Performed Operations Worldwide Research Articles

Mesh technology—an update

Abdominal wall hernia is a commonly encountered problem and its repair a frequently performed operation in any surgical unit. Repairing the hernia using mesh is currently the standard of care. Based upon the approach, usage of mesh and position where the mesh is placed, variety of techniques will be found on literature review, but lowest rates of recurrence are demonstrated only with mesh repair. Although polypropylene is most commonly used, in practice a variety of prosthesis made up from different polymer, knitting, architecture and designing are available. A commonly performed surgery worldwide, mesh repair of hernia adds a significant amount to healthcare costs. A successful repair is determined by a good surgical technique and use of appropriate size and type of mesh. With a billion-dollar worldwide market, prosthesis design, material used and its technology has a great impact on operative results. Through this update, our aim is to cover all aspects of mesh technology, the variety of classification used, the basis behind use of specific materials, designing available in practice. The search for ideal mesh will continue, paving the way for newer meshes and its technology.

Mesh technology—an update

Abdominal wall hernia is a commonly encountered problem and its repair a frequently performed operation in any surgical unit. Repairing the hernia using mesh is currently the standard of care. Based upon the approach, usage of mesh and position where the mesh is placed, variety of techniques will be found on literature review, but lowest rates of recurrence are demonstrated only with mesh repair. Although polypropylene is most commonly used, in practice a variety of prosthesis made up from different polymer, knitting, architecture and designing are available. A commonly performed surgery worldwide, mesh repair of hernia adds a significant amount to healthcare costs. A successful repair is determined by a good surgical technique and use of appropriate size and type of mesh. With a billion-dollar worldwide market, prosthesis design, material used and its technology has a great impact on operative results. Through this update, our aim is to cover all aspects of mesh technology, the variety of classification used, the basis behind use of specific materials, designing available in practice. The search for ideal mesh will continue, paving the way for newer meshes and its technology.

Preoperative education in hip and knee arthroplasty patients in Bloemfontein

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are frequently performed surgeries worldwide. Preoperative education enhances patient physiotherapy management and satisfaction and should be tailored to patients’ educational needs. Limited research is available regarding the preoperative educational needs for these patients.Objectives: To determine the extent of preoperative education received and the preoperative educational needs of patients undergoing THA and TKA.Method: A structured interview utilising a self-developed questionnaire was used and included questions exploring preoperative education, educational needs, method of education and health care professional providing education. A total of 14 THA and 36 TKA patients, 2–4 days post-operatively at private hospitals in Bloemfontein, were conveniently sampled.Results: All participants had arthroplasties because of osteoarthritis. All participants with THA and 35 (98%) participants with TKA received preoperative education from orthopaedic surgeons, and 8 (57%) participants with THA and 9 (25%) participants with TKA received preoperative education from physiotherapists. Education was mostly given as pamphlets months before the surgery. Participants received the least amount of information regarding exercises, especially preoperative exercise, pain relief and activities of daily living.Conclusion: This study highlights the need for improvement in patient engagement and education, together with enhanced health care practitioner communication and collaboration. Patient centeredness and individualised THA and TKA preoperative education programmes are recognised as a necessary attribute of quality health care and can lead to improved THA and TKA outcomes. The importance of exercise as part of preoperative interprofessional education in the management of THA and TKA should be emphasised as exercise is the cornerstone for rehabilitation of THA and TKA.Clinical implications: This study aimed to emphasise the importance of tailored preoperative education for THA and TKA patients to improve patient outcomes.

UNIFESP Info Plastica – An informative application covering the most frequently performed plastic surgeries worldwide

OBJECTIVES:The objective of this study was to develop a free smartphone application with reliable and useful information for the lay public on the most frequently performed plastic surgeries worldwide.METHODS:The five most frequently performed surgeries worldwide according to ISAPS (International Society of Aesthetic Plastic Surgery) were selected. Information from the websites of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS) and Brazilian Society of Plastic Surgery (SBCP) and from the Outpatient and Hospital Medicine Guide of the Plastic Surgery Division at the Federal University of São Paulo (UNIFESP) was used for content assembly. YouTube videos with patients’ postoperative testimonials were used for an improved understanding of their real concerns. Printed text was distributed to patients in Brazil’s Unified Health Service to improve comprehensibility. Content on each of the five surgeries was presented in the application with the following layout: What is the surgery?; Who are the candidates?; Preparations for surgery; Stages of surgery; Recovery after surgery; Complications; Choice of surgeon; Consultation; What is the cost? and Glossary. All material was delivered to an outsourced company to produce the application software.RESULTS:The result was the creation of an application with extensive content on the most frequently performed plastic surgeries.CONCLUSION:The UNIFESP Info Plastica application is an academically based, free and reliable source of information for the lay public interested in all aspects of the most frequently performed plastic surgeries worldwide.

Evaluation of risk factors associated with hyperbilirubinemia after surgery of perforation peritonitis

Aim: Gastrointestinal (GI) perforation repair is a commonly performed surgery worldwide. Postoperative septic conditions are frequently accompanied by cholestasis and postoperative jaundice. Our study was conducted to evaluate the risk factors and outcome of postoperative hyperbilirubinemia in patients with perforation peritonitis. Materials and Methods: A prospective observational study of 100 patients was conducted between January 2013 and December 2014; they underwent surgery for generalized peritonitis caused by GI perforations in the Department of Surgery of JLN Medical College and Associated Group of Hospitals, Ajmer, Rajasthan, India. Postoperative hyperbilirubinemia is defined as serum total bilirubin level of ≥5 mg/dl within 1 month after surgery. In all the patients with postoperative hyperbilirubinemia, risk factors and outcome were assessed. Data analyses done with Fisher's exact test, Mann–Whitney test, Chi-square test, Student's t test, and repeated-measures analysis of variance were used for statistical comparisons. Results: In our study of 100 patients, M:F ratio was 2.12. Sixteen percent of the total patients belonged to hyperbilirubinemia group and 84% belonged to no hyperbilirubinemia group. In the hyperbilirubinemia group, anemia was seen in 37.5%, poor nutrition in 44%, and shock in 62.5%, and these patients also had increased total leukocyte count counts, bilirubin level, aspartate aminotransferase level, and decreased platelet count, whereas in the no hyperbilirubinemia patients anemia was seen in 11%, poor nutrition in 15%, and shock in 15% cases and all of them had normal blood investigations. Postoperatively, in the hyperbilirubinemia group, cardiac and respiratory support was needed in 62% and 72% cases, respectively, renal insufficiency in 56% cases, prolonged paralytic ileus in 72%, and mortality in 62% cases. Infection-related complications developed in 20 patients (12 patients of hyperbilirubinemia group and 8 patients of no hyperbilirubinemia group). Conclusion: In our study, we concluded that in cases of perforation peritonitis, hyperbilirubinemia was associated with advanced age, poor nutritional status, and prolonged time until surgical intervention, and these patients with postoperative hyperbilirubinemia showed higher morbidity and mortality after surgery.

Predictors of Acute Postsurgical Pain After Inguinal Hernioplasty.

This study found that, when adjusted for depression, helplessness, and magnification scores, the variables younger age, previous chronic pain, presurgical anxiety, and the rumination component of pain catastrophizing are significant predictors of APSP intensity after inguinal hernioplasty. These findings improve knowledge on APSP and highlight potential modifiable intervention targets for the design of interventions focused on APSP prevention and management.

Minimally invasive hysterectomy for benign indications: an update.

Hysterectomy is one of the most commonly performed surgeries worldwide. Indication for hysterectomy is most often benign, which includes conditions such as prolapse, abnormal uterine bleeding, fibroids and pelvic pain. A broad range of surgical approaches exists for hysterectomy, ranging from open to minimally invasive techniques. Under this minimally invasive umbrella, the following techniques are included: vaginal hysterectomy, laparoscopic hysterectomy, and variations of those two techniques, such as laparoscopic-assisted vaginal hysterectomy, robotic-assisted hysterectomy, laparo-endoscopic single-site laparoscopic hysterectomy, mini-laparoscopic hysterectomy, and natural orifice transluminal endoscopic surgery hysterectomy. As hysterectomy is being performed increasingly via a minimally invasive route, it is important that gynecologists are familiar with the established as well as emerging techniques for minimally invasive hysterectomy (MIH). Surgical planning is a complex process, which requires an in depth and informed conversation between a patient and her physician. Patient preferences, surgeon skill and indication for surgery all should be taken into consideration when determining the most appropriate surgical approach. This article will review the different routes of MIH. Perioperative considerations will be discussed, as will the advantages and disadvantages of each minimally invasive approach.

Saphenous vein harvest wound complications: risk factors, identification, prevention, and management

Saphenous vein harvest wound complications: risk factors, identification, prevention and management Mohammad Salman Siddiqi Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman Abstract: Coronary artery bypass grafting is a commonly performed surgery worldwide that gives good results. Great saphenous vein is used as a conduit for bypass in over 95% cases. The harvesting technique has remained unchanged over the years. However, wound complications from harvesting the great saphenous vein by open method can be a major source of postoperative morbidity. With the objective of preventing major complications, identification of risk factors for saphenous vein harvest site infection is important. It is imperative to develop approaches that prevent infection and to allow for early recognition of patients who are at high risk and who may need more watchful monitoring so as to prevent development of wound complications. It is desirable to assess the patient completely, delineate the anatomy of peripheral vessels particularly in a patient with associated peripheral vascular disease, identify the best site to perform the saphenous vein harvest incision, employ a meticulous surgical technique, recognize complications early, and start the recommended treatment without delay. The aim of this paper is to identify the risk factors for saphenous vein harvest site complications and their identification, prevention, and management. Keywords: saphenous vein harvest, wound complication, coronary artery bypass grafting, risk factors, surgical site infection, endo vein harvesting

A prospective study of laparoscopic repair of inguinal hernia by intraperitoneal onlay mesh technique using fibrin glue

Background: Inguinal hernia repair is one of the most commonly performed operations worldwide. Laparoscopic repair is rapidly becoming the procedure of choice with increasing availability of resources. The present work focuses on the advantages and benefits of the fibrin glue and IPOM procedure in hernia repair. Methods: A total of 16 cases were included operated by a single surgeon. IPOM technique was adopted for hernia repair with use of fibrin glue for mesh fixation along with tackers. Patients with reducible hernia were included, while those with irreducible, obstructed or strangulated hernia were excluded. Results: All the patients were male with right indirect inguinal hernia being the most common presentation. The post-operative complications were none on one year follow up, without any recurrence or obstructions. All patients returned to normal activity within one day. Patients showed better compliance with reduced complaint of post-operative pain, early return to activity and work and less sick day leave. Intra-operative risk of damage to vital structures was also greatly reduced with the use of fibrin glue. Conclusions: Laparoscopic IPOM hernia repair is feasible, easy to learn, has a high patient acceptance rate, reduce operating time and low complication rate. Use of fibrin glue for mesh fixation lead to reduce post-operative pain, early return to activity and less intra-operative risk.

Abdominal Wall Abscess Harbouring Gall Stones and Adenocarcinoma after Laparoscopic Cholecystectomy: A Rare Case Report

Cholecystectomy is the most commonly performed operation worldwide. Laparoscopic cholecystectomy is the gold standard treatment of gall stones today. Over the decades the complications of laparoscopic cholecystectomy has decreased but gall bladder perforation and bile spillage is still a significant problem. The lost gall stones can lead to abscess formation both intra-abdominal and intraparietal. Rarely the port sites may harbor malignancy, which is the most feared of all complications. So gall bladder perforation and bile or gall stone spillage should be properly documented.

Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Cystic duct is the most common site of bile leak after cholecystectomy. The treatment of choice is usually conservative. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful. We report a technique for the successful treatment of persistent cystic duct leak. After failed ERCP and stenting, bile leak was treated by coiling the cystic duct through a drain tract. This technique is safe and effective and helps avoid the morbidity of reoperation.

How to interpret postoperative X-rays after total knee arthroplasty.

Today, total knee arthroplasty (TKA) is one the most commonly performed surgeries worldwide. The purpose of this article is to review the appearance of normal post-TKA roentgenographs and describe the correct sequence for their interpretation. It is unwise to depend solely on patients' symptoms when diagnosing TKA complications because serial radiographs can foresee failures well before they manifest clinically. Ideal post-TKA radiographs comprise whole lower extremity anteroposterior and lateral views taken under weight bearing conditions along with a skyline view of the patellofemoral joint. Among other things, weight bearing exposes the true alignment, ligamentous laxity and polyethylene wear. On the basis of follow-up of our TKA cases, we have drawn up a protocol for assessing postoperative X-ray films after TKAs. Following the proposed sequence, surgeon can easily decide how to proceed with follow-up and foresee complications. Careful interpretation of postoperative radiographs after TKA is essential to careful monitoring of patients and implant survival.

Designing the CORONIS trial. Why a non-regular fractional factorial design?

Caesarean section is one of the most commonly performed operations worldwide. A variety of surgical techniques for all elements of the operation are used. Many of them have not been rigorously evaluated in randomised controlled trials. The CORONIS Trial set out to simultaneously examine five elements of the caesarean section operation in seven low- to middle-income countries, using a novel adaptation of the factorial design.

Evaluation of robotic gastrectomy for gastric cancer based on the current evidence

Surgical modality undoubtedly has been developing rapidly resulting from the improvement of minimally invasive approach and instruments. Robotic gastrectomy for gastric cancer, as one of the most common performed operations worldwide, is playing a key role in maximizing potential benefits for both patients and surgeons. Most studies have demonstrated its satisfactory short-term outcomes including fast postoperative recovery course and similar oncological adequacy, while followed by several disadvantages or pitfall such as longer operation time, relatively high costs, and uncertain long-term outcome. However, the role of robotic gastrectomy is still controversial. This article is a review about robotic gastrectomy for treating gastric cancer based on the current evidence in terms of technology, application, clinical trials, and future prospects.

Hemolytic anemia in a female patient presenting for routine cholecystectomy

Hemolytic anemia in a female patient presenting for routine cholecystectomy

Comparison of Low Cost Net-mesh with Prolene Mesh in Management of Inguinal Hernia

Hernia repair is one of the most commonly performed operations worldwide. The use of alloplastic mesh is now common place in hernia repair. However in developing countries cheaper alternatives to commercial mesh are available to the high associated cost. The cost of the mesh used normally for inguinal hernioplasty ranges from 1000–1500 rupees. The mesh used in the study costs Rs 40 only. We aimed to investigate the use of mosquito net mesh in cases of inguinal hernioplasty in terms of cost effectiveness, handling, recurrence and complications.

The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs

Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.

Recurrence of gallstones after cholecystectomy is associated with ABCG5/8 genotype

Gallstone disease is a frequent and economically highly relevant disorder, with cholecystectomy representing one of the most frequently performed operations world-wide. Gallstone recurrence after cholecystectomy is associated with complications such as biliary sepsis and pancreatitis. As yet, variant ABCG8-D19H is the most widely recognized genetic risk factor for gallstone disease. The aim of the study is to investigate whether ABCG8-D19H is associated with gallstone recurrence after cholecystectomy. Two thousand three hundred and eight patients from an earlier study of gallstone risk factors were re-contacted by mail, leading to 1,915 patients with available clinical and genetic information. Symptomatic gallstone recurrence was established if it occurred more than six months after surgery. Median follow-up time after cholecystectomy was eight years. Gallstones recurred in 37 patients (1.9%). ABCG-D19H was found to be significantly associated with gallstone recurrence (p = 0.034). The allelic odds ratio was 1.97 (95% CI 1.12-∞). In a multivariate logistic regression analysis adjusted for age, sex, BMI and type of surgery, ABCG8-D19H remained a significant predictor, both in the total cohort (p = 0.024) and in the subgroup for whom information on type and scheduling of surgery was available (N = 1,650, p = 0.020). ABCG8-D19H is a predictor of gallstone recurrence, a major long term postoperative biliary complication. Moreover, the observed association also reemphasizes the importance of the sterolin transporter for stone formation.

Combined Spinal Epidural Anesthesia for Total Hip Replacement Surgery in Birendra Army Hospital

Introduction: Total Hip Replacement surgery is one of the most commonly performed surgeries worldwide. Epidural anaesthesia have shown decrease incidence of DVT in these patient. Hence, combined spinal epidural spinal anesthesia is now a preferred technique over spinal anesthesia alone. We have been practicing combined spinal epidural anesthesia routienely in total joint replacement, but have not analyzed the result. The aim of this study was to analyse various aspect of combined spinal epidura anesthesia. Methods: thirteen cases of ASA I and II who underwent Total Hip Arthroplasty under combined spinal epidural anesthesia were analysed. First epidural was given in space L2-3/L3-4 and patency was confirmed with test dose with InjXylocaine 2% with Adrenaline 3 ml, followed by Spinal anesthesia one space below with Bupivacaine 0.5% 3 ml. Results: Intra operative Mean Blood Pressure had dropped up to 55 mm of Hg.To maintain Blood pressure, Intravenous Fluid was given in average is 2423.077 ml and Vasopressure drug (Mephenteramine Maleate) was given in average of14.769 mg. Dura was accidentally puncture in one patient during epidural insertion and two epidural failed to provide post operative analgesia. Post operative rehabilitation was easy, one one patient developed DVT after 4 weeks of surgery. Conclusion: Combined epidural analgesia effectively manages postoperative pain, allows early ambulation and reduces the risk of deep vein thrombosis and thromboembolism, Although significant drop of Blood pressure was noted in all cases. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6447 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 32-36

Patient-assessment techniques for cataract surgery

Cataract is the most frequently cited self-reported cause of visual impairment and, as a consequence, cataract surgery is the most frequently performed surgery worldwide. Cataract surgery itself has improved significantly over the last few decades, as have patient-assessment techniques. As a consequence, a large variety of measurements prior to surgery are available to evaluate the patients’ symptoms, to grade cataract intensity and to calculate the best fitting intraocular lens for each patient. The purpose of this article is to provide an overview of these assessment techniques.