Patients In Postoperative Period Research Articles

Experience in performing multivisceral resections for pelvic cancer

Background. Treatment of patients with locally advanced pelvic cancer remains challenging. The use of modern surgical techniques has expanded the feasibilities of performing multivisceral resections (MVR) in this category of patients. However, the postoperative period in patients who have undergone MVR is associated with a high risk of developing postoperative complications. The purpose of the study was to assess the short-term and long-term treatment outcomes in patients with locally advanced and multiple-primary pelvic cancer. Material and Methods. From 2009 to 2021, 114 patients treated in the clinics of Cancer Research Institute of Tomsk National Research Medical Center underwent MVR for primary or recurrent rectal cancer (n=40, 35.1 % and n=4, 3.5 %, respectively), female reproductive cancer (endometrial cancer: n=18, 17.1 % and recurrent ovarian cancer: n=18, 17.1 %), primary and recurrent bladder cancer (n=15, 13.2 % and n=2, 1.8 %, respectively), synchronous multiple primary pelvic tumors (n=8, 7.0 %) and extraorgan mesenchymal tumors of the pelvis (n=4, 3.5 %). Paraneoplastic complications were observed in 31 (27.2 %) patients. Invasion to more than 2 adjacent pelvic organs was diagnosed in 52 (45.4 %) cases. Total pelvic evisceration (TPE) was performed in 9 (7.9 %) patients, including 5 (4.4 %) patients who underwent TPE for primary rectal cancer with extensive local spread and 4 (3.5 %) patients who underwent TPE for multiple primary cancer: 2 (1.75 %) for synchronous primary rectal cancer and bladder cancer and 2 (1.75 %) for primary rectal cancer and recurrent bladder cancer. MVR for rectal cancer was the most common (n=101, 88.6 %). Resections with the formation of colorectal anastomosis were performed in 75 (65.8 %) cases and obstructive resections of the rectum were performed in 14 (12.5 %) cases. Urinary tract surgeries were performed in 66 (57.5 %) cases. One-stage plastic surgery of the resected segment as a transposition of one or both ureters into the bottom of the bladder was performed in 22 (19.3 %) cases. Heterotopic and orthotopic plastic surgery of the bladder was performed in 19 (16.6 %) and 5 (4.4 %) cases, respectively. Combined uterine extirpations, including vaginal resection, were performed in 52 (45.4 %) cases. Grade III postoperative complications according to the Clavien–Dindo classification occurred in 18.4 % of cases. Urological complications were the most common (8.7 %). Postoperative mortality rate was 0.8 %. The assessment of the long-term outcomes was carried out using the example of patients with rectal cancer (n=45), as the most homogeneous and largest subgroup. The overall 3-year survival rate was 71.1 % and the relapse-free 3-year survival rate was 60.0 %. Conclusion. Treatment of locally advanced pelvic cancer requires extensive surgeries performed by a multidisciplinary team of surgeons. The immediate results can be assessed as satisfactory. In case of resection of the urinary tract as a component of MVR, regardless of the primary localization of the tumor, primary plastic surgery of the bladder and/or ureters is preferable. Long-term outcomes allow us to consider MVR as a method of choice in the treatment of this group of patients.

EVALUATION OF RETINAL MICROCIRCULATION CHARACTERISTICS FOLLOWING RHEGMATOGENOUS DETACHMENT

Introduction. Despite advancements in surgical techniques for treating retinal detachment, the risk of vision loss remains significant. Accurate assessment of changes in the macular microvascuature using optical coherence tomography-angiography (OCT-A) can improve predictions for recovery of vision in patients, making this a critical area of focus in modern ophthalmology. Purpose: to analyze changes in the retinal microvasculature following successful vitrectomy for rhegmatogenous retinal detachment (RRD), both with and without macular detachment, and to evaluate their impact on postoperative visual function. Materials and methods. A total of 89 patients were studied. Group I consisted of 47 patients with RRD without macular detachment, while Group II included 42 patients with RRD with macular detachment. Retinal microvasculature parameters were assessed in the late postoperative period (18 months) using OCT-A. All patients underwent closed subtotal vitrectomy, retinal endolaser coagulation, and vitreous tamponade with an octafluoropropane (C3F8) gas-air mixture. Results. In Group II, correlation analysis at 18 months revealed a significant relationship between the density of the deep capillary plexus and best-corrected visual acuity (BCVA) (r = 0.69, p = 0.023). Additionally, a correlation was observed between BCVA and the area of the foveal avascular zone (FAZ) (r = 0.24, p = 0.013). Conclusions. Restoration of the retinal microvasculature continues into the late postoperative period in patients with RRD involving macular detachment. OCT-A parameters, specifically deep capillary plexus density and FAZ area, are significant factors influencing visual function following surgery for RRD.

Microorganisms and peculiarities of the course of the postoperative period in patients with infective endocarditis and COVID-19

Microorganisms and peculiarities of the course of the postoperative period in patients with infective endocarditis and COVID-19

Risk Factors for Postoperative Acute Kidney Injury Requiring Renal Replacement Therapy in Patients Undergoing Heart Valve Surgery.

Background: Postoperative acute kidney injury (AKI) in patients undergoing heart valve surgery is a common complication requiring special treatment, including renal replacement therapy (RRT). Effective prevention remains the most effective tool to reduce this important clinical problem. The aim of the study was to evaluate the predictive abilities of selected perioperative parameters in predicting AKI requiring RRT in the early postoperative period in patients undergoing cardiac valve surgery. Methods: Prospective study on a group of patients undergoing cardiac valve surgery. The primary endpoint was postoperative AKI requiring RRT. The secondary endpoint was death in the RRT group. Logistic regression analysis was used to assess which variables predicted the primary and secondary endpoints. Results: 603 patients were included in the study. The primary endpoint occurred in 43 patients. At multivariable analysis, age (p < 0.001), preoperative CRP level (p = 0.007), troponin T measured one day after surgery (TnT II) (p < 0.001) and prolonged postoperative use of catecholamines (p = 0.001) were independent predictors of the primary endpoint. In turn, death in the group of patients requiring RRT occurred in 32 patients. Age (p < 0.001), preoperative CRP level (p = 0.002), TnT II (p = 0.009), and prolonged postoperative use of catecholamines (p = 0.001) remained independent predictors of the secondary endpoint. Conclusions: The results of this study indicate that older age, elevated values of preoperative levels of CRP, as well as increasing levels of postoperative troponin T and the need for a prolonged supply of catecholamines, are independent predictors of postoperative AKI requiring RRT as well as death. Accurate identification of patients at increased postoperative risk of AKI could facilitate preoperative patient informed consent and optimize the process of qualification and cardiac surgical treatment.

Effectiveness of a Nurse-Led Telecare Programme in the Postoperative Follow-Up of Bariatric Surgery Patients: A Quasi-Experimental Study.

Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery. A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions. The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients.

Role of leukotriene receptor antagonist in improvement of symptoms after functional endoscopic sinus surgery for chronic rhinosinusitis with or without sinonasal polyposis

Background: Chronic rhinosinusitis is one of the common ENT diseases encountered daily. Due to its chronicity, it leads to patient morbidity and decreased quality-of-life of the patient. Although various medical and surgical management options are available, none can manage the condition effectively. So, the aim of the study is to evaluate the efficacy of the montelukast in the subjective and objective improvement after the FESS for patients with chronic rhino sinusitis. Methods: This randomized controlled trial was conducted among 50 patients diagnosed with chronic rhino sinusitis. All the patients underwent FESS, and after that, they were divided into two groups; one group received the Montelukast tablet in addition to the standard post-operative regimen, and the other group received the standard post-operative medications only. The subjective and objective measurements were made using SNOT-22 and Lund-Kennedy endoscopic scores during the pre- and post-operative periods. Results: The study showed a significant reduction in the various parameters of SNOT-22, viz runny nose (p=0.013), cough (p=0.003), post-nasal discharge (p=0.037), thick nasal discharge (p=0.013), ear fullness (p=0.021), difficulty in falling asleep (p=0.018), walking up at night (p&lt;0.001), reduced concentration (p=0.001) in Group-A than in Group-B. The study also showed a significant reduction in the overall SNOT-22 score in the Group-A. The Lund-Kennedy endoscopic score (p=0.006) also showed a significant reduction during the postoperative period in Group-A. Conclusion: The Montelukast positively affects the reduction of the various domains in the SNOT-22 and the Lund-Kennedy endoscopic score. It can be used as adjuvant therapy during the post-operative period in patients operated with FESS for CRS.

The influence of rhythm disturbances on the results of combined operations of pulmonary endarterectomy and coronary artery bypass grafting in patients with chronic thromboembolic pulmonary hypertension and coronary heart disease

Aim. To study the features of the early postoperative period in patients with chronic thromboembolic pulmonary hypertension (CTEPH) with surgically significant stenosis of the coronary arteries and to evaluate the impact of cardiac arrhythmias on the hospital period after pulmonary endarterectomy (PEA) in combination with coronary artery bypass grafting (CABG).Material and methods. The study cohort included 45 patients with CTEPH with surgically significant coronary artery stenosis at the age of 61.4 (55.3-69.5) years. All patients underwent PEA (1st stage) and CABG (2nd stage). The relationship between concomitant rhythm disturbances and various complications in the early postoperative period was assessed using logistic regression analysis.Results. Initially, in the study cohort, rhythm disturbances were recorded in 33.3% of cases, where atrial fibrillation accounted for a large proportion. Among the early postoperative complications, the leading ones were neurological disorders (28.9%). Hospital mortality was 6.7%. Concomitant rhythm disturbances in the studied patients were associated with the postoperative development of neurological disorders (OR 4.7 (2.5-7.3; p=0.02)), heart failure (OR 2.2 (1.5-6.8); p=0.03)) and acute renal failure (OR 2.4 (1.4-7.9; p=0.01)).Conclusion. In high-risk cardiac surgical patients with CTEPH and surgically significant coronary artery stenosis, various rhythm disturbances are recorded in 33.3% of cases. In the hospital period after PEA and CABG in the studied patients, neurological disorders accounted for a large proportion of complications among the complications. Hospital mortality was 6.7%. Concomitant rhythm disturbances in patients with CTEPH with surgically significant coronary artery stenosis are associated with a more severe course of the early postoperative period and increase the chances of developing neurological disorders, acute renal failure and acute heart failure.

Early Postoperative Complications Following Extensive Lung Surgery

Background: Extensive surgical procedures play a key role in treatment of various lung diseases. Nevertheless, these complex procedures are associated with a high risk of early postoperative complications.Objective: To evaluate outcomes of the early postoperative period in patients with various lung diseases and determine risk factors for postoperative complications.Material and methods: We analyzed postoperative complications in 377 patients who underwent extensive lung surgery. The mean age was 45.7 ± 5.2 years. The majority of patients (56.0%) had malignant or benign lung tumors. Lobectomy was the most common type of surgery. Pneumonectomy accounted for 26.5%.Results: The overall rate of cardiovascular complications was 8.2%. The highest number of complications was observed after right-sided pneumonectomy (21.7%). Respiratory complications after right-sided pneumonectomy accounted for 34.8%. Lobectomy and bilobectomy had lower rates of complications (4.4% and 6.3%, respectively). The highest number of systemic complications was also recorded after right-sided pneumonectomy (23.9%), whereas lobectomy had a lower risk (4.4%). Patients with primary lung tumors had significantly more complications (32.2%) compared with patients without cancer (10.8%). The main risk factors were male gender (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = .032), age ≥60 years (OR, 1.9; 95% CI, 1.5-2.6; P = .001), smoking (OR, 1.7; 95% CI, 1.2-2.5; P = .019), C-reactive protein level &gt;3 mg/dL (OR, 1.8; 95% CI, 1.1-2.7; P = .015) and forced expiratory volume in the first second of expiration (FEV1) &lt;60% (OR, 1.5; 95% CI, 1.1-2.2; P = .042), surgery duration ≥180 minutes (OR, 1.8; 95% CI, 1.3-2.3; P = .002), and anesthesia without additional epidural analgesia (OR, 1.5; 95% CI, 1.2-2.1; P = .007).Conclusions: The complication rate after extensive lung surgery was 22.8%, with the highest rate after right-sided pneumonectomy (4.8%). Respiratory complications predominated (14.1%): hydrothorax/pneumothorax (5.0%), acute respiratory distress syndrome (4.2%), pneumonia (2.9%), and ventilator-associated tracheobronchitis (2.1%). The main risk factors were male gender, age ≥60 years, smoking, FEV1 &lt;60%, long surgery, no epidural analgesia, and high crystalloid infusion rate.

Osteopenia and osteoporosis in patients after bariatric surgery: mechanisms of development, course and prognosis

In recent decades, the medical community around the world has been searching for ways to combat morbid obesity, and despite the variety of methods and techniques, great progress has been noted in recent years in the field of bariatric surgery. Despite its effectiveness, bariatric surgery still has a large number of questions related to the effectiveness of certain methods, their long-term results and the choice of surgery. The purpose of this literature review: to consider the mechanisms of formation, development and course of osteopenia and osteoporosis after bariatric surgery, as well as the frequency of their occurrence depending on the type of bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass, gastric banding, biliopancreatic diversion). To achieve this goal, a literature search on this issue was conducted on the PubMed, eLIBRARY.RU, Google scholar platforms. The material was summarized and analyzed in order to find previously unexplored links in the pathogenesis of osteopenia and osteoporosis and, in general, the mechanisms of mineral metabolism disorders in the postoperative period in patients who underwent bariatric surgeries of varying volumes.

Caspase-9 and p53 Protein Levels in Cancer Patients after Different Anesthesia Techniques

The aim of this study was to investigate the changes in caspase-9 and p53 levels as biomarkers of pro- and anti-apoptotic pathways in the early postoperative period in patients who underwent lung surgery for malig-nant tumors under different types of multimodal or inhalation-intravenous anesthesia. Material and Methods. A single-center prospective study of 22 patients aged 45–64 years was conducted at the Omsk Clinical Oncology Early Treatment and Prevention Center from January to April 2020. The participants were divided into two groups. Group 1 patients received multimodal anesthesia, which included sympathetic nerve block and prolonged epidural analgesia in the postoperative period. Group 2 patients received inhalational and intravenous anesthesia followed by systemic morphine analgesia. Serum caspase-9 and p53 protein levels were measured at four time points: before anesthesia, one, twelve, and twenty-four hours after surgery. Statistical hypotheses were tested using nonparametric (rank) analysis methods. Friedman's ANOVA was used to compare multiple time points, while the Wilcoxon test was used to compare variables between two time points in dependent samples. The Mann-Whitney test was used to assess differences between groups in independent samples. P-values &lt; 0.05 were considered statistically significant. Results are expressed as median ± half interquartile range (Me ± (LQ – UQ) / 2). Results. At time point 2, caspase-9 levels were significantly higher in group 2 patients than in group 1 (P = 0.045). There were no significant differences between the groups at any other time points. Conclusion. The lack of a significant difference in serum levels of caspase-9 and p53 protein at most time points between the groups demonstrates the efficacy of the anesthesia and analgesia methods used. Mean-while, a significantly higher level of caspase-9 one hour after surgery demonstrates a greater susceptibility of patients without sympathetic blockade to activation of the apoptotic cell death program.

The Effect of Virtual Reality on Pain, Anxiety, Physiological Parameters, and Postspinal Headache in Patients Undergoing Spinal Anesthesia: A Randomized Controlled Trial

PurposeThe purpose of this research was to determine the effect of virtual reality (VR) on pain, anxiety, physiological parameters, and postspinal headache in patients undergoing spinal anesthesia. DesignThis was a randomized controlled experimental trial. MethodsThe research was conducted in the operating room unit of the state hospital in Hakkari-Şemdinli District Center between May 2021 and June 2022. Data were collected using the Descriptive Information Form, visual analog scale (VAS), verbal category scale (VCS), State-Trait Anxiety Inventory, and the Application Registration Form to record preoperative and postoperative oxygen saturation and heart rate. FindingsWhen the groups’ VAS and VCS mean scores were compared for head and incision site pain, the mean scores of headache and incision site pain in both groups were found to be significantly lower in the experimental group patients (P < .001). In addition, the difference between the groups in headache VAS and VCS mean scores at all hours was statistically significant; incision site pain VAS and VCS mean scores were significantly lower between the groups at all hours, except the 1st and 2nd hours (P < .001). While there was no significant difference in the State-Trait Anxiety Inventory (SAS) pretest mean scores between the groups (P > .05), the SAS post-test mean scores of the experimental group were significantly lower (P < .05). The mean heart rate in the intraoperative and postoperative periods and the mean saturation in the postoperative period differed significantly between the groups (P < .05). The difference between the blood pressure averages before, during, and after the operation was not statistically significant in both groups (P > .05). While nausea and vomiting was significant in the experimental group only at the 2nd hour (P < .05), it was not statistically significant at the other hours (P > .05). ConclusionsVR was found to effectively reduce pain, anxiety, postspinal headache, and increase the oxygen saturation level in the postoperative period in patients who underwent spinal anesthesia. Hence, VR is an effective treatment for patients who have undergone surgery under spinal anesthesia.

Biomarkers as Predictors of Severity Multiple Organ Dysfunctions After Cardiac Surgery (Case Series Study)

Introduction. The question of the possibility of predicting the severity of multiple organ failure that developed in the postoperative period in cardiac surgery patients is not sufficiently covered in the literature.The aim of the study is determine the prospects of studying the relationship between the level of biomarkers and the severity of multiple organ failure in patients undergoing cardiac surgery.Materials and methods. A series of seven observations was carried out on the clinical course of the immediate postoperative period in patients who underwent elective cardiac surgery. In the preoperative period, the risk of in-hospital mortality was assessed using the EuroSCORE II scale and the presence of multiple organ failure using the SOFA scale. Before surgery and at the beginning of the first postoperative day, the plasma level of presepsin was studied. Also, at the beginning of the first postoperative day, plasma levels of transferases and troponia T were studied, and the severity of multiple organ failure was analyzed using the SOFA scale. The length of stay of patients in the ICU was assessed. The results of the study are presented in the form of tables and graphs and subjected to visual analysis.Results. The obtained data do not allow us to accurately link the level of tissue damage markers (aspartate aminotransferase, alanine aminotransferase, troponin T) and the marker of the systemic inflammatory reaction presepsin with the severity of multiple organ failure in patients after cardiac surgery. At the same time, they do not exclude the existence of such a connection.

Acute Symptomatic Epileptic Seizures After Microsurgical Removal of Supratentorial Meningiomas

RELEVANCE. One of the problems complicating the early postoperative period in patients with supratentorial meningiomas is epileptic seizures, which in 9-16% of cases first develop within the first 7 days after tumor removal (acute symptomatic epileptic seizures).AIM OF THE STUDY. To identify risk factors for the occurrence of acute symptomatic epileptic seizures in the early postoperative period in patients with supratentorial meningiomas and to evaluate the effectiveness of prophylactic antiepileptic therapy.MATERIAL AND METHODS. A prospective, single-blind, randomized, placebo-controlled study was conducted using the sequential, alternate-arm randomization method. The treatment of 102 patients with supratentorial meningiomas was analyzed, in whom the tumor was removed between 01.01.2021 and 30.09.2023 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. To identify risk factors for the development of acute symptomatic epileptic seizures in patients, we assessed the data of the anamnesis, examination of the patient, electroencephalography before surgery, neuroimaging before and after tumor resection, as well as the characteristics of the intraoperative period, duration and outcomes of hospitalization. To evaluate the effectiveness of the prophylactic use of antiepileptic drugs, patients were divided into two groups. The first group consisted of 49 patients who took an antiepileptic drug as a prophylaxis of early epileptic seizures. The second group consisted of 53 patients who took a placebo drug. Both groups were divided into two subgroups each depending on the development of an epileptic seizure or its absence after surgery. In the first group, patients with epileptic seizures were considered the main subgroup, the patients without seizures were considered the control. We assessed the placebo group similarly.RESULTS. In the placebo group, a risk factor for the development of acute symptomatic epileptic seizures was the transection of one or more veins, which was necessary to achieve sufficient surgical access, leading to a change in cerebral venous blood flow (p=0.013, odds ratio (OR)=11.43; 95% CI [1.75–74.73]). In both the antiepileptic drug group and the placebo group, risk factors included an increase in the volume of cerebral edema according to postoperative CT scan data compared with preoperative (p=0.05, OR=18.8; 95% CI [2.0–182.7] and p=0.01, OR=12.6; 95% CI [2.36–68.0], respectively), as well as hemorrhagic transformation of the perifocal edema zone (p=0.03, OR=8.75; 95% CI [1.36–56.4] and p=0.02, OR=9.7; 95% CI [2.1–44.6], respectively). The efficacy of prophylactic use of antiepileptic drugs in reducing the incidence of acute symptomatic epileptic seizures in the first 7 days after surgery was not established (p=0.295, OR=0.533; 95% CI [0.181–1.572]).CONCLUSION. We have identified the following risk factors for the development of acute symptomatic epileptic seizures: an increase in the volume of cerebral edema compared to the preoperative level according to postoperative computed tomography, the development of hemorrhagic transformation of cerebral edema in both groups, and the intersection of one or more veins during surgery (in the placebo group). Confirmation of the efficacy of routine use of antiepileptic drugs for the prevention of acute symptomatic epileptic seizures not received.

Prophylactic antibiotic therapy during endovascular closure of patent foramen ovale: a clinical study

Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO). Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively). Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00]. Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p &lt; 0.0001).

Dynamics of changes in the diameter of the great saphenous vein in the postoperative period in patients operated on using non-thermal methods

Dynamics of changes in the diameter of the great saphenous vein in the postoperative period in patients operated on using non-thermal methods

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.

Lymphoblock surgical solution for the prevention of lymphogenic complications during robot-assisted radical prostatectomy and pelvic lymphadenectomy: first-use experience

Introduction. The clinical guidelines recommend performing extended pelvic lymph node dissection for patients with intermediateor high-risk cancer prostate. The incidence of lymphocele development reaches 10.3%.Objective. The aim of this study was to evaluate the efficiency of the drug Lymphoblock after radical prostatectomy with pelvic lymphadenectomy.Materials &amp; methods. The study involved 79 patients with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymphadenectomy, that were randomized into three treatment groups: 1. Patients with free peritoneal flap fixed to the pubic bone (n = 26); 2. Patients who received Lymphoblock: during the surgery (n = 26); 3. Control group (n = 27). The median follow-up was 180 d.Results. In postoperative period lymphocele was diagnosed in 8 (10.1%) patients: group 1 — 2 (7.7%) patients, group 2 — 1 (3.8%), group 3 — 5 (18.5%). Lymphocele had no clinical manifestation in group patients who received Lymphoblock.Conclusions. Preliminary results of Lymphobloc use indicate that it can reduce the incidence of lymphogenic complications in the postoperative period in patients undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy.

Improvement of Single-port Laparoscopic Cholecystectomy

The desire of both surgeons and patients to reduce the trauma of the operation and shorten the length of hospital stay, on the one hand, and on the other hand, the development of new technologies and the emergence of special devices led to the development and implementation of video endoscopic minimally invasive methods of surgical intervention. The results of single-port laparoscopic cholecystectomy and the possibility of choosing instrumental support when performing these operations should be analyzed. Our study included 116 patients hospitalized for planned surgical treatment with chronic calculous cholecystitis from 2019 to 2023. The patients were divided into two groups: the first main group consisted of 52 (44.8%) patients with chronic calculous cholecystitis who underwent single-port laparoscopic cholecystectomy (SLP) using the single access technique (SAL). The second group (TLCE) consisted of 64 (55.2%) patients with CCC who underwent laparoscopic four-port cholecystectomy. A comparative analysis of the results of the intraoperative and early postoperative periods in patients after TLCE using the single access method, the number of complications was minimal than with TLCE using a four-port approach. Long-term results of surgical treatment of patients with cholelithiasis after OLCE using the single access method are characterized by the least complications, high cosmetic effect, and low morbidity.

Evaluation of the use of tranexamic acid in the postoperative period in patients with scoliosis undergoing posterior fusion.

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.