Postoperative Complaints Research Articles

Factors Influencing Postoperative Morbidity in Women Undergoing Excisional Procedures of the Cervix [09H

INTRODUCTION: Pain, discharge, and bleeding are common after excisional procedures of the cervix. While generally benign, they can herald complications. Our hypothesis was that age, prophylactic antibiotics, smoking and/or diabetes might be associated with these postoperative concerns. METHODS: Medical records for women undergoing excisional or ablative procedures of the cervix at Cooper University Hospital from January 2013 to December 2018 were reviewed. There were 621 total subjects. Seventy-eight were excluded due to inadequate follow-up, yielding 543 analyzable procedures. Records were reviewed for pain, discharge, and bleeding. Subsequent interventions were then recorded. Age, smoking status, procedure type, prophylactic vaginal metronidazole usage (off-label) as well as smoking and diabetic history were collected. Descriptive data are reported as such, and proportions were analyzed via chi-squared tests. RESULTS: The average age of our subjects was 40.28 years (median 36.9, standard deviation 12.4). In total, 208 women re-presented with at least one postoperative concern following their procedure. Of these, 103 required intervention. Procedure type, postoperative prophylactic antibiotic usage (n=38), age greater than the median, and active smoking status (n=115) failed to predict postoperative complications. Former smokers (n=129, P=.047) did report more concerns, although they did not require more interventions (P=.14). CONCLUSION: Excisional and ablative procedures of the cervix are essential for the prevention of cervical cancer in patients with moderate to severe cervical dysplasia. Postoperative complaints of pain, bleeding and discharge are common and bothersome for patients. Based on our retrospective review, age, prophylactic vaginal metronidazole, smoking and diabetes were not associated with worse postoperative outcomes.

MP60-15 5-YEAR LONGITUDINAL OUTCOMES AFTER ANTERIOR URETHROPLASTY

INTRODUCTION AND OBJECTIVE: A urethral stricture classification system based on stricture length (L), segment (S) and etiology (E) has been previously validated to have sufficient inter-rater reliability when classifying a urethral stricture based on the retrograde urethrogram, physical exam and urethral stricture history, and to predict for urethroplasty type and stricture etiology. The purpose of this study is to determine if urethroplasty outcomes varied significantly by LSE stricture classification. METHODS: A graphical depiction of the (S) sub-classifications are shown in Figure 1. Five-year longitudinal analysis was available for 530 cases from six surgeons in the Trauma and Urologic Reconstruction Network of Surgeons. These cases were retrospectively classified using the LSE system and primary (functional surgical success) and secondary (persistent of bothersome lower urinary tract symptoms (LUTS), de novo sexual dysfunction, de novo genital pain) outcomes were determined. Differences in primary and secondary outcomes between (S) sub-classifications were determined with Kaplan-Meier and Chi-squared analyses, respectively. RESULTS: Overall functional success rate was 86%, which varied significantly by (S) sub-classification (Figure 2). Persistent post-operative urinary complaints were present in 21.3%, de novo sexual dysfunction in 9.6% and clinically significant perineal pain in 0.5%. Only persistent urinary complaints varied by (S) subclassification with 41% of S2c strictures reporting persistent complaints. CONCLUSIONS: We confirmed the validity of the LSE classification system to predict surgical outcomes. Utilization of the classification system will improve our abilities to compare surgical techniques for similarly classified strictures.Source of Funding: NIH Funding 1R21DK115945-01

A three year prospective study of functional and clinical outcomes of total hip replacement at a tertiary care hospital

<p class="abstract"><strong>Background:</strong> Hip joint is a crucial joint in the body whose function is essential for normal daily activities. Osteoarthritis of the hip cripples the daily functional capacity and total hip arthroplasty is considered to relieve the pain and increase the quality of life among these patients. The objective of present study was to assess the clinical and functional outcome in total hip replacement patients in terms of early joint function and stability of the hip joint and also to assess complications of procedures.</p><p class="abstract"><strong>Methods:</strong> A three-year prospective study was conducted on 58 cases that fulfilled the inclusion criteria. Ethical approval and consent were obtained for the study. Standard clinical and laboratory evaluation was performed on all the cases and the data was noted in Microsoft excel sheet and analyzed. Modified Harris hip scoring was done pre operatively and postoperatively and follow-up was done at discharge, 4<sup>th</sup> week, 6 months and one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Surgery was performed on 58 cases with age range 34-73 years and a mean of 43.58 years. Avascular necrosis was the main indication (55.2%). Maximum patient follow-up was 38 weeks. The mean preoperative score was 41.04 with minimum score being 10 and maximum being 76, postoperative score was 99.63 with minimum 64 and maximum was 109. Statistical significance was observed between preoperative and postoperative scores with regard to the parameters of pain, gait, functional activity and range of motion. Anterior thigh pain was the common postoperative complaint (15.5%).</p><p class="abstract"><strong>Conclusions:</strong> In conclusion, total hip replacement gives good clinical and functional outcomes. However, the outcomes are influenced by multiple factors which include indication for surgery, age of the cases, and type of prosthesis, operative technique and post-operative follow up.</p><p class="abstract"> </p>

Refractive results after cataract surgery using Optical biometry

Purpose: To assess the refractive outcome of optical biometry (Nidek AL-scan) after elective phacoemulsification in a study of 30 eyes.
 Study Design: Descriptive case series.
 Place and Duration of Study: Elective cataract surgeries done at a private clinic from July 2015 to June 2016 were selected and their records were analyzed.
 Material Methods: The measurements of IOL calculation was done using optical biometry with partial coherence interferometry (Nidek AL-scan) that provides information about axial length, central keratometry, white to white diameter and anterior chamber anatomical depth. SRK-T formula was used to calculate IOL power. All patients underwent a complete ophthalmological examination. Phacoemulsification with clear corneal incision of 2.75 mm was done and IOL was implanted in the bag (Alcon Acrysof SN60WF IOL and MA60AC IOL). Post-operative refraction was taken with autorefractor (Huvitz HRK-7000) after 4 weeks and it was compared with pre-operative objective refraction. Comparison of K readings taken by AL-scan and autorefractor were done.
 Results: We studied 30 eyes of 23 patients who underwent elective cataract surgery with foldable IOL. Post-operative spherical equivalent was plano in 53% of cases with mean of -0.05 after 4 weeks postoperatively. The mean keratometric power using autorefractor was 44.4 D while with AL-scan it was 44.7 D. There were no intraoperative complications or postoperative subjective complaints (such as halo or glare) in our patients.
 Conclusion: Intraocular lens power calculations done by optical biometry are easy to use, reliable and result in excellent refractive outcomes. Ultrasound biometry may still be required in case of mature and dense posterior subcapsular cataract.

Does Piezosurgery Decrease Patient Morbidity in Surgically Assisted Rapid Palatal Expansion Compared With Saw and Burrs?

The present study compared the postoperative pain, edema, patient satisfaction, and operating time with the use of piezosurgery, a reciprocal microsaw, and conventional burrs in the surgically assisted rapid palatal expansion (SARPE) technique for the correction of transversal maxillary deficiency. The results of the present study may help clinicians minimize the postoperative complaints of patients after SARPE. The present randomized single-blind study included patients who had undergone SARPE with piezosurgery, a reciprocating microsaw, or conventional burrs. To determine the facial norms and postoperative facial edema, 4 anatomic distances were measured on the patients' face using the modified flexible ruler method. The mean facial edema score was determined to evaluate and compare the overall edema among the groups. Two separate visual analog scales were used to assess patients' postoperative pain and intraoperative satisfaction. The duration of the osteotomies was recorded. Intragroup data were statistically analyzed via a t test, and intergroup data were analyzed via a nonparametric Kruskal-Wallis test. Spearman's correlation was used to evaluate the relationships among the variables. For the 80 patients, edema (second day: piezosurgery, 0.53±0.34; microsaw, 0.61±0.30; burrs, 0.94±0.33; P<.001) and pain (piezosurgery, 2.3±0.3; microsaw, 3.6±0.4; burrs, 3.9±0.6; P<.001) were greater for conventional burrs and microsaws, with statistically significant differences. Patient satisfaction (piezosurgery, 8.3±0.3; microsaw, 5.5±0.5; burrs, 5.1±0.9; P<.001) was greater with piezosurgery. However, in the piezosurgery group, the duration of osteotomies was 50% greater (piezosurgery, 16.10±3.30; microsaw, 11.05±2.09; burrs, 11.2±2.14; P<.001). The results from the present study have shown that piezosurgery is an effective method for minimizing facial edema and patient morbidity and increasing patient satisfaction during SARPE. Moreover, the use of conventional burrs and microsaws prolonged the duration of facial edema.

KORONER ARTER BAYPAS OPERASYONLARINDA OTOLOG VENA SAFENA MAGNA ÇIKARILMASINDA ENDOSKOPİK, TÜNEL VE STANDART YÖNTEMİN KARŞILAŞTIRILMASI

Objective: Autologous vena saphena magna is the most common bypass material used in coronary artery surgery. It is generally prepared with a long medial leg incision, and so healing problems are often observed. In this study, we aimed to compare endoscopic, classical and tunnel techniques in saphen harvesting. Material and Method: Fourty patients, who were selected randomly and retrospectively, were included in the study. Endoscopic saphen harvesting was performed on 10 patients, the tunnel technique was performed on 15 patients and the classical method was performed on 15 patients. Postoperative hospital stay, antibiotics, additional antibiotic requirement, upper leg size, hematoma, open care time, culture antibiogram, incision size, complication site, cost, postoperative complaints, median vena saphena magna harvesting time, vena saphena magna length, closed dressing time, elastic bandage time, drenaige amount, postoperative pain scores (Visual Analogue Scale-VAS) were all factors compared regarding saphen insicion site. Results: In tunnel end endoscopic procedures; insicion length, postoperative pain, major complication rate, incision closure time, the sutur material reqired for closing incisions were lower than the classical technique group. Moreover, the level of patients’ satisfaction was increased due to perfect cosmetic results and ease of early mobilization. Conclusion: Comparing classical saphen harvesting techniques with endoscopic and tunnel methods, it was found that incision problems, length of hospital stay, sutur material amounts, incision closure time, incision length and postoperative pain were detected in lower numbers in endoscopic and tunnel methods. Depending on these factors, the patient’s mobilization time was shortened. According to these results, the superiority of the endoscopic and tunnel methods compared to the classical method should be considered.

Post laser-assisted in-situ keratomileusis dry eye disease and temporary punctal plugs.

Purpose:The aim of this study was to compare the incidence of post laser in situ keratomileusis (LASIK) dry eye with and without intraoperative extended duration temporary punctal plug placement.Methods:This retrospective study included myopicastigmatic eyes without a preoperative diagnosis of dry eye disease that underwent LASIK surgery between January 2017, and March 2018. Patients who received punctal plugs during surgery in addition to usual postoperative care were compared to a control group who received usual postoperative care alone. Visual acuity, safety and efficacy indices, as well as predictability and presence of dry eye disease were assessed 3–6 months after surgery.Results:A total of 345 eyes of 345 patients were included, 172 eyes received punctal plugs and 173 did not. The mean age was 30.4 ± 10 years (range: 17–60 years) and 46.1% (N = 159) were female. Both groups were similar in terms of preoperative parameters, including age, gender, spherical equivalent, pachymetry or contact lens use. Patients treated with punctal plugs had significantly less postoperative dry eye complaints (N = 37 vs. 58, 21.5% vs. 34.1% respectively, P = 0.001). Patients treated with plugs that did develop dry eye disease did so later (51.2 ± 77.64 days' vs. 20.78 ± 26.9 days, P = 0.009). Postoperative visual acuities were similar between groups (P > 0.05) at all postoperative follow-up visits as were safety (0.95 ± 0.16 vs. 0.99 ± 0.09, P = 0.30) and efficacy (1.01 ± 0.13 vs. 1.00 ± 0.11, P = 0.52) indices.Conclusion:Preventative temporary punctal plug placement during LASIK appears to reduce dry eye disease in the short term, without affecting visual acuity outcomes.

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients.

Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

Effect of early post-cesarean section exercises on early resumption of women’s functional activities

Background Mothers undergoing cesarean section need more care than mothers undergoing vaginal delivery, and the time needed for recovery of post-cesarean section mothers is more than those needed for vaginal delivery. Aim To examine the effect of early post-cesarean section exercises on early resumption of women’s functional activities. Design A quasi-experimental design (i.e. nonequivalent control group design) was adopted for the present study. Setting The study was conducted at the antenatal unit and postpartum cesarean section unit at Shebin-Elkom University Hospital, Al-Menoufia Governorate, as well as women’s homes for follow-up. Sample A purposive sample of 60 mothers who underwent cesarean section was recruited in the study. This sample was divided into the study and the control groups, with 30 mothers in each group. Tools Data were collected by using the following: (a) an interviewing Questionnaire Schedule, (b) visual analog scale for pain intensity, (c) visual analog scale for functional activities, (d) Likert scale for daily activities at home, and (e) follow-up sheet for postoperative complaints at home. Results There were statistically significant differences between the study and the control groups regarding passage of first flatus, ability to perform functional activities like getting out of bed and walking, ability to perform daily activities at home, and occurrence of complaints such as constipation and breast engorgement (P≤0.001). Conclusion Post-cesarean section exercises were effective, as shown in early resumption of functional activities and high ability to perform daily activities. Recommendation Early post-cesarean section exercises should be integrated into the nursing care protocol in obstetric departments.

Effect of diaphragmatic breathing exercise on postoperative nausea, vomiting, and retching among orthopedic surgery patients

Background Postoperative nausea, vomiting, and retching (PONVR) is still the most common and distressing complaint after surgery and general anesthesia. Despite the potency of pharmacological management of PONVR, patients still experience such problem. Nonpharmacological strategies such as diaphragmatic breathing exercise could be integrated with pharmacological management to minimize the possibility of PONVR. Aim The aim was to evaluate the effect of diaphragmatic breathing exercise on selected postoperative complaints such as nausea, vomiting, and retching among postoperative orthopedic patients. Design One-group pretest–post-test quasi-experimental design was used. Research hypotheses H1: The mean score of nausea before will be different from the mean score of nausea after performing diaphragmatic breathing exercises among postoperative orthopedic patients. H2: The mean score of retching before will be different from the mean score of retching after performing diaphragmatic breathing exercises among postoperative orthopedic patients. H3: The mean score of vomiting before will be different from the mean score of vomiting after performing diaphragmatic breathing exercises among postoperative orthopedic patients. Patients and methods The current study was conducted at recovery rooms and orthopedic wards at Kaser Al-Ainy Teaching Hospital, affiliated to Cairo University Hospital, under supervision of the Ministry of Higher Education. A convenient sample of 100 adult male and female conscious patients who underwent orthopedic surgery under general anesthesia were included in the study along 3 consecutive months. Three tools were utilized to collect data: Demographic and Medical Related Data Form; Glasgow Coma Scale; and Index of Nausea, Vomiting, and Retching. Results The study results revealed that the mean total nausea, vomiting, and retching scores are statistically significantly decreased among postoperative orthopedic patients after performing diaphragmatic breathing exercise when compared with before performing. Conclusion Diaphragmatic breathing was effective in reducing the severity and occurrence of PONVR. Recommendations The diaphragmatic breathing exercise should be included in nursing curriculum as a new approach to treat postoperative nausea and vomiting.

Sacrocolpopexy: Patient Outcomes Support the Use of Non-Crosslinked Acellular Dermal Matrix as an Alternative to the Synthetic Polypropylene Mesh.

Objective: This study was conducted to evaluate the use of non-crosslinked acellular dermal matrix (ADM) in laparoscopic sacrocolpopexy by analyzing clinical outcomes and patient-satisfaction surveys.Materials and Methods: Two hundred and eleven patients underwent laparoscopic sacrocolpopexy for pelvic organ prolapse (POP) between January 6, 2012, and December 31, 2017. Each patient had her pelvic-floor measurements diagrammed with the POP-Q [Quantification] system using the interactive tool provided by the American Urogynecologic Society. The Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), used to make comprehensive assessments of women with urogynecologic problems, were mailed to all patients. If responses were not received, the patients were contacted by telephone. Patients who were not reached by either mail or telephone had their charts individually reviewed to extract the information. Trained surveyors scored the PFDI-20 and the PFIQ-7 questionnaires. The de-identified data were analyzed for patient satisfaction and outcomes. This information was obtained by a review of patient charts at 4-week postoperative and annual examinations; any phone calls with complaints and/or problem office visits were noted. Biopsies from the sacrocolpopexy area were taken if a patient had another incidental gynecologic procedure unrelated to the prolapse or at the time of repeat sacrocolpopexy for POP and the paraffin cell block was sent to McGowan Institute for Tissue Regeneration.Results: One hundred and five patients responded to the survey. Charts were completed for 106. The majority of interviewed patients stated that they were doing a “little better” or “much better” (77/88; 87.5%). The third-quartile PFDI-20 score was 93 with a median of 60 and the PFIQ-7 score was 43 with a median of 29. Five patients underwent reoperations (4.76%). The most-common postoperative complaint was overactive bladder symptoms, followed by vaginal discharge. Histology showed either a lack of regenerative healing tissue at the failure site or good results showing neovascularization and a presence of connective and ligamentous tissue around the matrix. No intense fibrosis or neoplastic formation was reported.Conclusions: A non-crosslinked ADM patch can be a good alternative to synthetic polypropylene mesh in patients undergoing sacrocolpopexy for POP.

Dermatologic Surgeons Can Positively Impact the Opioid Epidemic: A Quality Improvement Study of Pain Management in Dermatology Surgery.

The opioid epidemic is a national emergency, and it is imperative that all physicians are engaged in reducing exposure. Among dermatologists, dermatologic surgeons prescribe most opioids with the highest rates of prescription occurring in Southern states. Implement a quality improvement intervention to decrease opioids prescribed and filled to <10% of surgeries performed and have a 0% increase in the amount of patient complaints regarding postoperative pain. The number of opioids prescribed and filled in a single surgical facility in Georgia was obtained from the state's Prescription Drug Monitoring Program before, 1 month after, and 6 months after implementation of the quality improvement initiative. Telephone encounters regarding postoperative pain was also collected at the same specified periods. Proportion of opioids prescribed and filled decreased from 58% to 5% at 1-month postintervention and remained low on 6-month follow-up at 4%. There was no increase in postoperative pain complaints. Rather, a decrease in complaints was noted from 8.6% to 3.1% at 1-month postintervention and sustained on 6-month follow-up at 4.9%. Our data support the management of postoperative pain with nonopioid medications.

Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery

Background: Erectile dysfunction (ED) is a common disorder, which affects at least 50% of males aged 50-70 years. According to EAU Guidelines on male sexual dysfunction, implantation of an inflatable penile prosthesis (IPP) is a valid, third-line therapeutic option for treatment of ED. Objective: We conducted a retrospective single centre study to analyze mechanical reliability, complication rate, patient satisfaction and quality of life after penile prosthesis implantation. Materials and Methods: A total of 126 electronic patient files after primary implantation of an IPP during a 5-year period were investigated. A structured telephone interview concerning patient and partner satisfaction was conducted at least 1 year after implant surgery. Results: We found that 15 patients (11.9%) had revision surgery for various reasons. Mechanical failure occurred in 7.14% of the patients and was the main reason for revision surgery. Other major complications and complaints were loss of penile length (18.53%), postoperative pain (11.9%) and altered sensation (8.73%). No patients required explantation for infection, and 1 patient (0.79%) underwent revision surgery for an imminent erosion. One year or more after surgery, the patient and partner satisfaction rates, were 83.2 and 85.4%, respectively. We observed very high patient and partner satisfaction rates for the implantation of an IPP, with improvement of the general quality of life. These rates are negatively influenced by the occurrence of postoperative complications and complaints such as postoperative penile length shortening, pain and floppy glans syndrome. Most patients regain sexual function 6 weeks after surgery with no or minimal effect on the orgasm. Conclusion: The implantation of a 3-piece IPP has proven an effective, third-line treatment for patients with ED.

Postoperative morbidity in pediatric patients following dental treatment under general anesthesia.

The aims of this study were to investigate post-operative complications in pediatric patients 24 and 72 hours after general anesthesia (GA) and to identify any associations between dental procedures and complications. One hundred and thirty three healthy pediatric patients who had undergone dental treatment under GA (age range: two to nine years) were included in this study. The project was designed as a prospective, observational study supported by a questionnaire that collected data on children's post-operative complaints. Preoperative data were obtained from patients' files and included age, gender, medical condition and admission type (inpatient or outpatient) variables. The postoperative complaints were assessed either by phone contact or by face-to-face interviews using a questionnaire 24 and 72 hours after treatment. 69.9% of children reported one or more complaints after 24 hours and 35.3% after 72 hours. Coughing and pain (27.1%), inability to eat (24.8%), psychological changes (24.1%) and a sore throat (21.1%) were the most common complaints during the first day. After 72 hours, the severity and rate of the complications decreased significantly (p < 0.05). Post-operative complaints following dental treatment under GA tended to be of mild severity and were mainly limited to the first day after the procedure.

Analysis of partial bundle anterior cruciate ligament tears- diagnosis and management with ACL augmentation

ObjectivesPartial ACL tears are increasingly recognized in young active patients. They can evolve into complete tears. Controversy exists regarding the need to spare intact ACL bundle as it has its advantages considering biomechanical strength, blood supply and proprioception. The current study determined the challenges in partial ACL tear management and assessed the functional outcomes. MethodsTwenty consecutive patients with partial ACL tears were studied. Inclusion criteria were: age 16–45yrs and patients operated for partial ACL tear. Exclusion criteria were: combined ACL-PCL injuries, associated collateral injuries, complete ACL tear, chondral defect or bony malalignment and patients with radiographic signs of arthritis. ‘Partial’ tear was defined as continuous fibers from native tibial ACL footprint to native femoral ACL footprint in arthroscopy. Clinical and radiological assessment was done to evaluate anteromedial(AM) or posterolateral(PL) bundle tears. We used the term “ACL-augmentation” without disturbing the intact bundle or preserving the intact fibers as much as possible. Functional scoring was done using Lysholm score. Standard post-operative protocols were followed. Statistical analysis was done using SPSS software. ResultsMean age of patients was 31.2 years. Physically active age group (<30yrs) included 62.5% patients. Males were 87.5%. Pain and instability were the presenting complaints in 75% and 70% respectively. Average duration of presentation since injury was 4.2 months. Sports activities were the most common mode of injury (45%) followed by road traffic accidents (37.5%). Anterior drawer test was positive in 40%, pivot shift in 35% and Lachman test was positive in 65%. On arthroscopy, 65% had AM bundle tears and 35% had PL bundle tears. The intact bundle was found lax in 13% cases. Associated meniscal tear was present in 28% patients. Stiff knee was the most common post-operative complaint. Preoperative Lysholm knee score of 74.5 improved to 87.7 at 12months (p < 0.001). Around 97.5% of the patients reported outcomes as good and fair. ConclusionThe treatment strategy needs to be individualized. The ACL augmentation needs more systematic and accurate placement of portals while sparing the intact ACL fibers. For AM bundle, tibial tunnel entry point is about 1–2 cm medial to tibial tuberosity. For PL bundle, it is about 3–4 cm medial to tibial tuberosity to protect the AM bundle. Long term studies with greater number of subjects are required.

Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up

Beside the pain, there are 2 further problems in the management of endometriosis: the high recurrence rate (10% per year) and the high rate of impaired fertility.The objective of this study was to investigate the pathogenesis of these 2 factors. This is a retrospective cohort study, and the aim is to evaluate the complete excision of endometriotic lesions, including the posterior compartment of the peritoneum, with regard to postoperative outcome, focusing on relieving pain, increasing fertility rate, and decreasing recurrence rate. Charité-University Clinic, Department of Gynaecology, Endometriosis research Centre. Fifty-four patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (revised American Society for Reproductive Medicine [rASRM] I = 3; II = 15; III = 10; and IV = 26). Posterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as part of a complex surgery: complete excision of endometriosis. Postoperative outcomes were evaluated, based on the postoperative follow-up (up to 5 years) of 54 investigated patients. In 36 women (66%) preoperative complaints were eliminated. Furthermore, of 28 women seeking improved fertility, pregnancy was reported in 13 cases (46%). In 7 (54%) cases pregnancy occurred spontaneously, and in the remainder with assisted fertilization. In addition, long-term follow-up demonstrated a recurrence rate in 1.8% of patients. Overall, the number of complaints was significantly reduced. Only in the case of reproductive-aged women with ongoing postoperative complaints was it important to preserve the uterus. Although this pilot study on systematic posterior peritonectomy showed improvement in recurrence and fertility rate, the main question remains: will this surgical technique achieve better results and outcomes in the future? This has to be addressed in a prospective randomized study.

Comparison of efficacy of Nebulized ketamine versus lignocaine for postoperative sorethroat

Comparison of efficacy of Nebulized ketamine versus lignocaine for postoperative sorethroat - IJCA- Print ISSN No: - 2394-4781 Online ISSN No:- 2394-4994 Article DOI No:- 10.18231/j.ijca.2019.078, Indian Journal of Clinical Anaesthesia-Indian J Clin Anaesth

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Combined with Onionskin-Like Autologous Bone Grafting: A New Technique for Treatment of Tibial Nonunion.

BackgroundEstablished tibial nonunions rarely heal without secondary intervention; revision surgery is the most common intervention. Herein, we evaluated the clinical outcomes of patients with tibial nonunion treated with a new technique – minimally invasive percutaneous plate osteosynthesis (MIPPO) – combined with a new onionskin-like autologous bone grafting method.Material/MethodsFrom 2010 to 2013, 18 patients with tibial nonunions (average bone defect: 9.5 mm) were treated with MIPPO technology combined with onionskin-like autologous bone grafting. Indices for clinical evaluation included operative time, fluoroscopy time, blood loss, hospital stay, healing time, postoperative complaints, radiographic performances, the Short Musculoskeletal Function Assessment (SMFA) questionnaire, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score.ResultsThe average operation and fluoroscopy times for tibial nonunion were 65 min and 15.5 s, respectively, with a total blood loss of 107.7 mL. The mean duration of hospital stay was 12.8 days. The mean follow-up time was 11.9 months, and all patients achieved radiologically confirmed bony healing in an average time of 13.1 weeks. No lower-leg deformity, fixation failure, infection, and vascular, or nerve injuries were recorded in any patient, and only 4 patients complained of slight limb pain upon total weight-bearing at the end of follow-up. The SMFA and AOFAS ankle-hindfoot scores of patients were graded excellent in 14 (77.8%) and good in 4 (22.2%), indicating high functional recovery.ConclusionsMIPPO technology combined with onionskin bone grafting is an efficient method to treat patients with tibial nonunion, especially for patients with poor soft tissue condition.

Parasternal Pectoral Block for Right Anterior Minimally Invasive Thoracotomy in Cardiac Surgery

MINIMALLY invasive cardiac surgery (MICS) is being increasingly performed. 1 Gammie J.S. Zhao Y. Peterson E.D. et al. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010; 90 (1401-10.e1) Abstract Full Text Full Text PDF Scopus (270) Google Scholar Several approaches are listed under the term MICS, such as ministernotomy for aortic valve replacement, left minithoracotomy for minimally invasive direct coronary artery bypass, and right anterior minimally invasive thoracotomy (RMIT) principally for mitral or aortic valve surgery. Minimally invasive thoracotomy is associated with intense and prolonged postsurgical pain, which can be equal to that occurring after conventional sternotomy. Pain after RMIT is caused by rib retraction, pectoralis and intercostal muscle dissection, and intercostal nerve lesions. Moreover, this pain is exacerbated by breathing movements, coughing, respiratory physiotherapy, and chest tubes. 2 Furrer M. Rechsteiner R. Eigenmann V. et al. Thoracotomy and thoracoscopy: Postoperative pulmonary function, pain and chest wall complaints. Eur J Cardiothorac Surg. 1997; 12: 82-87 Crossref PubMed Scopus (150) Google Scholar

Pain-free and pain-controlled survival after sectioning the nervus intermedius in nervus intermedius neuralgia: a single-institution review.

Nervus intermedius neuralgia (NIN) or geniculate neuralgia is a rare facial pain condition consisting of sharp, lancinating pain deep in the ear and can occur alongside trigeminal neuralgia (TN). Studies on the clinical presentation, intraoperative findings, and ultimately postoperative outcomes are extremely limited. The aim of this study was to examine the clinical presentation and surgical findings, and determine pain-free survival after sectioning of the nervus intermedius (NI). The authors conducted a retrospective chart review and survey of patients who were diagnosed with NIN at one institution and who underwent neurosurgical interventions. Pain-free survival was determined through chart review and phone interviews using a modified facial pain and quality of life questionnaire and represented as Kaplan-Meier curves. The authors found 15 patients with NIN who underwent microsurgical intervention performed by two surgeons from 2002 to 2016 at a single institution. Fourteen of these patients underwent sectioning of the NI, and 8 of 14 had concomitant TN. Five patients had visible neurovascular compression (NVC) of the NI by the anterior inferior cerebellar artery in most cases where NVC was found. The most common postoperative complaints were dizziness and vertigo, diplopia, ear fullness, tinnitus, and temporary facial nerve palsy. Thirteen of the 14 patients reportedly experienced pain relief immediately after surgery. The mean length of follow-up was 6.41 years (range 8 months to 14.5 years). Overall recurrence of any pain was 42% (6 of 14), and 4 patients (isolated NIN that received NI sectioning alone) reported their pain was the same or worse than before surgery at longest follow-up. The median pain-free survival was 4.82 years ± 14.85 months. The median pain-controlled survival was 6.22 years ± 15.78 months. In this retrospective review, sectioning of the NI produced no major complications, such as permanent facial weakness or deafness, and was effective for patients when performed in addition to other procedures. After sectioning of the NI, patients experienced 4.8 years pain free and experienced 6.2 years of less pain than before surgery. Alone, sectioning of the NI was not effective. The pathophysiology of NIN is not entirely understood. It appears that neurovascular compression plays only a minor role in the syndrome and there is a high degree of overlap with TN.