectively). Both LUCL repair and LUCL reconstruction resulted in good to excellent outcomes on patient-reported outcome measures; however, a superior rate of return to activity and a lower complication rate were found after LUCL reconstruction versus LUCL repair (8.3% vs 14.9%). Ulnar nerve event (2.3%) was the most common complication in both groups. Findings indicated that LUCL reconstruction had a superior rate of return to activity and a lower complication rate compared with LUCL repair.

From Zone -1 to Zone 3: Feasibility and Safety of Complex Endovascular Aortic Repairs in Type A Aortic Dissection.

Over 30% of patients presenting with acute type A aortic dissection (ATAAD) are considered high - risk or inoperable. This study aims to investigate the early and mid-term outcomes of complex endovascular aortic repair of aortic root, ascending aorta, and aortic arch among patients with ATAAD. From January 2018 to January 2023, 29 patients who were considered high risk for open operation underwent endovascular aortic repair. Patients were considered high risk due to: frailty (N=14), severe malperfusion (N=5), chronic obstructive pulmonary disease on home oxygen (N=4), frozen chest (N=3), metastatic cancer (N=3), ejection fraction < 20% (N=4), and cirrhosis (N=2). For an isolated tear in the ascending aorta (Zone 0), ascending stent graft placement was performed using commercially available aortic stent grafts. For patients with a tear in the aortic root, Endo-Bentall was performed using a physician-modified modular device composed of a self-expanding transcatheter aortic valve incorporated inside an aortic stent graft. For patients with a tear in the ascending aorta as well as the aortic arch (Zone 0, Zone 1, 2), ascending stent graft placement and endovascular arch repair was performed. Follow-up electrocardiogram-gated computed tomography (CT) was performed to evaluate aortic remodeling. The mean age for this cohort was 76.3 ± 11.1 years. Endovascular repairs included: Isolated ascending stent placement in 65.5% (19/29), Endo-Bentall in 6.9% (2/29), Endo-Bentall plus Endo arch in 6.9% (2/29), and ascending TEVAR + Endo arch in 20.7% (6/29). The operative mortality was 10.3% (3/29). Stroke rate was 10.3% (3/29). During the follow-up time of a median of 6.25 months (range 0.85 to 64.6), an endoleak was observed in 42.3% (11/26) patients (80% among patients with a tear < 2cm of STJ). Seven patients had a type 1a endoleak, while four patients had a type 1b endoleak on follow-up CTA. Three patients required reintervention. The Kaplan-Meier 5-year probability of survival for the entire cohort post-intervention was 35%. Early outcomes of complex endovascular repair of ascending aortic dissection are promising with acceptable mortality and stroke rate. However, the rate of endoleak after isolated ascending TEVAR with a tear within 2cm of the aortic root is high with poor long-term survival.

CLINICAL OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT REPAIR IN PATIENTS WITH NYSTAGMUS.

To report the anatomical and visual outcomes of rhegmatogenous retinal detachment repair in patients with congenital or acquired nystagmus. This was a case series involving a retrospective review of medical records from January 1, 2015, to April 1, 2021, of eight eyes of eight patients (seven men and one woman) with documented nystagmus who underwent rhegmatogenous retinal detachment repair. Primary outcomes included final reattachment rate and single surgery anatomical success at three months postoperatively. Secondary outcomes included final visual acuity and mean number of additional procedures required for retinal reattachment. Mean age was 52.1 years (range: 14-77 years), and mean follow-up time was 18.6 months (range: 2.8-32.9 months). Pars plana vitrectomy (PPV) was performed in four patients (50.0%), scleral buckle in 3 (37.5%), and PPV/scleral buckle in 1 (12.5%). A repeat PPV was required in three eyes (37.5%) because of proliferative vitreoretinopathy, two of which initially underwent PPV, and one had PPV/scleral buckle. Two eyes (25%) required a third PPV because of proliferative vitreoretinopathy or retinal breaks. Mean time to first redetachment was 29 days. Single surgery anatomic success at three months was achieved in five patients (62.5%). Complete final retinal reattachment was achieved in all patients. Final visual acuity improved or stabilized in seven eyes (87.5%). Despite a 100% final retinal reattachment rate, rhegmatogenous retinal detachment repair can be challenging among patients with nystagmus, including postoperative complications such as recurrent retinal detachment because of retinal breaks. No silicone oil emulsification or related complications were observed in our series.

Triangular Flaps Combined with Full-thickness Skin Graft for Repairing Concha-type Microtia

BackgroundMicrotia is a common congenital craniofacial malformation, with concha-type microtia presenting unique challenges due to the relatively large residual auricle and flexible surgical methods. The authors employed triangular flaps combined with full-thickness skin graft technique for the treatment of concha-type microtia, achieving marked treatment effects. Method35 patients with unilateral concha-type microtia were enrolled in this study from January 2023 to June 2024. All patients were performed with the method of the triangular flaps combining with full-thickness skin graft method. Preoperative and postoperative data regarding the auricles were precisely measured and statistically analyzed, and patient satisfaction along with complications post-surgery were monitored. ResultsTotal 35 patients were follow-up for 3-13 months. The mean preoperative length, width and perimeter of affected auricle was 4.79±0.28, 2.44±0.24 and 9.10±0.54cm. The mean immediate postoperative length, width and perimeter of affected auricle was 5.35±0.30, 2.85±0.25 and 10.16±0.54cm. Significant differences were observed when comparing immediate post-operation and last follow-up results to pre-operation measurement(P<0.05). There is no significant difference in the data of the postoperative auricle compared to the unaffected side. All patients expressed satisfaction with the treatment effect and no complications were reported. ConclusionThe method using triangular skin flaps combined with full-thickness skin graft proved to be a remarkable approach for concha-type microtia, maximizing the utilization of the residual auricle, simplifying treatment procedures, and yielding satisfactory repair outcomes.

Management of Horizontal Cleavage Meniscus Tears.

The management of horizontal cleavage meniscus tears (HCT) has evolved in recent years. Historically, HCTs have been treated with partial meniscectomy, but multiple studies have shown the long-term risks of development of arthritic changes in the knee following meniscectomy. These findings have renewed interest in meniscal preservation whenever possible, even in older patients not previously considered for meniscus repair. This article provides an overview of current management of horizontal cleavage meniscus tears and describes modern surgical techniques for repair of HCTs. Current research studies have continued to emphasize the benefits of meniscal preservation on long-term function. Recent data has demonstrated similar success rates following repair of HCTs compared to repair of other types of meniscus tears. Additionally, multiple recent studies have demonstrated the potential benefit of biologic augmentation in decreasing failure rate after meniscal repair. Modern surgical techniques and biologic augmentation have improved outcomes of meniscal repair. However, consideration of a patient's individual goals, activity level, and expectation are important to achieve a successful outcome regardless of treatment modality. While not every patient is a candidate for meniscal repair, current data has shown it should be considered for a growing number of patients.

Dual-Double Stem Cell Ovarian Therapy: A Comprehensive Approach in Regenerative Medicine

Dual-double stem cell therapy, which integrates mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs), represents a cutting-edge approach in regenerative medicine, particularly for conditions such as ovarian decline, premature ovarian insufficiency (POI), and induced ovarian failure. This therapy leverages the unique properties of MSCs and HSCs, enhancing tissue repair, immune modulation, and overall regenerative outcomes. MSCs, known for their ability to differentiate into various cell types, provide a supportive microenvironment and secrete bioactive molecules that promote angiogenesis and reduce inflammation. HSCs, crucial for hematopoiesis and immune function, further enhance this environment by supporting hematopoietic processes and immune regulation. Clinical evidence increasingly supports the effectiveness of stem cell therapy in ovarian regeneration. Studies have demonstrated improved folliculogenesis, normalization of hormone profiles, and successful pregnancies in patients with POI. Furthermore, recent clinical trials in various medical fields underline the superior potential of dual-double therapy compared to monotherapies involving MSCs or HSCs alone, enhancing tissue repair and functional outcomes. However, despite these benefits, the therapy presents risks that require careful consideration. For autologous MSC therapy involving expanded cell populations, risks include tumorigenic potential, with evidence of sarcoma formation in certain cases of cultured MSCs. In contrast, autologous non-expanded MSC and HSC therapies may be limited by low cell yields, potentially compromising therapeutic efficacy. Additionally, non-expanded HSC therapy poses risks of insufficient cell numbers for successful engraftment and delayed immune reconstitution. These considerations underscore the importance of quality control and rigorous screening to optimize safety and efficacy. This article explores the mechanisms of action, clinical applications, and potential complications of dual-double stem cell therapy, underscoring the need for continued research and optimized protocols to enhance safety and outcomes in ovarian insufficiency and related conditions, offering new hope for affected women.

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3–25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5–79.0) years, and the aneurysm diameter was 56 (50–61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45–60) min and 92 (79–308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7–41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained “unchanged” in four patients, including the one with delayed type Ia endoleak, while two patients experienced “shrinkage”. Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes.

The association of reduced ejection fraction with the outcomes of endovascular abdominal aortic aneurysm repair.

It is estimated that 20% of patients undergoing elective abdominal aortic aneurysm (AAA) repair suffer from cardiomyopathy. This study examines the impact of reduced ejection fraction (EF) on the outcomes of endovascular aneurysm repair (EVAR) and compares the different types of cardiomyopathies causing reduction of EF. Our hypothesis is that reduction in EF is associated with higher mortality after EVAR. We examined the Vascular Quality Initiative (VQI) database for EVAR from 2003-2020. Patients presenting with symptomatic AAA or rupture were excluded. Patients were excluded if age, sex, mortality, and EF were not available. Patients were stratified into categories in two separate analyses. The first analysis examines differences between <30% EF, 30-50% EF, and >50% EF, and the second analysis examined differences between ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) in patients with reduced EF. Patients' demographics, comorbidities, operative characteristics, and outcomes were compared. Statistical comparisons were performed using chi-squared analysis for categorical variables and ANOVA for continuous variables. Multivariable comparison was performed to find characteristics impacting mortality. There were 26,037 patients included and 20,127 (77.3%) had a normal EF>50%, 4,885 (18.7%) patients had a moderately reduced EF of 30-50%, and only 1,025 (3.9%) patients had a severely reduced EF<30%. The 30-day mortality was not significantly different between patients with very reduced (1.9%) and reduced EF (1.7%) but was significantly higher than patients with normal EF (0.8%) (P<0.001). There was a nearly two-fold increase in 30-day mortality for ICM (1.1% vs 2.0%, p=0.024) compared to NICM but there was no difference in long-term mortality between the 2 groups. Elective EVAR in patients with reduced EF is associated with higher 30-day mortality compared to patients with normal EF but the overall mortality rate in VQI falls within the acceptable range of SVS guidelines. Amongst patients with reduced EF, the type of cardiomyopathy seems to have more important association with 30-day mortality than severity of cardiomyopathy does.

Outcomes of Complete Repair of Mixed-Type Total Anomalous Pulmonary Venous Return

Outcomes of Complete Repair of Mixed-Type Total Anomalous Pulmonary Venous Return

Total extra peritoneal Repair of Inguinal Hernia under General Anesthesia Versus Spinal Anesthesia

Background: Total extra peritoneal inguinal hernia repair is established approach to inguinal hernia repair usually performed under general anesthesia. Aim of the study was to compare Total extra peritoneal inguinal hernia repair outcome when operated under spinal anesthesia and general anesthesia. Methods: A prospective cross-sectional study was conducted at Bir hospital on patients undergoing Total extra peritoneal inguinal hernia repair under either spinal anesthesia or general anesthesia for inguinal hernia from September 2022 to August 2023. Operative time, postoperative hospitalization time, postoperative pain, postoperative adverse effects, level of satisfaction and recurrence rate at one year was compared.Results: Fifty-eight patients were included, divided into two groups TEP-GA and TEP-SA, 29 in each arm. All procedures were completed by allocated method of anesthesia. Though pain score was low in TEP-SA in initial four hours, 2.79±1.08 (GA) and 1.99±0.97 (SA) and 2.28±1.09 (GA) and 1.80±0.80 (SA) at one and four hours post-operative respectively, no statistical difference was noted between two groups regarding surgery time, pain score complications, hospital stay, recovery or recurrence.Conclusions: Spinal anesthesia is at par with general anesthesia instead of better than generalanaesthesia for total extra peritoneal inguinal hernia repair, if not better. It may be appropriate anesthetic modality in patients considered high risk for general anaesthesia.Keywords: general anesthesia; inguinal hernia; spinal anesthesia; total extra peritoneal inguinal hernia repair.