Post Operation Research Articles

Comparative Analysis of Postoperative Radiotherapy Dose Escalation in Oral Cavity Cancer Patients with Positive Margins: A Propensity Score-Matched Study

Introduction This study aimed to determine the impact of postoperative (PO) radiotherapy (RT) dose escalation in oral cavity squamous cell carcinoma (OCSCC) patients with positive margin (PM) in terms of local control (LC), duration of RT interruption, and toxicity in a tertiary care center. Materials and Methods Patients with OCSCC who were candidates for adjuvant RT were categorized into PM and negative margin (NM) arms depending on the margin status as per the histopathology report retrospectively. PM and NM patients received a total dose of 66 Gy to the site of the PM and 60 Gy for the NM. LC, acute and chronic toxicities, and duration of RT interruption were evaluated. Results A total of 56 patients were included in the study, of whom 39 had NM and 17 had PM. After propensity score matching, 11 patients were matched in each arm. The mean duration of RT treatment in the PM and NM arms were 49.5 days (standard deviation [SD] = 5.4) and 50.7 days (SD = 10.15) (p = 0.3), with mean interruptions of 3.9 days (SD = 3.9) and 3.8 days (SD = 6.2), respectively (p = 0.39). LC was 72.7% in the PM arm and 81.8% in the NM arm (p = 0.6). Acute and chronic toxicities were comparable between the two arms. Conclusion Dose escalation to 66 Gy for PM during adjuvant RT for PO OCSCC can be used as an alternative strategy to reresection, especially in patients who have poor performance status, who have negative consent for surgery, and who have more than one adverse prognostic factor with comparable LC and toxicity as in the NM. However, further prospective studies are needed to establish its role as an alternative, which is highly unlikely in modern oncology practice, as PM patients are rarely seen in clinics currently with good surgical oncology practices.

Free Interleukin 18 (IL-18F) Blood Levels Following Midline Laparotomy: A Prospective Randomized Study of Patients With Benign Disease and Patients With Cancer.

The purpose of this work was to assess blood level correlations of free IL-18 (IL-18F) and various cytokines (CYTs), caspase-1 (Casp1), high sensitive C-reactive protein (hs-CRP), and 4-hydroxynonenal (4-HNE) in 56 patients subjected to midline laparotomy (MLa) and to investigate their link to pain scales. Blood levels of IL-18F and seven CYTs (IL-18, IL-18BP, IL-1ra, IL-6, IL-8, IL-10, IL-1β), Casp1, hs-CRP, and 4-HNE were measured and the pain surveys were reported using numerical rating scale (NRS) and the Brief Pain Inventory (BPI) scales conducted preoperatively (PRE) and postoperatively (POP). The IL-18F levels decreased at POP and the decrease between POP1 (immediately after MLa) and POP2 (24 hours after MLa) blood levels (26.5 versus 20.0) was significant (p<0.001). Moreover, the IL-18F levels at POP2 were slightly higher in patients with cancer than in patients with benign disease (21.2 versus 17.8). Interestingly, the IL-18F levels correlated to IL-18 (r=0.523, p<0.001), IL-18BP (r=-0.475, p<0.001), and 4-HNE (r=0.414, p<0.001) levels. Furthermore, the IL-18F levels correlated with BPI score values (r=-0.459, p=0.05). This is the first report to demonstrate a link between increased IL-18F levels and pain scales in MLa. IL-18F levels decreased significantly after operation and correlated with IL-18, IL-18BP, and 4-HNE blood levels, and inversely correlated with BPI pain scores. These results support the applicability of acute phase response biomarkers in understanding pain in patients subjected to MLa.

Comparison of post operative outcomes of non-stented versus stent for 7 days versus stent for 14 days following uncomplicated ureteroscopic lithotripsy-a single institution study

Background: Ureteral stenting after uncomplicated URSL (ureteroscopic lithotripsy) is preferred by most urologists. Routine stenting exposes patients to more stent related complications. This study was done to compare post-op outcomes of stented and non-stented URSLs and to determine the optimal stent duration time following uncomplicated URSLs at our institute. Methods: A total 90 patients with ureteric stones of &lt;1.4 cm size admitted to our Institute between August-2023 and March-2024 were treated by URSL and randomized to 3 groups namely-non-stented group (n=30); stented for 7 days group (n=30); stented for 14 days group (n=30). The patients were followed up for 4 weeks following URSL. The primary outcomes assessed were post-op LUTS, dysuria, flank/suprapubic pain, hematuria and stone free state. The secondary outcome assessed was rehospitalization rate. Results: The incidence of flank pain, LUTS and dysuria was higher in the stented groups compared with non-stented group. Loin/suprapubic pain, Irritative symptoms were higher in the 14 days stented group than 7 days stented group. However, there was no statistical difference in the three groups in terms of stone-free rate. Mean operation time was less in non-stented group than in stented groups (p&lt;0.05). Conclusions: The non-stented group has less incidence of pain and irritative symptoms with comparative stone free rate to the stented groups. The incidence of post op stent related complications increases with increasing duration of stent. We suggest that it is not necessary to place a ureteral stent routinely after uncomplicated URSL for ureteric stones smaller than 1.4 cm.

Perfusion index monitoring and its correlation with outcome in neonates undergoing surgery

Background: The perfusion index (PI) has been found to be a reliable indicator of peripheral perfusion and can be used to monitor perfusion in neonates undergoing surgical procedures. To study correlation of perfusion index with the need for post op mechanical ventilation, ICU care and inotropic support in neonates undergoing surgery. Methods: Eighty neonates posted for surgery were enrolled after taking proper written informed consent from the parents. HR, BP and SPO2 and PI were recorded at 3 minutes interval for the first 30 minutes of surgery, followed by every 5 minutes till the end of procedure. Neonates requiring admission in the Department of Pediatrics were shifted to the Neonatal ICU or ward. Post-operative vitals were monitored initially every 30 minutes for first 24 hours followed by 2 hourly. Results: There was a statistically significant association between PI and need for post-op mechanical ventilation (MV). Duration of post-operative MV based on PI showed no significant difference. A lower PI was strongly correlated with an increased likelihood of requiring ICU-level care post-operatively, but not the duration of ICU stay. There was a potential association between PI and the requirement for inotropic support. Mortality rate was higher in patients with low PI, but not statistically significant. Conclusions: Low PI in neonates is associated with poor outcome in terms of need for ICU stay, need of postoperative mechanical ventilation and inotropic support.

Reducing postoperative morbidity by diminishing chest tube drainage utilizing tranexamic acid following vertebral body tethering for adolescent idiopathic scoliosis.

Vertebral body tethering (VBT) is a non-fusion surgical option for adolescent idiopathic scoliosis (AIS) that requires a postoperative (PO) chest tube. This study evaluates whether 48h of PO TXA reduces chest tube (CT) drainage and retention compared to 24h of TXA following VBT for AIS. Consecutively treated patients with a diagnosis of AIS who underwent VBT were assessed. Thirty-eight patients who received 48h of PO IV TXA (48-TXA) were compared to 35 VBT patients who received 24h of PO IV TXA (24-TXA) and 48 patients who did not receive TXA (non-TXA). TXA use in thoracic CT and thoracolumbar CT drainages were also assessed separately. Group comparisons were performed using one-way ANOVA and Chi-square tests. There were no significant differences in demographics between groups. TXA significantly reduced CT drainage (p < 0.001) and retention (p < 0.001), with no differences between 24-TXA and 48-TXA (p = 0.88). Sub-analyses showed that both 24-TXA and 48-TXA reduced thoracic CT drainage (p = 0.002, p = 0.02) and retention time (p = 0.04, p = 0.007) compared to non-TXA, respectively. For thoracolumbar CT, differences were observed only between 24-TXA and non-TXA (p = 0.01, p = 0.03). TXA was an independent predictor of reduced CT drainage (p < 0.001) and retention (p < 0.001). Hospital stay, ICU stay, and complications didn't differ between TXA groups (p > 0.9, p = 0.4), respectively. Intravenous TXA reduces CT drainage and retention after VBT for AIS for thoracic CTs. There was no additional benefit of 48-TXA over 24-TXA in decreasing overall drainage and CT retention time.

BHSeP2 Light and heavy weight mesh comparison for incisional hernia repair

Abstract Introduction Incisional hernia or surgical hernia is quite a common occurrence in large operative wounds. Prosthetic mesh repair is imperative to tackle its high risk of recurrence. Conventional mesh (heavy weight) is considered thicker than is probably sufficient, with a volley of contradictory data regarding the outcomes of the light weight and the heavy weight mesh in incisional hernia repair. Objective To compare light and heavy weight mesh for foreign body sensation in the repair of incisional hernia. Materials and methods To proceed with this randomized controlled trial at the Surgical Unit III, Dept. ofSurgery, Lahore General Hospital, Lahore 260 patients based on inclusion criteria were selected from S-III ward. Then they were randomly and equally divided in two groups. Where group A was having light weight mesh (weight ≥35–&amp;lt;70 g/m2) repair and group B had a heavy weight mesh (≥140 g/m2) used in repair. At 7th post OP day, feeling of foreign body was noted. Then follow up for recurrence till 3 months. Results With light weight mesh feeling of foreign body was significantly low. (Light Weight Mesh: 14.6%vs. Heavy Weight Mesh: 36.9%, P-value = 0.000). Conclusion The lightweight meshes have benefits over the heavy weight mesh for incisional hernia repairs for having a reduced foreign body sensation.

P0777 Sonographic transmural induction outcomes across advanced therapies in Crohn’s Disease

Abstract Background Intestinal ultrasound (IUS) is increasingly being used to evaluate induction efficacy in both clinical practice and clinical trials. The differential healing rates across advanced therapies (AT) remains unknown. We aimed to quantify the rates of early post induction IUS transmural (TM) remission and response across AT in Crohn’s Disease (CD). Methods Single center retrospective review of patients with CD initiating AT who underwent IUS pre and post induction and had disease activity and biomarker data available. Patients with normal pre-AT IUS or post op were excluded. Primary outcome was post-induction TM response of the most affected segment (segmental response compared to baseline: &amp;gt;25% decrease in bowel wall thickness (BWT), absolute BWT decrease &amp;gt;2mm, or absolute decrease &amp;gt;1mm with ≥1-point improvement in Modified Limberg Score (MLS)). Secondary outcomes were segmental and complete (all bowel segments) TM remission (BWT ≤ 3.0mm and MLS 0). Descriptive statistics summarized data (median [IQR]), univariate and multivariate analysis tested associations. Results 101 patients (53% female, age 17.4 [15.0-21.1] years); disease duration 0.80 years [0.17-3.96]; post induction IUS performed 78 days [56-102] on AT (44% anti-TNF, 53% AT naïve). Segmental TM induction response across all AT was 63%. Segmental and complete TM remission was 36% and 35%, respectively (figure). Complete TM remission was seen at a higher rate with upadacitinib (UPA) than ustekinumab (UST) (p=0.009) and risankizumab (RZB) (p=0.032) but not anti-TNF (NS). Patients with severe IUS inflammation (MLS 3) at baseline were less likely to achieve TM remission independent of AT (aOR 0.21 [0.059-0.76]). Complete TM remission was independently associated with infliximab (IFX) (aOR 11.7 [2.2-62.4]) and UPA (aOR 5.22 [1.0-27.2]). Rates of segmental TM response were greater for colonic than ileal disease in UST/RZB (88% vs 47%, p=0.038), but no different in TNF/UPA. Patients started on UST/RZB after &amp;gt;1 failed prior AT had a trend for lower rates of TM outcomes (NS), while number of prior therapies had no impact on UPA response or remission rates. Conclusion Post-induction TM outcomes are achievable across AT: 2/3 of patients achieve segmental TM response and 1/3 achieve complete TM remission. This data, combined with the high correlation between IUS and endoscopy, suggests that IUS response could be considered as a clinical trial endpoint.

Analysis of Physiological Factors that Affect MAP (Mean Arterial Pressure) in Post Trepanation Patiens in Intensive Care Instalations

MAP (Mean Arterial Pressure) is the average arterial pressure required for blood circulation to the brain. In trepanation post op patients, MAP is an indicator of postoperative prognosis. This MAP is influenced by several physiological factors, namely heart rate, hematocrit and age. This study aims to determine and explain the effect of these three factors on MAP (Mean Arterial Pressure) in post-op trepanation patients at the Intensive Care Installation of Mardi Waluyo General Hospital, Blitar City. The design of this study is Cross-Sectional. Source of data used is secondary data. Data collection is done by observation method. The research sample was all medical records of trepanation post-op patients at the Intensive Care Installation of Mardi Waluyo Hospital, Blitar City who were treated from January to December 2022 who met the inclusion criteria, totaling 42 respondents. Data analysis using binary regression with a significance degree of p value less than 0,05 (p&lt;0.05). The results showed that the Nagelkerke R Square (Model Summary) value was 0.314. This shows that the contribution or influence of physiological factors (heart rate, hematocrit, age) on MAP is 31.4%, while the remaining 68.6% is determined by other variables that are not taken into account in this research model. It is suggested to health service providers, especially nurses, to further improve their ability to analyze critical values of patients to prevent worsening of the prognosis.

Pre‐clinical evaluation of the Hyaguard™ sub‐conjunctival insert in maintaining post‐trabeculectomy intra‐ocular pressure vs MMC and Prednisolone drops

Aims/Purpose: Post‐trabeculectomy rabbit model efficacy and safety evaluation of HyaGuard™; a biodegradable sub‐conjunctival drug eluting platform, designed to replace Mitomycin C (MMC) and post‐operate steroid drops in glaucoma drainage surgeries.Methods: Pre‐clinical evaluation was conducted on normotensive New Zealand White rabbits (8‐12 weeks old, 50/50 male/female). A 4x4 mm trabeculectomy was performed on the left eye of each rabbit. All animals received Ofloxacin 3mg/ml (2 drops) 4 times daily for one week. Control and 1% w/w prednisolone HyaGuard groups did not receive MMC or prednisolone drops, whereas positive control animals were treated with 0.04% MMC for 4 minutes followed by prednisolone acetate 0.5% drops (2 drops) 4 times daily for two weeks. Intraocular pressure (IOP) was measured using TonoVet® pre‐operatively (week ‐1) and on days 3, 7, 14, and 28 post operation. Ophthalmic examinations were performed. Post study, eyes were histologically analyzed using H+E staining.Results: 1% prednisolone HyaGuard inserts demonstrated significantly better welfare and safety scores than standard of care. Histological analysis revealed no fibrotic encapsulation and intact conjunctivas. From an initial average IOP of 11.5 (± 1.0) mm Hg, the Day 28 ΔIOP (% of starting IOP) was ‐35.38 ±19.75% for MMC‐drops (p &lt; 0.01), ‐8.61 ±10.56% for blank HyaGuard (non‐significant), and ‐24.54 ±10.20% for 1% prednisolone HyaGuard (p &lt; 0.05). The 1% prednisolone HyaGuard group maintained a significantly greater reduction in IOP compared to the negative control (p &lt; 0.01) and was statistically equivalent to the positive control.Conclusions: HyaGuard demonstrated improved tolerability and safety following subconjunctival insertion in rabbits. The 1% prednisolone loaded HyaGuard effectively maintained significant decreases in post trabeculectomy IOP, without the need for MMC or repeat drop administration, suggesting its potential as a viable solution to the long running fibrotic failures associated with bleb forming drainage surgeries.

Retrospective Analysis of the Efficacy and Safety of Benign Gynecological Laparoscopic Surgery in Patients with a History of Open Abdominal Surgery

Objective : In our clinic, we aim to analyze the operative characteristics and complications of patients who have undergone abdomen surgery prior to total laparoscopic hysterectomy, in comparison to those who have not. Materials and Methods: The study analyzed a total of 2012 cases of laparoscopic hysterectomy conducted at the Women's Diseases and Birth Clinic in Tepecik Training and Research Hospital from January 2021 to December 235. The cases were categorized based on whether the patients had previous abdominal surgery or not. Various demographic characteristics, surgical treatment methods, operation durations, indications for hysterectomy, and postoperative findings were documented. Statistical analysis was performed using the SPSS program, with a significance level set at P &lt; 0.05. Findings :No significant differences were found between the two groups in terms of age, body mass index (BMI), preoperative and postoperative hemoglobin (Hb) values and values. In contrast, the difference between preop and post op Hb value measurements ; the level of statistically significant is higher in the group without obdomen surgery (p=0,001). There is no statistically significant difference between indications in both groups as surgical indication (p=0,043). In the group without western surgery, adhesion was observed to be statistically significantly lower (p=0,001). In the group with abdomen surgery, the presence of adhesions sufficient to require adezyolisis is statistically significant (p

Deep neuromuscular blockade during major laparoscopic surgeries might reduce postoperative pain via amelioration of the surgery-induced immune response

ABSTRACT Objectives Evaluation of the effect of deep neuromuscular blockade (DNMB) with low abdominal insufflation pressure (AIP) during laparoscopic colectomy on serum levels of inflammatory cytokines and on wound and shoulder-tip pain (STP) scores. Patients & Methods NMB was provided as rocuronium 0.6 mg/Kg initial dose and 0.15 mg/kg as maintenance dose according to the required depth of blockade and was reversed by sugammadex 4 mg/kg. AIP was provided at 10 and 14 mm Hg for Group-D and Group-C, respectively. Blood samples were collected for ELISA estimation of cytokines’ serum levels. Results The doses of intraoperative (IO) fentanyl (p = 0.026) and postoperative (PO) morphine, and 24-h cumulative pain score were significantly lower (p = 0.025) in Group-D. The measured cytokines’ serum levels increased progressively during surgery with significantly lower percentage of increase in Group-D (p = 0.0022; 0.0043; <0.001 for IL-1β, IL-6 and TNF-α, respectively). The percentage of increase in immediate PO serum cytokines’ levels was negatively related to the depth of NMB, while it showed positive correlation with the total dose of IO fentanyl, post-anesthetic care unit (PACU) pain scores, 24-h cumulative pain score and STP scores. Statistical analyses defined DNMB and serum IL-6 levels as significant predictor for cumulative pain scores. Conclusion The use of DNMB with low AIP significantly ameliorated the impact of surgery on immune milieu, reduced IO consumption of narcotic and reduced PO pain.

Impact of Gender Affirming Vaginoplasty on Lower Urinary Tract Function: A Single-Center Prospective Cohort Study.

With increased access to gender affirming care, the rate of vaginoplasties in the US has risen rapidly. Although some retrospective studies report high rates of lower urinary tract symptoms (LUTS) after gender affirming vaginoplasty, the type and severity of symptoms has not been well-described. The purpose of this study was to prospectively characterize postoperative changes in lower urinary tract function after robotic peritoneal flap vaginoplasty as measured by the American Urological Association Symptom Index questionnaire (AUASI), Urogenital Distress Inventory 6 (UDI6), and additional measures. This was a prospective observational study of patients undergoing gender affirming robotic peritoneal flap vaginoplasty enrolled between August 2020 to September 2021. LUTS were evaluated pre- and postoperatively (1, 3, 6, and 12-month) via the AUASI, UDI6, uroflowmetry, and post void residual (PVR) measurements. Averages and 95% confidence intervals over time were estimated and compared through univariate mixed-effect linear regression models. A total of 43 patients were enrolled. The average patient age was 31.1 ± 9.1 years. Overall AUASI Score declined over time (p = 0.002; -0.42,-0.09), though the decrease was less than the clinically minimum importance difference (MID) of 3 points. Preoperative AUASI was 8.1 ± 5.2, 1 month: 8.1 (95% CI: -1.9,1.8); 3 months: 5.2 (-5.0,-1.2); 6 months: 5.7 (-4.6,-0.62); 12 months: 5.2 (-4.9,-0.81). Similarly, UDI6 score declined over time (p = 0.002; -1.12,-0.26), though the decrease was less than MID of 16.7 points. UDI6 score preoperatively was 16.3 ± 1.8; 1 month post op: 16.5 (-5.2,5.0); 3 months: 16.2 (-5.6,5.1); 6 months: 11.6 (-10,1.0), and at 12 months: 8.1 (-13,-2.3). Overall uroflowmetric outcomes measured at postoperative visits including post void residual volume, maximum flow velocity, and average flow velocity did not show any difference at any postoperative time point when compared with preoperative measurements. In this study both the AUASI and UDI6 declined over time from initial preoperative evaluation to the 12 month follow up period, although the changes in AUASI and UDI6 score did not reach MID. Additionally, urodynamic measurements remained unchanged postoperatively. This data suggests that robotic peritoneal flap vaginoplasty has no effect on lower urinary tract function.

Forty-eight-hour cold-stored whole blood in paediatric cardiac surgery: Implications for haemostasis and blood donor exposures.

Cold-stored whole blood (CS-WB) in paediatric cardiac surgery is making a resurgence, given its identified benefits compared to conventional blood component therapy (CT). A single-centre retrospective study was conducted from January 2018 to October 2018 by including children <18 years of age undergoing cardiac surgery requiring cardiopulmonary bypass. ABO-compatible CS-WB from non-directed random donors was leukoreduced with platelet-sparing filters and compared with CT. Fifty-seven patients (30, 53% CS-WB; 27, 47% CT) were studied. Patient demographics were similar, although CT patients were cooled to a lower intra-operative temperature. Blood product requirements 24 h post operation were less in the CS-WB group (11.1 vs. 26.7 mL/kg, p = 0.048). Twelve (40%) patients in the CS-WB cohort had more than one donor exposure versus 25 (93%) in the CT group (p < 0.001). CT patients compared to CS-WB patients had a greater decrease in pre-operative versus 48-h post-operative haemoglobin, platelets and prothrombin time. Patients who received CT compared to CS-WB had a trend towards higher median (interquartile range [IQR]) chest-tube output (mL/kg/h) in the first 4 h post cardiac intensive care unit (ICU) admission (2.1 [0.8, 3] vs. 1.6 [0.8, 2.2], p = 0.197). There was no difference in antifibrinolytic use, length of stay, sepsis, acute kidney injury or wound infection. Survival to discharge was similar. CS-WB in paediatric cardiac surgery may reduce donor exposure and improve haemostatic balance. Future multi-centre prospective studies are needed to validate these findings and identify patients who would benefit from CS-WB in paediatric cardiac surgery.

Analysing Colour Shift effect of various Lamination Techniques on Coated Media using Offset Printing

Colour accuracy is the inevitability in every printing industry. Even minor deviations may impact severely in terms of print quality. Offset printing is widely used printing technique and also known for high quality production and efficiency also relies on precise colour reproduction in order to meet print quality expectations as per industry standards. Lamination and other post printing operations are common for embellishment to improve visibility aspects. In contrast, lamination technique cause colour shift in terms of colorimetric attributes which alters the appearance of printed colour significantly. This research is an attempt to analyze colour shift effect due to various lamination techniques on coated media printed by using offset printing. This research will explore the relationship between colour shift and lamination techniques while offset printing.

COMPARATIVE STUDY OF PROPOFOL AUTO-COINDUCTION VERSUS KETAMINE PROPOFOL COINDUCTION USING PRIMING PRINCIPLE BY BISPECTRAL INDEX ANALYSIS FOR DAY CARE SURGERY

Aim:The aim of our study was to do the comparison of Propofol Auto-coinduction versus Ketamine Propofol coinduction using priming principle by bispectral index analysis for day care surgery. Methods:150 patients participated in our study at Govt. Medical College and Rajindra Hospital, Patiala. Patients aged above 18 years and ASA Grade I and II scheduled to undergo elective surgery were included in this prospective, randomized controlled trial. All patients were randomly assigned into 3 groups of 50 each. Group A- patients were given Propofol 0.5mg/kg body wt., Group B- patients were given Ketamine 0.5mg/kg body wt., Group C- patients were given normal saline 2.5ml 2 minutes before induction. Patients were induced with injection Propofol 1% at rate of 30mg/10 sec until BIS value reaches to 40. Induction dose requirements of Propofol, Haemodynamic parameters including HR, MAP, SBP, DBP,SPO2, ECG, RR were recorded. Incidence of post op complications / side effects were also recorded. Data was tabulated and subjected to statistical analysis. Results: Groups were comparable to each other with respect to age, weight, gender, ASA status. Significant difference was found in HR, SBP, DBP between Group A and Group B at 1 minute and 2 minute after coinduction. MAP shows statistically highly significant (p &lt; 0.001) results after 1minute and 2 minute of coinduction. Total dose of propofol required and mean BIS value shows highly significant results when compared between groups. Conclusion: In conclusion, our study identified that overall dosage of propofol was significantly lower when modest doses of propofol and ketamine were given beforehand than when a placebo was used. When used as an induction agent, ketamine offers better haemodynamic stability.

Medial congruent with posterior cruciate ligament resected achieves similar short term outcome as posterior stabilised total knee arthroplasty.

Medial congruent (MC) systems and Posterior stabilized (PS) systems are widely utilized as implant options in total knee arthroplasties (TKAs). Nevertheless, determining which system yields superior clinical outcomes remains unresolved. This study seeks to compare these two systems by conducting a retrospective analysis of data from a single surgeon's registry encompassing both systems. Evaluation parameters consist of range of motion (ROM) and various clinical scoring systems. A retrospective analysis of data from a single surgeon's registry compared 45 MC with PCL resected (MC-PCLR) TKAs with 44 PS TKAs. Inclusion criteria comprised primary knee osteoarthritis with a minimum 1-year follow-up, while exclusion criteria involved secondary knee osteoarthritis and revision TKAs. Range of motion, Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS), and KS Knee Score (KS-KS) were assessed preoperatively, at 3months, and at 12months postoperatively. Statistical analysis was performed on retrieved data. Both group has similar baseline demographics in terms of gender (68% vs. 73% female, p = 0.60), BMI (26.4 ± 5.7 vs. 28.3 ± 5.1 p = 0.81) and American Society for Anaesthesiology score (75% vs. 84% score of 2, p = 0.12), with the exception of age where the PS group is significantly greater (71 ± 8 vs. 66 ± 7years, p < 0.01). There was no significant difference in range of motion (ROM), Oxford Knee Score (OKS), Knee Society Scoring System (KS) Function Score (KS-FS) and KS Knee Score (KS-KS) for all time periods except for one time stamp where preoperatively, the preoperative KS Knee Score (KS-KS) was significantly lower in the PS group. However, when comparing the change between KS-KS of pre-operation and 3months post operation (44 ± 18 vs. 31 ± 18,p < 0.01), and pre-operation and 1year post operation (46 ± 16 vs. 34 ± 17,p < 0.01), it is found to be significantly higher in the PS group for both time periods. All other comparisons between the three time periods were found to have similar parameters. PS and MC-PCLR demonstrates similar outcomes at the 1-year mark. However PS exhibits a faster rate of improvement from pre-operation to 3months as compared to MC-PCLR.

Efficacy of Sodium Tetradecyl Sulphate for the Treatment of Venous Malformation of The Head and Neck

Objective: To assess the efficacy of Sodium Tetradecyl Sulphate for the treatment of venous malformations of the head and neck region. Study Design: A prospective clinical study. Place and Duration of Study: Oral and Maxillofacial Surgery department of Sharif Medical and Dental College Lahore, Pakistan from Apr 2021- Apr 2022. Methodology: All the patients who met the inclusion criteria and were willing to take part in the study were enrolled. Pre-operative demographic data, clinical examination findings were noted in the specially designed proforma. The diagnosis was confirmed using doppler ultrasonography. 0.5-2ml of 3% STS was injected in the lesions transcutaneously or transmucosally depending on the location after aspiration and till blanching of the lesion occurred. Cases were followed up for 04 weeks and pre-op and post-op results were assessed independently by a consultant using the Achauer’s scale. Results: Total 22 patients were enrolled. Mean age in the study was 17+11.93 years. Male to female ratio was 1:2.1. Buccal mucosa and the tongue were the most common sites, involved in 7(31.8%) cases. Complete and partial resolution was obtained in 14(63.6%) 22 cases. There were no post op complaints in majority of the patients. Post op pain, ulceration and sloughing was reported by 2(9.1%) of the patients. Conclusion: The results of the study show that 3% STS was effective in reducing the size of the lesion to approximately 50% to the original size. Overall efficacy was found to be 63.6% with minimum morbidity and side effects.

Comparison of Onlay Mesh Repair Vs Sublay Mesh Repair for Ventral Abdominal Hernias: A Focus on Post Op Seroma Formation

Objective: To compare the effectiveness of Onlay mesh repair versus Sublay mesh repair for ventral abdominal hernias in terms of post op seroma formation. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Feb to Sep 2020. Methodolgy: A total of 140 patients (70 in each group) of ventral abdominal hernia who met the inclusion and exclusion criteria were included in the study. Patients with complicated or recurrent hernias were excluded. Group-A patients underwent Onlay hernioplasty while in group B hernioplasty was performed via Sublay technique. All patients were followed for post op seroma formation till 2 weeks via ultrasonography. Data was analyzed by Statistical Package for Social Sciences version 22. Results: Mean operation time in Group-A was 52.30±6.65 minutes while in Group-B the mean operation time was 85.82±8.26 minutes. Post op seroma formation between the two groups was 18.10% vs 4.65%, which was statistically significant (p=0.023). Conclusion: The occurrence of Post op seroma formation is less in Sublay lay mesh repair as compare to Onlay mesh repair however it requires longer operative time.

AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer

Abstract Background Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer. Method A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included. Results 63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m. Conclusion In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.

VS 03 - BN Laparoscopic Excision of Aortic Schwannoma

Abstract Background This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy. Method The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative Results MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma. Conclusion This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up