Perioperative Findings Research Articles

Comparative Evaluation of Upper Pole and Non-Upper Pole Puncture Techniques in Percutaneous Nephrolithotomy (PCNL): A Retrospective Analysis of Efficacy and Safety Parameters

Background: Percutaneous nephrolithotomy (PCNL) is a critical intervention in the management of large renal calculi, with the choice of calyx puncture technique impacting the efficacy and safety of the procedure. While the upper pole approach is associated with better visualization and stone clearance, it is used with caution due to a perceived increase in complication rates. Objective: This study aimed to compare the upper pole calyx puncture technique's efficacy and safety with that of the non-upper pole (middle and lower) puncture techniques in PCNL. Methods: A retrospective analysis was conducted on 173 patients who underwent PCNL at the Urology and Transplant Unit A of The Institute of Kidney Diseases in Peshawar from January 2017 to December 2020. Data on demographics, stone characteristics, perioperative findings, and postoperative outcomes were collected. Statistical significance was determined using Chi-square tests with SPSS version 25. Results: The average stone size was 21.38 mm (±11.2 mm) overall, with the upper pole group presenting a smaller average size of 19.8 mm (±7.6 mm) compared to 21.55 mm (±10.8 mm) for the non-upper pole group (p=0.032). Pre-operative hemoglobin levels were slightly lower in the upper pole group (12.5 ± 1.8 mg/dl) than in the non-upper pole group (12.9 ± 1.8 mg/dl, p=0.007). Complete clearance rates were comparable between groups. Post-operative blood transfusion was required more frequently in the non-upper pole group (12.1%, n=12) versus the upper pole group (4.0%, n=3, p=0.04). Conclusion: The upper pole approach in PCNL may afford a higher rate of stone clearance and reduced operative times with acceptable safety when compared to non-upper pole approaches. The selection of puncture technique should be tailored to individual patient anatomy and stone characteristics, with consideration given to the surgeon's experience and skill.

Discrepancies in staging and perioperative classification of pelvic endometriosis according to #Enzian 2021.

The aim of this study is to compare the extent of ovarian endometriosis diagnosed at preoperative staging with subsequent perioperative findings. Definition of discrepancies observed according to the #Enzian 2021 classification. The cohort includes 62 patients of reproductive age with preoperative findings of ovarian endometrioma. Patients were divided according to the #Enzian 2021 classification into subgroups (O1, O2 + O3) with unilateral and bilateral findings. The percentage concordance of preoperative and perioperative findings was evaluated. In the evaluation of ovarian involvement, the preoperative ultrasound diagnosis shows almost 100% agreement with the findings on the ovaries during surgery. Periadnexal adhesions were predicted preoperatively in only half of the cases. The difference in laterality was confirmed with T3 involvement in the O2 + O3 subgroup. In the bilateral involvement, the finding of the presence of grade 3 adhesions was doubled. An association of ovarian form of endometriosis (O2-O3) with deep infiltrating endometriosis of the small pelvis was observed in 50% of the cohort. The ovarian form of endometriosis is associated with the occurrence of other endometriosis lesions in the small pelvis. In this study, it was confirmed that preoperative staging underestimates the extent of endometriosis in the small pelvis. In the surgical management of ovarian endometriosis, extensive adhesive process should be expected.

Replacement of Total Abdominal Hysterectomy by TLH in a Patient with Previous Pelvic Surgery

Background: In a patient who had previous pelvic surgery, total laparoscopic hysterectomy (TLH) has well-established advantages over total abdominal hysterectomy. The hysterectomy is a common gynaecological operation. Although the vaginal route is preferred for hysterectomy, the best route for women who are not candidates for the vaginal approach is unknown. Hysterectomies are increasingly being performed laparoscopically as technology advances and experience grows. Objectives: The aim of this study is to evaluate the replacement of total abdominal hysterectomy by TLH in a patient with previous pelvic surgery. Method: This observational study was carried out on 60 women admitted in the Department of obstetrics and gynaecology, Labaid specialized Hospital, Dhaka, Bangladesh during the study period. The duration of the period was from July 2021 to June 2022. The data for this study about had been accumulated from patients sociodemographic & obstetrics information, physical examination and per-operative findings. Statistical evaluation of the results used to be got via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: A total of 60 patients were included in final analysis. According to the study population's age distribution of the study population, it was observed that 15(25.0%) were in group 35-38, 23(38.33%) were in group 39-42, 16(26.66%) were in group 43-46 and 6(10.0%) were in group 47-50. according to patient demographics, it was observed that 44(73.33%) were Leiomyoma, 29(48.33%) were Bleeding, 3(5.0%) were Pelvic pressure, 19(31.66) were Pelvic pain and 15(0%) were size growth. Conclusion: TLH for endometrial pathology has few problems and is well tolerated by a restricted group of patients. For suitable patients, the benefits include decreased blood loss and a shorter hospital stay. TLH can be performed effectively despite previous abdominal surgery. Patients who had previous .......

Etiology of Intestinal Obstruction - Correlation between Pre-operative and Per-operative Findings with Histopathology

Background: Intestinal obstruction is one of the most common causes of acute abdomen and often requires surgical intervention. However, pre-operative and per-operative diagnosis often do not correlate with postoperative histopathology done in suspected cases. Therefore, the study was designed to identify the etiology of intestinal obstruction correlating to pre-operative and per-operative findings with postoperative histopathological findings in suspected cases. Methods: A cross sectional study was conducted at the department of General Surgery, Mymensingh Medical College & Hospital, Mymensingh for 18 months following ethical approval from Institutional Review Board (IRB) of Mymensingh Medical College. During the study period, all patients with suspected intestinal obstruction admitted in Department of Surgery were included based on selection criteria. Total 103 patients were assessed in pre-operative and per-operatively. Histopathological examination was done in suspected cases where diagnosis could not be confirmed without histopathology. Data collection was done with a data collection form. After collection of all the required data, final analysis was carried out by using the SPSS version 21.0. Results: Among 103 cases of intestinal obstruction, mean age was 45.50±14.37 SD (years) with male female ratio-1.78:1. About 66% came from rural areas and 34% were from urban areas. Abdominal pain was the commonest symptom present among the cases which was observed in 91.3% cases. Others common symptoms were vomiting, abdominal distension absolute and relative constipation in 72.8%, 69.9%, 12.6% and 63.1% cases respectively, while abdominal tenderness was the commonest sign present in all cases. Among study population, 68.9% was small bowel obstruction and 31.1% was obstruction in large bowel. According to per-operative findings 22.3% cases were suspected as malignant. Finally 24.3% cases were proved as malignant in subsequent histopathological examination and 75.7% cases

Hollow viscus injury due to blunt abdominal trauma: a tertiary trauma center experience.

Hollow viscus injuries (HVIs) present less frequently than solid organ injuries in patients with blunt abdominal trauma, potentially leading to significantly increased morbidity and mortality rates. Modern imaging equipment, confidently used for diagnosing solid organ injuries, may fail to identify hollow viscus injuries. In this study, we aim to present our tertiary center's experience with this entity. Patients treated in our clinic from April 2011 to December 2021 for hollow viscus injury following blunt abdominal trauma were included in this study. We recorded and retrospectively evaluated patients' demographic data, injury site and mechanism, preoperative and perioperative findings, and mortality rates in a prospective database. Of the 607 blunt trauma patients, 35 (5.8%) had hollow viscus injuries, with 88.6% being male. Motor vehicle accidents were the leading cause of injury (80%). The mean duration between admission and surgical exploration was 26±21.2 hours. The mean Injury Severity Score was 21.8±13.6. Rigidity was the most frequent clinical finding (60%). The jejunum and ileum were the most frequently injured organs (54.1%). Mortality and morbidity rates were 11.4% and 17.1%, respectively. Nondeclining white blood cell (WBC) counts within 24 hours of admission, alongside any physical or radiological finding indicating an HVI, should prompt immediate surgical exploration.

Nonacute Subdural Hematoma Evacuation via Rigid Endoscopy System: A Clinical Study.

We aimed to determine the clinical relevance of a rigid endoscopy surgical method for subdural hematomas previously described in a cadaver study. Between May 2021 and September 2023, 21 patients underwent subdural hematoma drainage using a 0-degree rigid endoscope. Traumatic acute subdural hematomas were excluded. The demographic data of the patients, antiplatelet/ antiaggregant use, perioperative findings, and pre- and post-surgery modified Rankin Scale (mRS) scores were recorded and analyzed. The mean age of our cohort was 65.63 (±20.52), and the male/ female ratio was 3.2: 1. The hematoma was unilateral in 90.5% of the patients, and the rate of trauma history was 42.9%. The most common radiological diagnosis was chronic subdural hematoma with septa (61.9%). The percentage of patients with a history of antiplatelet/ antiaggregant therapy was 23.8%. No mortality related to the surgery was observed in the early postoperative period; however, two patients underwent reoperation for further bleeding. The neurological grade was the only preoperative factor that had a statistically significant effect on the mRS score at discharge, with significantly better discharge mRS scores in grade 1 and 2 patients. (p = 0.014) Conclusion: The procedure was found to be safe and feasible, with surgery-related morbidity and mortality within acceptable limits.

Physical Examination-Indicated Cerclage in Singleton and Twin Pregnancies and Risk Factors for Predicting Preterm Birth < 28 Weeks.

We compare the outcomes of physical examination-indicated cerclage (PEIC) between singleton and twin pregnancies and analyze predictive factors for preterm birth < 28 weeks of gestation. Patients who underwent PEIC at our center were reviewed. We compared perinatal outcomes between singleton and twin pregnancies. The primary outcome was delivery before 28 weeks of gestation. Also, we analyzed perioperative clinical, laboratory, and sonographic findings to determine the risk factors for predicting preterm birth < 28 weeks. The rate of preterm birth < 28 weeks was not significantly different. Also, neonatal outcomes were not different. Also, we compared the outcomes according to GA (gestational age) at delivery before (Group A) or after (Group B) 28 weeks, which is the primary outcome. In perioperative findings, group A was likely to have more advanced cervical dilatation, bulging membranes into the vagina, positive fFN or IGFBP-1, and shorter postoperative CL (cervical length) than group B. Also, positive fFN or IGFBP-1 and postoperative CL < 21.6 mm were independently associated with a higher risk of preterm birth < 28 weeks. These findings provide the effectiveness of PEIC with twin pregnancy as well as singleton pregnancy and helpful predictive methods that might effectively identify women at high risk of preterm birth < 28 weeks following PEIC.

Robot-assisted radical nephroureterectomy for upper urinary tract tumor: initial experience with the use of novel surgical robot system, hinotori.

The hinotori surgical robot system is a promising robotic platform that has been recently introduced into routine clinical practice. The aim of this study was to report our initial experience of robot-assisted radical nephroureterectomy (RANU) using hinotori. This study included a total of eight patients with upper urinary tract tumor (UUTT) who underwent RANU using hinotori via the transperitoneal approach. In this series, nephrectomy was initially performed at the kidney direction stage followed by distal ureterectomy and bladder cuff excision at the bladder direction stage without repositioning of patient or port. Lymphadenectomy was performed at either stage. Median age, body mass index, and tumor diameter were 76 years, 21.7 kg/m2, and 13 mm, respectively. Of eight patients, three were diagnosed with renal pelvic tumors and five with lower ureteral tumors. They underwent lymphadenectomy targeting the renal hilum plus para-aorta and the pelvis, respectively. All procedures in this series were completed without conversion to open surgery. Median operative time, time using the robotic system, estimated blood loss, and length of hospital stay were 230 minutes, 138 minutes, 23 mL, and 8 days, respectively. No major perioperative complication occurred. Pathological examinations of the tumors revealed seven urothelial carcinomas and one papilloma, the median number of resected lymph nodes was 13, and one patient was positive for both cancer margin and lymph node metastases. Despite being a small case series, this is the first study characterizing RANU using the hinotori surgical robot system. RANU was efficaciously and safely performed, resulting in the achievement of favorable perioperative findings.

Per-Operative Predictors of Conversion of Laparoscopic Cholecystectomy into Open Procedure

Laparoscopic cholecystectomy, a minimally invasive procedure for gallbladder removal, is widely preferred due to its advantages like reduced postoperative pain and quicker recovery. However, in certain cases, this procedure may need to be converted to an open cholecystectomy. The ability to predict such conversions preoperatively is crucial for better surgical planning and patient counseling. Objective: To identify and analyze the per-operative predictors that may necessitate the conversion of laparoscopic to open cholecystectomy. Methods: This study was conducted in Surgical Unit 3 at Bahawal Victoria Hospital, Bahawalpur as a prospective observational study spanning over 6 months from September 2022 to February 2023. All patients who were booked for Laparoscopic cholecystectomy were included. The data of preoperative and perioperative factors were collected on a standard proforma. Operative findings which were analyzed and documented by the surgeon were then, compared to look for the factors that contribute to conversion of Laparoscopic cholecystectomy into open procedure. Results: Mean ± SD of age was 42.59 ± 13.14. Regarding frequency of per-operative findings. It reveals that adhesions were found in 20 (22.7%) of the 88 procedures, difficult anatomy at Callot’s triangle was present in 12 (13.6%) cases, unmanageable bleeding occurred in 4 (4.5%) cases, and damage to nearby structures was observed in 6 (6.8%) procedures. The remaining procedures did not exhibit these issues. Conclusions: Our study has conclusively identified critical per-operative predictors for the conversion of laparoscopic cholecystectomy to an open procedure. These insights are instrumental for preoperative assessment and planning, potentially guiding clinical decisions to optimize patient care and surgical outcomes.

A Literature Review of Perioperative Outcomes of Robotic Radical Nephrectomy (RRN) Versus Laparoscopic Radical Nephrectomy (LRN) for Renal Cell Carcinoma (RCC).

Renal cell carcinoma (RCC) is an adenocarcinoma of the renal cortex. Radical nephrectomy remains the standard of care for managing massive renal tumours. Robotic-assisted radical nephrectomy is an increasing alternative technique to laparoscopic radical nephrectomy (LRN). The da Vinci Surgical System allows for improved dexterity, increased visualisation, tremor filtration and an ergonomic setting to enhance surgeon comfort. The aim was to compare the perioperative outcomes pertaining tooperative time, intraoperative complications, blood loss and length of hospital staybetween the robotic and LRN for RCC. Studies that compared the perioperative findings between robotic radical nephrectomy (RNN) and LRN for RCC were included. The literature review was carried out according to the Cochrane collaboration standards where applicable. Highly sensitive search strategies like MeSH terms and controlled vocabularies were used to identify relevant studies that compare the RNN outcomes to the LRN. Following the literature search, a total of 73 articles were collected, 60 articles were excluded at the stage of reviewing the titles, eight articles were excluded after reading the abstracts, and five articles were included in this paper. Five studies were included in this analysis, with a total sample size of 1770 patients, 735 were in the robotic arm, and 1035 were in the laparoscopic arm. Generally, there were no differences between both arms in terms of demographic data and age of patients. Closer analysis of the perioperative outcomes did not reveal significant differences between the two groups related to the estimated blood loss, length of hospital stay or post-operative complications. The laparoscopic techniques have less operative time than the robotic ones. RRNis an expanding approach for patients with RCCwith some potential technical benefits over laparoscopic ones. RRN is similar to LRN in the perioperative outcomes, with few potential drawbacks of RRN, including higher costs. However, a prospective comparison of RRN with LRN in many cases at multiple centres with long-term oncological results best illustrates the status of RRN versus LRN.

Low-Grade Injury following Testicular Torsion: A Multicenter Study Confirming a Disturbing Possibility

Introduction: There is an ongoing debate whether to perform orchiectomy or orchidopexy following testicular torsion (TT) in cases where the testis seems non-viable. The main problem is lack of objective criteria defining testicular viability. The aim of this study was to investigate the grade of injury in orchiectomy specimens obtained from cases of TT and its association with clinical findings. Methods: This multicenter retrospective study involved double-blinded reassessment of the patient files and the pathological specimens using Mikuz classification to analyze the relation between clinical and pathological findings. Results: A total of 289 patient charts from 14 centers were reviewed and 228 were included in this study. Twenty (8.8%) patients had grade 1 injury which refers to reversible injury. The clinical findings of these 20 patients were compared to 208 patients with higher grades of injury. As expected, there was statistically significant difference regarding duration of symptoms (p < 0.001); however, range was wide in both groups (as long as 96 h for grade 1 and as short as 7 h for higher grades). There was no statistically significant difference in any other variable including age (median 14 for both, p = 0.531), symptoms (pain: 19/20 vs. 189/202, p = 0.801; swelling: 13/19 vs. 168/197, p = 0.094), absence of blood flow in Doppler US (15/19 vs. 164/197, p = 0.635), or degree of torsion (median 720° for both, p = 0.172). Conclusion: Our study revealed necessity for better criteria to define viability of testis following TT. Histopathological injury appeared to be reversible even in some patients with more severe perioperative findings, late admission, or high degree of twisting. Our findings support the tendency for testicular fixation instead of orchiectomy as none of the clinical or perioperative findings could be attributed to high-grade injury.

Endoscopic dilation using two guidewires: a novel approach for establishing access tract during percutaneous nephrolithotomy under ultrasonographic guidance.

To evaluate the efficacy and safety of a novel endoscopic dilation (END) method during percutaneous nephrolithotomy under ultrasonographic guidance. We retrospectively reviewed the clinical records of 138 patients who underwent percutaneous nephrolithotomy from June 2020 to December 2021. The patients were divided into three groups based on the method of nephrostomy tract creation: those who underwent fascial Amplatz serial fascial dilation (AMD) (n = 45), one-shot dilation (OSD) (n = 45), and END (n = 48). For END, a 20-Fr dilator with sheath was accessed over the first guidewire. A second guidewire was inserted into the collecting system via the endoscope. The nephroscope was then accessed to enlarge the renal puncture point using both guidewires. Demographic variables and important intraoperative and postoperative findings were compared among the three groups. The preoperative characteristics were similar among the three groups. The END group had a significantly shorter access time than both the AMD and OSD groups and significantly less severe hemoglobin loss than the OSD group. There were no significant differences in the other important perioperative findings. Use of this novel END method with two guidewires may be associated with less blood loss and a reduced access time.

Retrospective analysis of perineal herniorrhaphy with cone-shaped polypropylene mesh in dogs: technique description and outcome.

This study aimed to describe the technique for the surgical repair of perineal hernia (PH) in dogs using a polypropylene mesh (PM) and to evaluate its outcomes. All dogs were placed in the Trendelenburg position. Castration and caudal celiotomy for cystopexy and colopexy were performed as needed. Ipsilateral perianal incision was performed in the affected hernia side. A PM was formed a cone-shape with suturing and placed in hernial foramen. The PH was repaired with suturing between PH and pelvic diaphragm including the sacrotuberous ligament, internal obturator muscle, and external anal sphincter muscle. The medical records of all dogs were reviewed to evaluate signalment, perioperative findings, postoperative complications, and prognosis. Of the 22 dogs, 15 were intact, and 7 were previously neutered. The median age and body weight were 10 years and 6.8 kg, respectively. The PH reconstruction using a cone-shaped PM was feasible in all dogs. The median operative time was 60.5 min for unilateral PH and 109 min for bilateral PH. Major postoperative complications occurred in seven dogs (32%), and three dogs (14%) had a recurrence of PH. In the long-term (> 2 weeks) follow-up period, 16 dogs (73%) had an excellent prognosis. Our study suggests that PH reconstruction surgery using a cone-shaped PM may be a viable treatment method for PH in dogs. Therefore, a cone-shaped PM could serve as an alternative treatment option for canine PH reconstruction.

Trocar Site Location in Laparoscopic Appendectomy-A Prospective Randomized Study.

Laparoscopic appendectomy has been used in the treatment of appendicitis, which is among the most common emergency pathologies worldwide. There is no consensus on the best trocar entry sites. The purpose of the present study was to compare various trocar entry sites in the literature and to find the localization with the optimal usage area. Patients who underwent laparoscopic appendectomy between 2021 and 2022 were randomized into 4 groups and included in the study. The demographic data, perioperative, and postoperative findings of the patients were evaluated. A total of 200 patients participated in the study and 73% were male. No differences were detected between the groups in terms of demographic data, preoperative findings, length of stay, and complications of the patients. However, when the mean surgery times of the groups were examined (47.2±26.9, 58.4±23.1, 54.5±18.3, 55.8±18.6min), it was observed that this period was less in Group 1 (P=0.02). When the postoperative Visual Analogue Scale values were analyzed (4.8±2.2, 6.2±1.7, 5.5±2.0, and 5.8±1.9), Group 1 was found to be less painful (P=0.00001). When the surgical procedure is optimized and environmental factors are homogenized, Group 1 trocar entry sites seem advantageous for the procedure in terms of postoperative patient pain scale and operation times.

A case of primary mesenteric synovial sarcoma: a challenging presentation

BackgroundSynovial sarcoma is an uncommon soft tissue malignancy that mainly occurs near tendon sheath and bone joints. Primary intra-abdominal location is exceedingly rare and characterized by non-specific clinical signs.Case presentationWe report the case of a young female without medical history who presented with acute abdominopelvic pain. Ultrasound echography revealed a right mass measuring 7 cm in greater diameter cystic with solid areas, likely of ovarian origin. A coelioscopy with peritoneal biopsies was performed. Histological examination with immunohistochemistry concluded the diagnosis of GIST. The patient was referred to the surgery department and after laboratory routine analysis and computed tomography, the patient was proposed to surgical management. Per-operative findings revealed a mesenteric mass locally invading the greater omentum and the appendicular wall. Pathological examination with immunochemistry confirmed the diagnosis of mesenteric monophasic synovial sarcoma invading the appendicular wall with positive surgical margins. Chemotherapy was proposed with a good response. Our patient is free from disease 9 months later.ConclusionsWe aimed through this case report to discuss mesenteric presentation monophasic SS, mimicking ovarian malignancy, emphasizing clinicopathological features and differential diagnoses.

Surgical techniques and perioperative surgical outcomes after discectomy for calcified lumbar disc herniation: a review and meta-analysis.

Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The data regarding outcomes after surgery for CLDH are limited. This review was conducted to analyse the surgical techniques, perioperative findings and the postoperative clinical outcomes after surgery for CLDH. PRISMA guidelines were followed whilst conducting this systematic review and meta-analysis. The literature review was conducted on 3 databases (PubMed, EMBASE, and CINAHL). After thorough screening of all search results, 9 studies were shortlisted from which data were extracted and statistical analysis was done. Pooled analysis was done to ascertain the perioperative and postoperative outcomes after surgery for CLDH. Additional comparative analysis was done compared to CLDH with non-calcified lumbar disc herniation (NCLDH) cases. We included 9 studies published between 2016 and 2022 in our review, 8 of these were retrospective. A total of 356 cases of CLDH were evaluated in these studies with a male preponderance (56.4%). Mean operative time was significantly lower in NCLDH cases compared to CLDH cases. The mean estimated blood loss showed a negative correlation with the percentage of males. Satisfactory clinical outcomes were observed in majority of patients. The risk of bias of the included studies was moderate to high. Surgical difficulties in CLDH cases leads to increase in operative time compared to NCLDH. Good clinical outcomes can be obtained with careful planning; the focus of surgery should be on decompression of the neural structures rather than disc removal.

Robot-assisted radical nephrectomy using novel surgical robot platform, hinotori: Report of initial series of 13 cases.

The aims of the present study were to describe the perioperative findings of the first series of patients undergoing robot-assisted radical nephrectomy (RARN) with a newly launched platform, the hinotori surgical robot system, and compare the findings with a similar set receiving RARN with the existing system, da Vinci. This study included 34 patients, consisting of 13 and 21 undergoing RARN using the hinotori and da Vinci robotic systems, respectively. As a rule, RARN was performed via an intraperitoneal approach employing 3 robotic arms, irrespective of the robotic systems. In the hinotori group, the median age, body mass index and tumor diameter were 65 years, 23.3 kg/m2 and 50 mm, respectively. All surgical procedures with hinotori could be completed by a purely robotic approach. In the hinotori group, the median operative time, time using the robotic system, estimated blood loss and length of hospital stay were 157, 83 min, 11 mL and 6 days, respectively, and major perioperative complications did not occur. In this group, 3, 1 and 9 patients were pathologically diagnosed with pT1a, pT1b and pT3a tumors, respectively. No significant differences in baseline characteristics were noted between the hinotori and da Vinci groups, and there were also no significant differences in perioperative findings between them. Despite a case series with a small sample size, this is the first report evaluating RARN using the hinotori surgical robot system, which could be safely conducted and achieved perioperative outcomes similar to that using the da Vinci system.

Laparoscopic Pediatric Inguinal Hernia Repair with Percutaneous İnternal Ring Suturing with Finer Needle and Suture; A 5-Year Experience of A Single Surgeon

Introduction: Percutaneous internal ring suturing (PIRS) method is an effective minimally invasive laparoscopic method that was preferred for indirect hernia repair in children. Purpose: The aim of this study is to report the evaluation of surgical results in our PIRS series modified with finer needle and suture with the diagnosis of indirect inguinal hernia, communicating hydrocele and incarcerated inguinal hernia. Methods: This was a retrospective study that included children aged 3 months to 12 years who underwent PIRS technique due to inguinal hernia between 2017 and 2022. Per-operative findings, surgical time, follow-up findings, complications, and recurrence data were evaluated. Results: One hundred patients underwent a total of 129 PIRS procedures. Right inguinal hernias were diagnosed in 63 (63%) of the patients (1 communicating hydrocele and 1 recurrent inguinal hernia). One communicating hydrocele and one recurrent inguinal hernia were present on the left side of 32 (32%) patients. Five patients were diagnosed bilaterally (one incarcerated hernia). 24 patients (29%) with no symptoms were found to have contralateral hernias: 11 on the right (45%) and 13 on the left (55%) side. The average duration of surgery for unilateral PIRS was 13.5 minutes and bilateral PIRS was 24.3 minutes. Average follow-up duration was nine months. There were complications in nine patients (9%). Recurrence was observed in 3 (or 3%) of 100 (or 100) patients. Conclusion: PIRS is a simple and safe alternative to open hernia repair in terms of surgical outcomes for the management of inguinal hernia in children.

Omphalocele containing an umbilical evagination of the bladder: A case report

An omphalocele is a common congenital abdominal wall defect, however co-occurring urological anomalies are rare. With the aim of optimizing treatment in future cases, we present a case of a male newborn with an omphalocele containing an unusual mucosal protruding mass, and give an overview of differential diagnosis and current literature. A newborn presented with an omphalocele containing small bowel, and a defect in the sac through which a protruding annular mucosal mass was visible. On previous prenatal ultrasounds, there were findings of an enlarged urinary bladder with patent urachus, communicating with a large allantoic cyst. The patient was taken to the operating room for exploration of the mucosal mass, which then appeared to be connected to an opening in the urinary bladder. The mucosal mass was successfully excised and the urinary bladder and abdominal wall defect were both primarily closed. Omphalocele with co-occurring urological anomalies are rare and come with a broad differential diagnosis. Surgeons must take prenatal, clinical and perioperative findings in consideration in order to adequately diagnose and treat the anomalies.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.