Postoperative Problems Research Articles

Low Preoperative Albumin Levels Significantly Associated with Increased Risk of Wound Infection and Bleeding After Panniculectomy

Introduction: Panniculectomy is recognized to have a high complication rate with up to 56% of patients having postoperative wound healing problems. As they are generally elective procedures, surgeons have the chance to optimize preoperative variables. We reviewed the relationship between preoperative serum albumin and BMI with short-term postoperative panniculectomy complications. Methods: Patients undergoing panniculectomy between January 2005 and December 2019 were identified via CPT code 15830 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate logistic regression was performed on intra/postoperative bleeding and postoperative wound infection against preoperative serum albumin, diabetes status, age, body mass index (BMI), and smoking status. Odds ratios were adjusted for comorbidities. We established statistical significance at p value <0.01. Results: Out of 1472 patients, 69 sustained intra/postoperative bleeding and 31 suffered wound infection. Lower preoperative albumin levels (R2 = 16.3%, p < 0.0001) and elevated BMI (R2 = 9.4%, p < 0.0001) were both significantly associated with increased likelihood of wound infection. For every 1 g/dL decrease in albumin, patients’ odds of bleeding increased 1.85 (OR = 1.85, CI 95%= [1.14–2.99]) times, and odds of wound infection increased 5.03 (OR = 5.03, CI 95%= [2.78–9.10]) times (p < 0.0001). BMI and albumin were weakly correlated (r = -0.28) suggesting each had independent effects on complications. Conclusion: In patients undergoing panniculectomy, preoperative albumin level is significantly inversely associated with postoperative bleeding and wound complications. More research is needed to evaluate whether proactively optimizing albumin may reduce complications.

Improving the Supraalar Groove Aesthetic Subunit and Lateral Crura Convex-Concave Deformity.

Lateral crura surface problems are one of the most difficult challenges in nose tip surgery. Closed Preservation Rhinoplasty (CPR) is a revolutionary concept keeping nose tip flexibility and elasticity. Solving lateral crura surface problems and keeping tip flexibility the surgeon will accomplish a sharper supraalar groove transition between the dorsum and the tip. The convex-concave lateral crura deformity (CCLCD) or S shape lateral crura is one of the biggest constraints to accomplish a beautiful tip and dorsum-tip transition (DTT). This deformity is the reason of commonly said parenthesis deformity of cephalic malposition. This LLC convexityconcavity shape creates a C shape shadow. This DTT is one of the key areas to accomplish natural results and it depends on different nose structures, not just the lower lateral cartilages (LLC). A total 560 rhinoplasty cases were studied retrospectively between September and December 2023. Three hundred and twenty patients had at least 1 year of follow-up. Patients had follow-up at 2 weeks, 1 month, 3 months, 6 months and 1 year after surgery. No secondary rhinoplasty was included. Just 2 secondary septoplasty cases were included without any nose skin undermining in the previous surgery. Surgical details were documented, including the 6 fundamental steps of this technique (1) mucosal lower lateral incision, (2) dorsum subperichondral dissection and vertical scroll release, (3) lateral crura tail caudal release, lateral crura steal and slide under flap lateralization, (4) upper laterals caudal resection, (5) vertical scroll reconstruction, and (6) turning point extension graft. Three hundred and twenty patients had at least 1 year of follow-up. 516 underwent a closed approach and 47 patients an open approach. All patients had subperichondral dissection of the hump envelope. All patients who underwent a closed approach had a low strip let down dorsal preservation technique. All patients who underwent an open approach had structural technique with spreader flaps or grafts at the keystone area. All the patients underwent their osteotomies with a piezoelectric device. Twenty-three revision surgeries were necessary. CPR taught us how important ligament and soft tissue preservation are. It taught the less damage you do to the nose soft tissues and scaffold the less support you need on it. Surgeons have been over grafting the lateral crura to solve postoperative problems mainly due to dissection problems and lack of lateral crura support. This paper shows how to solve lateral crura surface problems keeping the tip flexible and elastic creating also a nice and natural supraalar groove transition by applying 6 surgical manoeuvres.

New Insights into the Assessment of Peri-Operative Risk in Women Undergoing Surgery for Gynecological Neoplasms: A Call for a New Tool

Existing tools for predicting postoperative complications in women undergoing surgery for gynecological neoplasms are evaluated in this narrative review. Although surgery is a very efficient therapy for gynecological tumors, it is not devoid of the possibility of negative postoperative outcomes. Widely used tools at present, such as the Surgical Apgar Score and the Modified Frailty Index, fail to consider the complex characteristics of gynecological malignancies and their related risk factors. A thorough search of the PubMed database was conducted for our review, specifically targeting studies that investigate several aspects impacting postoperative outcomes, including nutritional status, obesity, albumin levels, sodium levels, fluid management, and psychological well-being. Research has shown that both malnutrition and obesity have a substantial impact on postoperative mortality and morbidity. Diminished sodium and albumin levels together with compromised psychological well-being can serve as reliable indicators of negative consequences. The role of appropriate fluid management in enhancing patient recovery was also investigated. The evidence indicates that although current mechanisms are useful, they have limitations in terms of their range and do not thoroughly address these recently identified risk factors. Therefore, there is a need for a new, more comprehensive tool that combines these developing elements to more accurately forecast postoperative problems and enhance patient results in gynecological oncology. This paper highlights the need to create such a tool to improve clinical practice and the treatment of patients.

Comparative Study Between Autologous Platelet-rich Fibrin Membrane and Local Flaps as Intervening Layer in Management of Distal Hypospadias

Background/PurposeThe most frequent complication following hypospadias correction is fistula formation. Recently, fibrin glue has been employed as a 2nd layer covering the urethroplasty resulting in a reduction in the incidence of fistulas. Platelet-rich fibrin (PRF) is an autologous growth factor-rich source. Although the authors recommend the use of additional layers in hypospadias correction, there remains a controversy. In a trial to address this issue, our research was conducted to compare the accessibility of urethroplasty coverage using PRF to traditional local flaps, aiming to prevent fistula formation in hypospadias repair. Patients and methodsThis is a prospective single-blinded randomized controlled study that involved 60 hypospadias cases admitted to Mansoura University Children Hospital's Pediatric Surgery department between March 2021 and March 2023. These 60 cases were randomly divided into 2 equal groups: (group A platelet-rich fibrin coverage membrane & group B local dartos flap as an additional layer). Both groups were compared regarding the rate of complications. All cases were evaluated regarding age at repair, type of hypospadias, urethral plate width, length of urethroplasty, and size of the 2nd layer. The blood loss and operative time were documented and post-operatively; the cases were assessed for the repair intactness, shape, and size of the neo-meatus, existence of any post-operative problems such as urethral fistula, urethral stricture, meatal stenosis, failure of the repair, or diverticulum. Statistical analysis was carried out following data collection. ResultsThe median length of the 2nd layer in group A was 20 mm (range 15–23 mm) and in group B was 22.5 mm (range 19.5–25 mm) and the difference between the two groups was statistically significant (p = 0.012∗), while its median width in group A was 10 mm (range 10–11 mm) and in group B was 15 mm (range 10–18 mm) and also there was statistically significant difference (p = 0.001∗). The mean operative time in group A was 95.73 ± 11.9 min and in group B was 102.33 ± 10.32 min and there was a statistically significant difference (P < 0.001). The length of hospital stay in group A was 5.47 ± 1.11 days and in group B was 5.47 ± 0.89 days. The urethral fistula was detected in 4 cases of group A (13.3%) and 3 cases of group B (10%). The failure of repair was similar, one case of each group (3.3%). The meatal stenosis was reported in only one case of group A (3.4%) and 7 cases of group B (24.1%) (P = 0.02∗) and the difference was statistically significant. There were no reports of urethral strictures among the cases in either group over the follow-up period (mean 9 months, range 5–17 months). ConclusionPRF patch may be employed as a coverage layer over the urethroplasty in repair of the distal hypospadias, especially in cases without accessible vascular flap with comparable outcome to traditional local flaps. Type of studyA prospective single blinded randomized controlled trial (computer-generated numbers method). Level of evidenceLevel 2.

Postoperative Complications After Gynecological Surgry in Al Kut City

Introduction: Post-operative problems are common. How the complications develop depends on the kind of operation, the preoperative treatment, and the patient's pre-existing comorbid condition. Problems following surgery can be divide into two categories: general and procedure-specific, as well as having emerged promptly, early, or late. Objectives: To determine the postoperative complications type after gynecological surgery in AL-Kut city. Methodology: A cross-sectional study had carried out in AL-Kut City, at the AL-Zahraa Teching Hospital and AL-Kut Hospital for Gynecology and Pediatrics. The seven-month data collection period started on October 16, 2023, and ended on May 16, 2024. Results: 400 female participants, ranging in age from 13 to 72, were be studied. The age distribution of the patients was 31.5 ±10, with the age group 24-34 accounting for the largest percentage of patients (41%) and the age group over 45 accounting for the lowest percentage (7.8%). In terms of marital status, the largest proportion of women (96.2%) were married, while the lowest (1.3%) were widowed. 51.2% of patients lived in urban areas, compared to 48.8% in rural ones. Patients with two to three children had the highest number of parities (34.8%), whereas 18% of patients did not have any parties. 31.8% of patients had an abortion, whereas 68.3% did not. Of which 44.3% had considered as normal BMI, 34.5% of people are overweight, 12% belong to the obese I, 4.3% to the obese II, and 4.5% are morbidly obese. Based on the patients' past medical history, hypertension was the most common ailment detected, accounting for 30.3% of cases (chronic HTN 13%, gestational HTN 17.3%), while diabetes patients made up 9.5% (chronic D.M. 6.5%, gestational D.M. 3%). Classification of Complications: 90.3% of complications occurred within 48 hours, whereas 51.3% developed intraoperative complications. Finally, 50.2% of patients experienced a late problem 48 hours later. Conclusion: The study discovered a link between complications after gynecologic surgery and pre-operative blood transfusion and hospital stay. Hemorrhage, anesthesia difficulties, and cardiac arrhythmia were significant, were the most common late complications among the patients. On the other hand, late complications had linked to surgical duration, number of parities, and age.

The push-through total femoral prosthesis for revision of a total hip or knee replacement with extreme bone loss.

The aim of the present study was to assess outcomes of using the push-through total femoral prothesis (PTTF) for revision total hip replacement with extreme bone loss. 10 consecutive patients who received PTTF between 2012 and 2018 for revision hip arthroplasty were included in the study. Primary functional outcomes were assessed using Harris Hip Score (HHS), Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scores. Range of motion, complications, and ambulatory status were also recorded to assess secondary outcomes. 2 of 10 patients underwent surgery with PTTF for both knee and hip arthroplasty revision. The mean time between index surgery and PTTF was 15 years (3-32 yrs). Acetabular components were revised in 6 of 10 patients during PTTF application. After a mean follow-up of 5.9 years, hip dislocations occurred in 3 patients. All of the dislocated hips were ones with retained conventional non-constrained acetabular bearings. Patient satisfaction was high (MSTS: 67%, HHS: 61.2%, TESS 64.6%) despite high re-operation rate (40%) and minor postoperative problems. PTTF should be considered for hip and knee arthroplasty revision procedures in patients with an extreme bone defect. Consistent usage of constrained liners should be considered to avoid hip dislocation, which was our main problem following the procedure.

Adults who Smoke Should Have Pulmonary Function Testing Before and After Coronary Artery Bypass Grafting (CABG)

Background: Recent research has shown that coronary artery bypass grafting (CABG) has a mortality rate of 0.6–3.0%, making it a popular and generally safe cardiac operation. The purpose of this study is to examine the relationship between sex, age, and diabetes in the early changes in lung volumes measured by pulmonary function tests before and after coronary artery bypass grafting (CABG) in individuals who smoke. Subjects and procedures: Elective coronary artery bypass surgery was the procedure of choice for 200 consecutive patients in this prospective controlled trial. Participants who were not part of the trial were those who were in an emergency or who had a valve operation done alongside a CABG procedure. Based on the data from the operation, the cardiopulmonary bypass time was 98.89 minutes with a standard deviation of 25.14 minutes. The average time for cardiac ischemia was 67.8 minutes with a standard deviation of 26.6 minutes and a range of 25 to 227 minutes. The total time spent in the intensive care unit was 53.54 hours with a standard deviation of 27.98 hours and a range of 4 to 102 hours. Thirteen patients, or 6.5%, were cold, while the remaining patients were warm. Thirteen patients, or 6.5%, used ice slush as a topical cooling method. The results of the pulmonary function tests taken before and after surgery were significantly different. Conclusion: Postoperative obstructive and restrictive breathing problems are associated with cigarette smoking's detrimental effects on pulmonary functioning. Patients with a smoking history who are scheduled for elective revascularization surgery should have their pulmonary status evaluated before surgery, and they should be strongly encouraged to quit smoking as soon as possible before surgery to minimize the risk of respiratory complications after surgery.

The use of AI in Predicting Surgical Complications

Significant obstacles exist for both patient outcomes and healthcare systems in the form of surgical complications. New approaches to anticipate these issues are being investigated by artificial intelligence (AI) researchers using machine learning, quantile regression forest, and Bayesian optimisation. This paper examines the predictive potential of AI for early postoperative problems, specifically in the context of coronary artery bypass graft surgeries. AI models offer insights into patient hazards through the analysis of large datasets, facilitating better surgical planning and early treatments. Implementing AI is fraught with difficulties, including data quality, clinician trust, and legal barriers, despite encouraging outcomes. In addition to outlining future research possibilities, this paper looks at the promise and constraints of AI in lowering surgical complications. Keywords: Artificial intelligence, surgical complications, coronary artery bypass graft, machine learning

Safety and feasibility of “Pant-Shaped” anastomosis in laparoscopic-assisted total gastrectomy: Study of 210 cases at a single center

BACKGROUND: Advancements in laparoscopic technology have popularized laparoscopic total gastrectomy over traditional open surgery, yet postoperative complications like anastomotic leakage and stenosis persist, particularly in esophagojejunostomy. To address this, since 2017, the authors have introduced the “Pant-Shaped” esophagojejunostomy as an improvement over the classic Roux-en-Y method, especially beneficial for patients with small intestinal diameters or those with gastric body cancer or Siewert III. OBJECTIVE: To assess the viability and safety of employing ‘Pant-Shaped’ anastomosis following laparoscopic-assisted total gastrectomy. METHODS: A method of descriptive case study was used. In our department of the First Affiliated Hospital of Wannan Medical College, records of 210 patients who underwent laparoscopic-assisted total gastrectomy for gastric body cancer or adenocarcinoma at the junction of esophagus and jejunum with “Pant-Shaped” anastomosis between January 2017 and December 2022 were examined. Clinicopathological features and postoperative conditions were also examined and assessed. RESULTS: The mean age of the 164 male and 46 female research participants was 69.2 ± 8.3 years. There was a mean estimated blood loss of 63.4 ± 29.7 ml, an anastomosis time of 25.9 ± 3.0 minutes, an operation time of 208.2 ± 40.4 minutes, and a postoperative hospital stay of 12.2 ± 8.0 days. Nine patients (4.3%) experienced postoperative problems (Clavien-Dindo &gt; grade II), including two episodes of anastomotic leakage that were resolved with irrigation and drainage, anti-infection therapy, and nutritional assistance. After an unforeseen reoperation, two cases of duodenal stump leaking were resolved. Anastamotic hemorrhage was treated with hemostasis and blood transfusion, and the patient made a full recovery. Due to a Peterson’s hernia, one patient required emergent open surgery. three months subsequent to LATG. CONCLUSIONS: The “Pant-Shaped” anastomosis method after laparoscopic-assisted total gastrectomy is simple, easy to promote, and has fewer complications. It is a safe and feasible modified method for esophagojejunostomy, especially suitable for patients with poor intestinal dilation and contraction ability and small jejunal diameter.

Comparison of Oncological and Aesthetic Outcomes between Tissue Rearrangement Technique and Pedicled Latissimus Dorsi Flap Reconstruction in Cases of Upper Outer Quadrant Breast Cancer.

Emerging as an adjunct to breast-conserving surgery, oncoplastic breast surgery seeks to improve the cosmetic and functional outcomes for breast cancer surgery. The objective was to assess the potential advantages of using the latissimus dorsi (LD) flap, in comparison with local tissue rearrangement, in terms of aesthetic results and postoperative problems. This study compared the outcomes of patients with a malignant tumor removed from the upper outer quadrant of the breast using a comparative nonrandomized control approach. Participants were split into two groups: reconstruction using local tissue rearrangement was performed on 20 patients (group A), and a pedicled LD flap was used to treat the same number of patients (group B). All patients were examined in the clinics' outpatient setting. Every 3 months, the medical oncology team would do a thorough clinical assessment. Better aesthetic outcomes were significantly higher among patients with an LD flap. The LD flap was able to maintain breast shape in 90%, breast volume in 85%, and the nipple-areola complex direction in 90% of patients. Surgeons' evaluation of both techniques reported significantly higher satisfaction for LD flap than local tissue replacement. Patient satisfaction was significantly higher among patients with an LD flap. With regard to the postoperative complications, there were no significant differences between either group. Oncoplastic breast surgery with reconstruction using the pedicled LD flap provides maintenance of the shape of female breasts with better aesthetic outcomes and patient and surgeon satisfaction than reconstruction using local tissue rearrangement, with a comparable complication rate.

Post-surgical complications of supernumerary teeth in the mandibular premolar area: A systematic review

In the mandibular premolar area, supernumerary teeth are a rare disorder that are rarely documented in the literature. The purpose of this study was to evaluate the post-surgical problems associated with the buccal and lingual techniques used to treat the extra teeth in this area. Using PubMed, PubMed Central, Science Direct, Cochrane, Wiley, and manual search, a thorough search was done to locate and identify cases and case series with extra teeth in the mandibular premolar region. For every study that was included, data on the surgical technique and postoperative problems were documented. Seven studies involving 90 patients were included. Supernumerary teeth in the mandibular premolar region were predominantly found in male patients (65.55 %), with most cases occurring in the right mandibular region (77.16 %). Postoperative complications after removing supernumerary teeth using buccal and lingual approaches were similar, with only one complication reported among the 90 cases reviewed. Although the findings suggest that surgical management of supernumerary teeth in the mandibular premolar region is relatively safe, caution is advised due to the limited sample size. Detailed pre-operative evaluation, a comprehensive treatment plan, and regular follow-up can minimize postoperative complications.

General skin and nasal decolonization with octenisan® set before and after elective orthopedic surgery in selected patients at elevated risk for revision surgery and surgical site infections—a single-center, unblinded, superiority, randomized controlled trial (BALGDEC trial)

BackgroundThe preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI) but yields conflicting results in the current orthopedic literature.MethodsWe perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidine® set). We will randomize a total number of 1000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists score 3–4 points) between a decolonization (octenisan® wash lotion 1 × per day and octenisan® md nasal gel 2–3 × per day; during 5 days) and no decolonization. Decolonized patients will additionally fill a questionnaire regarding the practical difficulties, the completeness, and the adverse events of decolonization. The primary outcomes are SSI and revision surgeries for postoperative wound problems until 6 weeks postoperatively (or 1 year for surgeries with implants or bone). Secondary outcomes are unplanned revision surgeries for non-infectious problems and all adverse events. With 95% event-free surgeries in the decolonization arm versus 90% in the control arm, we formally need 2 × 474 elective orthopedic surgeries included during 2 years.DiscussionIn selected adult orthopedic patients with a high risk for SSI, the presurgical decolonization may reduce postoperative wound problems, including SSI.Trial registrationClinicalTrial.gov NCT05647252. Registered on 9 December 2022.Protocol version: 2 (5 December 2022).

The Effect of Magnetic Therapy on Postoperative Urinary Retention in Patients Undergoing Surgery: A Randomized Clinical Trial.

Urinary retention is a postoperative problem that causes pain and discomfort for patients, even when catheters are used. The potential role of magnetic therapy in treating postoperative urinary retention through acupuncture points remains uncertain. This research aims to assess the impact of magnetic therapy on urinary retention in patients undergoing surgery. This single-blind clinical trial study was conducted in a recovery department within an operating room and subsequently in the Surgery Department of Amin Hospital. The study took place in Isfahan in 2022, with a sample of 64 patients selected using a simple random sampling method and divided equally into two groups. In the intervention group, magnet plates were applied, while the control group received iron plates at seven specific points for duration of 35 ± 5 minutes. Demographic information, the type of urinary excretion, the duration of urinary retention, and the volume of excreted urine were recorded using a researcher-made checklist for both intervention and control groups. These data were compared and subjected to descriptive and analytical statistical analysis. Among the participants (N = 64), the majority were male (N = 37, 57.80%), and the mean age was 40.17 years. The Chi-square analysis revealed no significant difference between the intervention and control groups in terms of the type of urinary excretion (p = 0.106). However, the Mann-Whitney U-test demonstrated significant difference between the two groups regarding the duration required to eliminate urinary retention and the volume of excreted urine (F2,41 = 62 and F1,76 = 62; p < 0.001). The use of a novel approach involving magnetic therapy applied to acupuncture and reflexology points has been shown to reduce the time required for the first urination and increase the volume of urine in post-surgery patients.

Efficiency of Different Approaches in Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Comparative Study

ABSTRACT Objective: Current research compared traditional FESS, balloon sinuplasty, and powered instruments for CRS efficiency. Methods: A prospective comparison analysis of 150 CRS patients who received FESS. The surgical method divided the patients into three groups: Group A (conventional FESS, n = 50), Group B (balloon sinuplasty, n = 50), and Group C (powered instrumentation, n = 50). Primary outcome measures included symptom alleviation, measured preoperatively and six months postoperatively using the “22-item Sino-Nasal Outcome Test (SNOT-22)”. Preoperative and six-month postoperative “Short Form 36 (SF-36)” Health Surveys assessed postoperative complications and the quality of life. Results: Balloon sinuplasty relieved symptoms better than FESS and powered instrumentation. Mean SNOT-22 scores reduced by 62.1% in the balloon sinuplasty group, much higher than the standard FESS and powered instrumentation groups (49.1% and 45.8%, respectively) (P &lt; 0.001). Balloon sinuplasty had fewer postoperative problems than FESS and powered instrumentation, including bleeding, infection, and synechia. Conclusion: Balloon sinuplasty treats CRS better than FESS and powered instrumentation and has fewer postoperative sequelae. These data imply that balloon sinuplasty may be a preferred FESS surgical strategy for CRS, but patient-specific characteristics and disease severity must be considered. Current findings need to be confirmed by larger studies with longer follow-up periods to determine the best FESS surgical strategy for CRS.

The Functional Outcome of Proximal Femoral Nail Antirotation-2 (PFNA-2) in Peritrochanteric Fractures of the Femur.

Introduction Peritrochanteric fractures are defined as extra-articular fractures involving the trochanter and frequent extension into the subtrochanteric region. These fractures exhibit a bimodal distribution in terms of age. These fractures commonly happen in young individuals who experience high-energy trauma, often in combination with other injuries. In contrast, elderly individuals with osteopenia are more prone to fractures caused by low-energy trauma. Methods This study is a prospective investigation that was carried out over 30 months. The study focused on peritrochanteric fractures that were treated using proximal femoral nail antirotation-2 (PFNA-2) as a fixation device. A range of criteria were examined and documented, encompassing the mean duration of surgical procedures, blood loss, the duration of hospitalization, mobility, and any potential post-operative problems. Subsequent assessments were conducted at fixed intervals of two weeks, six weeks, three months, six months, and two years. The functional outcome analysis for all patients involved the utilization of the modified Harris hip score (HHS). Results The study involved 60 cases of peritrochanteric fractures. The average age was 56 years.The most common mode of trauma was trivial fall/slip (46.66%), followed by road traffic accidents (RTA) (31.66%) and falls from height (21.66%). The average operating time was 53.03±5.66 minutes. The average modified Harris hip score was 84.78 with 26.66% excellent,70% good, and 3.33% fair results. Complications included superficial wound infection (5%), knee stiffness (11.66%), hip pain (8.33%), and shortening (1.66%). Conclusion PFNA-2 is a safe and easy implant option for treating peritrochanteric fractures as it preserves periosteal covering, minimizes blood loss, has a short operative time, and helps in early mobilization. PFNA-2 provides excellent outcomes in patients with peritrochanteric fractures with minimum complication rates compared to all other open methods and is highly recommendable.

Evaluating the Outcomes of Laparoscopic versus Open Cholecystectomy in a Community Hospital Setting

Background: Gallstone obstruction is the most common reason for presenting acute cholecystitis (AC), where inflammation may have dire consequences. Given that the laparoscopic cholecystectomy (LC) process is minimally invasive and more beneficial than other surgical operations such as open cholecystectomy (OC). Methods: This was a prospective observational study comparing LC and OC in a one-year follow-up from a community hospital in Larkana. Descriptive statistics and inferential tests apply to collect and analyze data on patient demographics, surgical details, postoperative problems, and recovery factors. Results: Out of the 70 patients, 50 had LC, and 20 had OC. Significantly shorter hospital stays (2.3±1.1 days) and surgical times (75.2±20.4 minutes vs. 105.6±25.3 minutes, p&lt;0.001) were linked to LC. The LC group experienced shorter recovery times (10.4± 3.7 days vs. 18.6±5.2 days, p&lt;0.001) and lower postoperative pain levels (3.2±1.1 vs. 5.6±1.7, p&lt;0.001). Although the OC group had proportionally greater rates of gastrointestinal problems, wound infections, and bleeding, the differences were not statistically significant. Conclusion: A shorter operative time, less hospitalization, less postoperative pain score, and faster recovery were observed with LC compared to OC. Further studies are needed to confirm these results; thus, LC is recommended as the surgical strategy of choice for AC. Keywords: Gallstones, Pain, Operation, Recovery.

The Role of the Omniflow II Biosynthetic Graft in Postoperative Wound Problems After Lower Limb Revascularization: A Single Center Prospective Registry

To investigate the role of the Omniflow II prosthesis in the prevention of vascular graft infection (VGI) in patients with peripheral arterial disease and to report on short-and mid-term graft-related morbidity. Patients were included in prospective registry between October 2019 and March 2023. The primary endpoint was to report infection-related problems, operation-related wound problems, and short- and mid-term graft-related morbidity. Secondary endpoint was to report the bypass patency rates and limb salvage rates. A total of 146 Omniflow II grafts were implanted in 125 patients. Sixty-seven patients (45.9%) received a femoral interposition graft, and 77 patients (52.7%) underwent ipsilateral bypass surgery (femoropopliteal or femorocrural). Forty-one patients (28.1%) underwent crural bypass surgery. Seventy-six patients (52.1%) had previous vascular operation in the groin. The mean follow-up time was 352days (range 0-1108days). 3.4% of the patients suffered a wound infection limited to the dermis, and in 8.2%, the subcutaneous tissue was involved. Five early VGI (3.4%) and one late VGI (0.7%) occurred. One year primary patency rate of above-the-knee bypass was significantly better compared to the bypass below the knee (74.5%±0.131 versus 54%±0.126 (P=0.049)). This difference was not significantly different when below-the-knee bypass surgery was compared with crural bypass surgery (54%±0.126 versus 23.8%±0.080 (P=0.098)). The performance of the Omniflow II prosthesis in the preventive setting is highly influenced by the anatomic location of the distal anastomosis. No influence on the incidence of postoperative wound problems could be observed. The rate of Omniflow II VGI in a high-risk population is similar to reported outcomes in other prosthetic grafts.

Effect of case management based on Omaha system on clinical symptoms and quality of life of coronary heart disease patients after percutaneous coronary intervention.

To investigate the effect of case management (CM) based on the Omaha system on clinical symptoms and quality of life (QOL) of coronary heart disease patients after percutaneous coronary intervention (PCI). Patients with coronary heart disease after their first PCI in the People's Hospital of Longhua in Shenzhen were randomly divided into a control group (received CM based on the Omaha system) and an observation group (received routine nursing) using a random number table. Nursing problems and the knowledge-behavior-status (KBS) score of patients were evaluated on the day after surgery, on the day before discharge, at 5 weeks after discharge, and at 12 weeks after discharge. The QOL of patients was evaluated using the coronary intervention coronary revascularization outcome questionnaire (CROQ-PTCA-Post, Chinese version) score on the day after surgery and at 12 weeks after discharge. A total of 104 patients completed the study (51 in the control group, 53 in the observation group). There were no significant differences in baseline data between the 2 groups (P gr.05). The main nursing problems were circulation, mental health, and pain in both groups on the day after surgery, whereas they were circulation, sleep and rest, and mental health after nursing. There were no significant differences in the KBS scores of the co-existing nursing problems on the day after surgery (P Th.05). The KBS scores of the co-existing nursing problems were significantly increased between the 2 groups (P < .01) on the day before discharge and at 5 weeks and 12 weeks after discharge. The KBS scores of the most co-existing nursing problems in the observation group were significantly higher at 12 weeks after discharge than at the day before discharge and at 5 weeks after discharge. Moreover, there were no significant differences in the CROQ-PTCA-Post scores on the first day after surgery between the 2 groups (P gr.05). These scores were significantly increased between the 2 groups at 12 weeks after discharge (P < .01). CM based on the Omaha system for patients after PCI can effectively improve the KBS scores and QOL of PCI patients with postoperative nursing problems, making this approach worthy of clinical promotion.

EPEN-05. SURGERY FOR CHILDHOOD EPENDYMOMA: THE EPENDYMOMA MULTIDISCIPLINARY ADVISORY GROUP (EMAG) CLINICAL TRIAL EXPERIENCE

Abstract INTRODUCTION The National Ependymoma Multidisciplinary Advisory Group (EMAG) is the central review mechanism for the SIOP Ependymoma II clinical trial in the UK. EMAG is a multiprofessional group which meets weekly to support decision making. We report detailed surgical outcomes for children with confirmed intracranial ependymoma, discussed through EMAG between January 2020 and November 2022. METHODS Data was collected on resection status, surgical outcomes, reasons for not achieving Gross Total Resection (GTR), number of surgeries and adjuvant therapies. Data was analysed descriptively. RESULTS After first surgery, GTR or near total resection (NTR) rate was 69/105 (66%) rising to 83/105 (79%) following repeated surgeries. 17 patients underwent second-look surgery prior to further therapy, whilst 9 underwent second-look surgery after chemotherapy but before radiotherapy. Eight (17%) posterior fossa (PF) surgeries were not completed due to factors including patient instability and tumour attachments. Most post-operative problems were seen in PF tumours with 26/60 (43%) bulbar palsy, 13/60 (22%) focal weakness and 12/60 (20%) cerebellar mutism. Incomplete PF resections were associated with increased bulbar palsy risk (p=0.02, Chi-Square test). 73% of PF patients required hydrocephalus management with external ventricular drainage, endoscopic third ventriculostomy (ETV) or shunt. Longer term hydrocephalus management with ETV or shunt was required in 29% and was more common in those with subtotal resection (R3-RX, 8/16, 50%) compared to GTR or NTR (R0-R2, 9/43, 21%, p=0.03). 27/60 (45%) received post-op NG feeding and 2/60 (3%) needed tracheostomies. Second surgery was associated with lower complication rates. DISCUSSION Our National MDT approach supports collaborative surgical decision making without a need for centralisation of the surgery itself. There was no evidence of increased complication rates compared to historical trials despite a more aggressive surgical approach. We argue for continued centralisation of EPN evaluation to support optimal care for children with this devastating disease.

Absence of the Posterior Element of C1 and C2 Along With Mild Wedge Shape in Body of C3: Case Report

Due to the wide variety of cervical vertebral congenital anomalies, knowledge of their types and related clinical conditions can prove to be helpful for physicians and surgeons in the diagnosis and treatment of patients. The aim of this study is to report on a rare case of unstable cervical vertebral congenital anomaly in which the patient had a defect in the body of the C3 vertebra in addition to defects in the posterior arch of C1 and posterior element of C2. This type of anomaly has not been reported so far in the literature. To reduce the patient’s related neurological disorders, our treatment choice for this patient was occipitocervical fusion (OCF) surgery. At the 3-year postoperative follow-up, all sensory and motor problems related to this anomaly affecting the patient's upper and lower limbs and causing shoulder and neck pain were eliminated. In this rare type of anomaly, OCF surgery seems to be an effective choice in relieving the patient's neurological symptoms.