Postoperative Management Techniques Research Articles

Pre- and postoperative management techniques. Before and after. Part 1: medical morbidities.

This article provides readers with an overview of available evidence in relation to providing care to patients in different medical circumstances within oral surgery. There is evidence available to support discussions with patients taking particular medications (such as bisphosphonates, anticoagulants and corticosteroids) and also to try to prevent certain complications (such as 'dry socket'). In order to reduce the risks of potential morbidities, either perioperatively or postoperatively, operators must use high-quality, reliable and informed protocols, management techniques, advice and interventions to provide patients with the best care. These are used both preoperatively and postoperatively and patients should be consented appropriately, in a manner tailored to their own individual circumstances, but also using available evidence to explain the benefits and harms of any given procedure. In this short series we will outline and discuss common pre- and postoperative management techniques, protocols and instructions, and the evidence available to support these.

Pre- and postoperative management techniques. Part 3: before and after - endodontic surgery.

In the last of this series of articles, the author will review some of the current interventions and advice that is most commonly used before and following endodontic surgical procedures. The aim of this article is to review the current evidence in the literature to support or refute current practices, management methods and protocols. The relative strength of the research discussed - including strengths and weaknesses - will be commented on. There are also some medicaments and instructions in dentistry that have no researched basis; some of these will also be identified and discussed.

Pre- and postoperative management techniques. Before and after. Part 2: the removal of third molars.

This article aims to highlight the strengths and weaknesses within the selected evidence to aid readers in clinical decision-making when managing patients before and after third molar surgery. Preoperative methods to prevent nerve damage, including the use of computed tomography (CT), are discussed. Preoperative considerations are also summarised, including risk factors such as increasing the occurrence of nerve deficit, weakness and damage, and the role of cone beam CT and when this should be used. The postoperative complications pain, swelling and infection are considered and the available evidence for the use of different protocols, regimes and combinations of therapies summarised.

New and Emerging Concepts in Parathyroid Surgery

Program Description: Diagnosis and management of hyperparathyroidism represents a rapidly changing field in surgery. Much of the change is technologically driven, with the advent of high-resolution imaging, intraoperative assays, and application of robust neuromonitoring. These have led to a preponderance of targeted, outpatient procedures that have a high rate of success. As the role of the otolaryngologist in treating this condition continues to be established, mastery of fundamental and emerging concepts is essential. This miniseminar will explore the importance of ultrasound, sestamibi, 4-dimensional (4D) computed tomography (CT), and other imaging options as well as proper use of hormone assays, postoperative management techniques, and the recent controversy regarding 4-gland exploration. Educational Objectives: (1) To become familiar with the latest refinements in parathyroid imaging, including high-resolution ultrasound, 4D CT scans, and CT-mibi. (2) To understand the strategy behind focused exploration and the principles promoted by surgeons who routinely perform bilateral neck exploration. (3) To appreciate the nuances of modern postoperative management, including calcium prophylaxis and persistent eucalcemic hyperparathyroidism.

Management of Postoperative Lymphoceles After Lymphadenectomy: Percutaneous Catheter Drainage With and Without Povidone-Iodine Sclerotherapy

To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS). The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient's symptoms that prompted the intervention. Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15-1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4). PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.

Risk factors for postoperative respiratory complications following esophageal cancer resection

The development of surgical and postoperative management techniques has improved the treatment outcomes of esophageal cancer resection. However, respiratory morbidity is still the most frequent complication after esophagectomy. The objective of the present study was to identify risk factors for respiratory complications following resection for esophageal cancer. This study included 96 patients with esophageal cancer who had undergone esophagectomy with lymph node dissection. The patients were divided into 2 groups according to the presence (20 patients, 17 had pneumonia and 3 had acute respiratory distress syndrome) or absence (76 patients) of postoperative respiratory complications (PRC). The two groups were compared with respect to their preoperative clinical variables, such as age, body mass index, smoking history, serum albumin, serum C-reactive protein (CRP), number of lymphocytes, %VC, FEV1.0% and FEV1.0. Furthermore, multiple logistic regression analyses were used to estimate relative risk factors for respiratory complications. Results of the univariate analysis showed that smoking history (+/-, patients with PRC, 19/1 and without PRC, 53/23), serum CRP (≥1.0 mg/dl/<1.0 mg/dl, patients with PRC, 6/14 and without PRC, 6/70) and FEV1.0% (≥60%/<60%, patients with PRC, 16/4 and without PRC, 73/3) were significantly different between the two groups. Multiple logistic regression analysis showed that FEV1.0% was the strongest predictor of PRC. FEV1.0%, serum CRP and smoking history are reliable predictors of the risk of respiratory complications following esophageal cancer resection. For patients with these factors, perioperative management for the prevention of postoperative respiratory complications should be considered.

Pancreaticoduodenectomy versus pylorus‐preserving pancreaticoduodenectomy: the clinical impact of a new surgical procedure; pylorus‐resecting pancreaticoduodenectomy

Pylorus-preserving pancreaticoduodenectomy (PpPD) has been performed increasingly for periampullary tumors as a modification of conventional pancreaticoduodenectomy (PD) with antrectomy. Five randomized controlled trials (RCTs) and two meta-analyses have been performed to compare PD with PpPD. The results of these trials have shown that the two procedures were equally effective concerning morbidity, mortality, quality of life (QOL), and survival, although the length of surgery and blood loss were significantly lower for PpPD than for PD in one RCT and in the two meta-analyses. Delayed gastric emptying (DGE) is the major postoperative complication after PpPD. One of the pathogeneses of DGE after PpPD is thought to be denervation or devascularization around the pyloric ring. Therefore, one RCT was performed to compare PpPD with pylorus-resecting pancreaticoduodenectomy (PrPD; a new PD surgical procedure that resects only the pyloric ring and preserves nearly all of the stomach), concerning the incidence of DGE. The results clarified that the incidence of DGE was 4.5% after PrPD and 17.2% after PpPD, which was a significant difference. Several RCTs of surgical or postoperative management techniques have been performed to reduce the incidence of DGE. One RCT for surgical techniques clarified that the antecolic route for duodenojejunostomy significantly reduced the incidence of DGE compared with the retrocolic route. Two RCTs examining postoperative management showed that the administration of erythromycin after PpPD reduced the incidence of DGE.

重度歯周疾患患者に矯正治療を併用して審美，機能回復を行った１症例

The patient was a 44-year-old woman who presented with masticatory and esthetic problems. She had discoloration of CR filling of a maxillary anterior tooth, marginal discoloration, anterior protrusion, median diastema, and closed bite where the mandibular anterior tooth region occluded with the maxillary alveolar region, tooth 8 elongation and tooth 4 defect. Periodontal and orthodontic treatments were therefore performed for esthetic and functional recovery. After prosthodontic therapy, postoperative management techniques are crucial, including thorough plaque control, use of a retainer to prevent teeth from moving back towards the original positions (Begg technique), muscle function therapy (improving tongue movement patterns and strengthening the lingual and oral sphincter muscles) and occlusal adjustment. In the present patient, the effectiveness of orthodontic therapy before prosthodontic therapy was reaffirmed: dentine can be preserved, prosthodontic therapy is easier to perform, and therapeutic outcomes are highly predictable.

The Effects of LASIK on the Ocular Surface

Laser in situ keratomileusis (LASIK) can affect corneal sensation, aqueous tear production, wound healing, and the incidence of corneal erosions. Virtually all patients experience dry eye at least transiently after LASIK. Because intact corneal sensation drives tear production, denervation associated with the LASIK procedure is the most significant cause of post-LASIK dry eye. To prevent symptomatic postoperative dry eye, it is crucial to identify and treat pre-existing dry eye before surgery. This review addresses the pathophysiology and management of dry eye, as well as the relationship between LASIK and corneal erosions, and suggests intra- and post-operative management techniques to minimize complications and maximize the stability of the ocular surface. Contraindications to LASIK and alternative refractive surgical procedures are discussed.

A clinical report of the effect of mechanical stress on functional results after fasciectomy for dupuytren's contracture

Early postoperative treatment after Dupuytren's fasciectomy traditionally has included the application of mechanical stress to digital extension with splints and exercise. This study examines the effect of mechanical stress, which may compromise nutrient delivery to the tissues, on inflammation, flare, hypertrophic scar, digital range of motion (ROM), and therapy visits. The authors compared functional outcomes in operated digits treated postoperatively with tension applied (TA) and no tension applied (NTA), retrospectively from 1983 to 1993 (TA only) and prospectively from 1993 to 1999 (TA and NTA). The charts of 268 patients who underwent Dupuytren's fasciectomy were reviewed and divided into 2 groups (TA and NTA). Each case was analyzed with respect to age, sex, number of digits operated, postoperative management technique, therapy visits, metacarpophalangeal joint, and proximal interphalangeal joint ROM, degree of flare, and scar. There were significant differences in ROM, scar formation, flare, and treatment time in favor of the NTA technique. The results indicate that postoperative management that prevents applied mechanical tension in the early phases of wound healing decreases complications after this surgery and that no digital motion is lost to extension with the NTA technique. J HAND THER. 2002;15:331-339.

Chronic thromboembolic pulmonary hypertension: clinical picture and surgical treatment

Chronic, major vessel thromboembolic pulmonary hypertension (CTEPH), is an uncommon condition which, in the past, was an autopsy curiosity. Advances in diagnostic approaches, surgical techniques and postoperative management have transformed this disorder into a potentially curable form of pulmonary hypertension. The predominant symptom is unexplained dyspnoea on exertion. In patients with this complaint, CTEPH should be considered. Numerous pitfalls exist along the diagnostic path. Perfusion lung scans point toward the diagnosis, but often underestimate the extent of central arterial obstruction. Pulmonary angiography is the key diagnostic procedure, but the many patterns of thrombus organization-recanalization require a base of experience for proper interpretation. Criteria for selection of patients for surgery are evolving, but assurance of thrombus accessibility to surgery is critical. Surgical thromboendarterectomy bears no resemblance to acute pulmonary embolectomy. Recognition of thrombus (versus normal intima), meticulous dissection and a bloodless surgical field are essential for adequate restoration of pulmonary vascular patency. Multiple complications may arise postoperatively, and detailed attention to these is required for patient survival. With a co-ordinated, multi-specialty team effort, however, haemodynamic and clinical outcomes have been rewarding and persist long-term. Surgical mortality should steadily decline with such a co-ordinated effort, as well as earlier diagnosis and advances in surgical and postoperative management techniques.

Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease

The consecutive 2 year experience with patients undergoing first-time surgery for mitral regurgitation with and without coronary artery disease was reviewed. From January 1988 to January 1990, 127 patients with pure mitral regurgitation undergoing first-time operation were surgically treated. No other valve lesion, no reoperation and no congenital defects were included. The mean patient age was 62 years with 26% of the patients > 70 years. Twenty-six percent of the entire group was in functional class IV. Seventy-five patients received mitral valve repair and 52 underwent mitral valve replacement with a St. Jude or Hancock valve. In patients undergoing mitral valve repair, there was a higher incidence of those > 70 years old and of coronary artery disease and in patients undergoing mitral valve replacement there was a higher incidence of functional class IV.The operative mortality rate was 2.3% (3 of 127 patients). No patient failed to be discontinued from cardiopulmonary bypass and all three deaths occurred after mitral valve replacement, with one from complications of chronic renal failure and dialysis. There was no significant difference in patients who either did or did not have a concomitant coronary artery bypass graft and there was no difference related to age or functional class. Postoperative complications occurred in five patients in the valve repair group, including recurrent mitral regurgitation in two necessitating reoperation, and in three patients in the valve replacement group.With newer operative and postoperative management techniques, especially preservation of the papillary muscle annular continuity, the risk of mitral valve surgery, particularly of valve repair, is considerably lower than in previous years.

The anaesthetic management of tracheo-oesophageal fistula: a review of ten years' experience.

The overall survival rate in cases undergoing surgical correction of tracheo-oesophageal fistula at The Hospital for Sick Children, Toronto, has improved from 63.5 per cent in the 104 cases treated during the 1959-1963 period, to 78.3 per cent in the 83 cases treated during the 1964-1968 period. Cases in the two 5-year series were comparable with respect to the types of anomaly, the incidence of prematurity and associated congenital anomalies, and the age at operation. In the second series a higher incidence of pulmonary complications was recorded. In the second series the survival rate was 100 per cent in those cases over 1,800 gms without significant associated anomalies and/or pulmonary complications. There was also 100 per cent survival rate in group B2. Review of the survival rates indicates that the fate of many infants with tracheo-oesophageal fistula is probably determined by prematurity, associated anomalies and/or pulmonary complication before operation is undertaken,13 However, the 1964-1968 survival rate indicates that efforts to improve the anaesthetic and surgical management during pre-, per-, and post-operative periods can increase survival even in premature babies, The anaesthetic and postoperative management techniques have improved with more meticulous attention to details of the techniques of management and monitoring of the neonatal patient. The most obvious change in surgical management was the increased number of staged procedures in poor-risk patients. The overall improvement in management of these cases is also reflected in the markedly reduced proportion of the deaths which occur during the first 48 hours postoperatively. In conclusion, babies undergoing general anaesthesia for surgical correction of tracheo-oesophageal fistula, who weigh over 1,800 gm and are without severe associated anomalies and/or pulmonary complications (Group A, B2) and those of a higher birth weight with moderate pneumonia and a less severe congenital anomaly (Group B2), can be reasonably expected to survive.