Postoperative Sequelae Research Articles

Laparoscopic Partial Nephrectomy by Transperitoneal Approach: A Case Report

Laparoscopic partial nephrectomy (LPN) is compared to traditional open partial nephrectomy and robotic-assisted partial nephrectomy in terms of oncologic and surgical outcomes for renal tumors after good indication. Studies have shown that the modality is feasible with similar oncologic efficacy and better renal function outcomes compared to laparoscopic radical nephrectomy (LRN) for renal tumors. The main advantages of LPN include decreased estimated blood loss, decreased surgical site pain, shorter postoperative recovery, and nephron preservation. The purpose of this clinical report is to evaluate the surgical techniques and steps and the postoperative sequelae.

The effects of lyophilised platelet-rich plasma in third molar extraction sockets and its surrounding tissues

ObjectiveTo determine the effects of repeated placement of quantified lyophilised platelet-rich plasma (LPRP) on the soft and hard tissue components. MethodsLyophilised platelet-rich plasma was topically placed, and later injected, into fresh sockets using the third molar surgical model, randomised according to the split-mouth approach. The control site received placebo. The application of LPRP was done intraoperatively, one month and two months postoperatively. The measured endpoints included post-operative pain, swelling, trismus, pocket depth at mid-distal adjacent second molar, soft tissue healing, and bone formation (which was assessed radiographically). Fifteen healthy young adults, aged between 21 and 35 years, visiting the Oral and Maxillofacial Surgery Clinic at the University of Malaya were recruited for this study. ResultsThere was no significant difference in post-operative pain, swelling size, trismus, and bone healing within their specific timelines during this study. However, the LPRP group showed significant reduction in pocket depth at the two-month post-operative period, suggesting that LPRP improves soft tissue healing. ConclusionSoft tissue healing, measured as the change of periodontal pocket depth, showed significant reduction, suggesting the benefit of LPRP for soft tissue healing. However, bone regeneration and reduction of post-operative sequelae showed no improvement even after quantification and repeated LPRP application.

Complications related to orthognathic surgery: A 10-year experience in oral and maxillofacial training center

This article aimed to review adverse events and complications to orthognathic surgery based upon 10 years.This study was a retrospective investigation between 2009 and 2018. Independent variables such as sex, age, pre-operative conditions, diagnosis, type of surgery, bleeding volume, surgery duration, and hospitalization were recorded. The data regarding orthognathic surgery adverse events and complications were evaluated and statistically analyzed with a significance level of p < 0.05.A total of 891 patients were included in this study (male 39.1%, female 60.9%) with a mean age of 26.4 ± 6.09 years. A neurosensory disturbance was found as immediate post-operative sequelae as 93.5%. The four most frequent complications had a relapse (6.4%), post-operative TMD (5.7%), unfavorable osteotomy (5.5%), and infection (4.9%), which seem to be more common in males. An average blood loss was 497 ± 371 ml and the average operative time was 401 ± 109.3 min. Complication rates were statistically affected by bleeding volume (p-value = 0.01), operative time (p-value = 0.03), and type of skeletal deformity (p-value = 0.01).Although numerous complications were recorded, no fatal complications were experienced. Bleeding time, operative time, and skeletal classification have significant influence on orthognathic surgery complications. However, a multitude of factors could be modified to reduce the complication rate and improve the result of the treatment. One of the most significant factors was the operative time.

Review of dexamethasone administration for management of complications in postoperative third molar surgery.

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

Effect of dexamethasone, ketoprofen and cold compress on postoperative sequelae in mandibular third molar surgery: A randomized clinical trial

PurposeThis is a single blinded, randomized clinical trial to assess and compare the effect of dexamethasone, icepack and ketoprofen on the postoperative pain, swelling and trismus following surgical removal of impacted lower third molar (ILTM). MethodologyConsecutive patients who require surgical extraction of ILTM with a modified Pederson difficulty index score of 5-6 were recruited. Ninety patients were randomly allocated into 3 groups. Group A received 100mg of ketoprofen and group C received 8mg of dexamethasone per-oral 1hr preoperatively. Subjects in group B used a pre-standardized ice pack held against the skin over the angle of the mandible for 6 hours postoperatively. Swelling, trismus and pain were recorded on postoperative day 1, 2 and 7. ResultA total of 78 subjects with mean age of 27.8 ± 4.9 years comprising of 59.0% males completed the study. There were no statistically significant difference found in the sociodemographics. Subjects in the dexamethasone group showed a significant reduction in pain on postoperative day 1 and 2, and in swelling on all postoperative days in review. ConclusionOral dexamethasone showed superior reduction in postoperative pain and swelling after ILTM surgery. It also offers an effective, painless, easy route of administration and single dose safety profile. However, icepack provides a low-cost option and may be of importance in low resource settings or in patients allergic to dexamethasone.

The effect of zinc lozenge on pain, oedema, and trismus after impacted third molar surgery: A prospective randomized, double-blinded, placebo-controlled study

The postoperative sequelae after third molar surgery include pain, swelling and trismus, Zinc acts as anti-inflammatory agent, can promote wound healing, immune system modulation, tissue repair, and significant reduction in the use of analgesics for oral pain. This study was aimed to evaluate the efficacy of oral zinc lozenge given 30 min before surgery on reducing postoperative sequelae.s: We recruited 70 patients, randomly assigned to two groups: Zinc and Control group, groups received 40mg Zinc lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h.Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whit­ney U test was performed for non-parametric samples. P &amp;#60; 0.05 was considered as statistically significant: The overall incidence of Pain in the Zinc group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P &amp;#62;0.05) better in Zinc group oral zinc lozenge administered 30 minutes preoperatively can significantly reduce complications like pain, swelling, and limited mouth opening after third molar extraction.

Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics

PurposeOne of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis.MethodsWe collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up.ResultsAltogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery.ConclusionThe use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account.

Flap vs flapless technique for impacted third molar removal: A split mouth prospective randomized control study

The aim of this study was to compare the post-operative sequelae of removal of impacted third molars in participants treated with conventional flap elevation technique or with a minimally invasive flapless technique.Participants with bilaterally impacted mandibular third molars were included. They were divided into two sites constituting 2 groups. One group was operated by using conventional flap design and elevation and other with flapless technique. Objective clinical parameters were recorded and compared in the post-operative period like mouth opening, swelling, surgical time, and pocket depth. Subjective parameters including pain were also assessed and statistically analyzed.The sites operated in Group II (Flapless technique) had better results (p≤0.05) in terms of pain, swelling, trismus, and pocket depth distal to second molar when compared to Group I (Flap).The flapless technique gives better surgical results and improved healing process after third molar removal and so should be recommended in routine clinical practice.

Outcomes of Early Surgical vs Nonsurgical Management of Pediatric Hand Friction Injuries Caused by Treadmills.

Pediatric hand friction injuries caused by running treadmills are ever more prevalent due to the increasing presence of home exercise equipment. These and other related injuries have received recent attention in the media, leading to mass product recalls in some cases. These friction injuries are similar to deep thermal burns, and these patients are usually cared for in the pediatric burn unit at our institution. We sought to describe our recent experience managing 22 patients with these injuries. Patients were queried from our urban pediatric burn center database. After Institutional Review Board approval, a retrospective chart review of all patients admitted for a treadmill-related hand injury over a 5-year period was performed. Data collected included patient demographics, initial treatment methods (surgical vs nonoperative), type of dressing used, hospital length of stay (LOS), and compliance with follow-up. We collected patient-centered outcomes included the time to healing and the need for subsequent surgical and/or nonsurgical interventions to treat the sequelae of these injuries. Our center treated 22 hand friction injuries caused by treadmills over the 5-year period. Five patients (23%) underwent early surgical intervention (<30 days from injury), with a median time from injury of 7 days (interquartile range 1.75-13.5). This cohort required additional interventions to treat postoperative sequelae with 2 (40%) requiring additional surgery and 3 (60%) managed nonsurgically. Of the 17 (77%) who were initially treated nonoperatively, 5 (29%) healed completely with dressing changes only and required no further treatment. Eleven (65%) had injury-related sequelae and were managed successfully with nonsurgical interventions. Only 1 patient (6%) required scar modification by Z-plasty. Average LOS was 14 hours and the median number of weekly follow-up visits was 4 until complete healing. Given the excellent outcomes observed in patients treated without acute surgical intervention in this case series, nonoperative management appears to be feasible, safe, and may reduce the need for operative intervention. These injuries, although small, are deep and require a prolonged period of dressing changes and aggressive therapy including posthealing time commitment to scar management in order to achieve best outcomes. Our study supports the need for increased community awareness of this type of injury.

Ventilatory performance of AMBU® AuraGain™ and LMA® Supreme™ in laparoscopic surgery: A randomised controlled trial

The Ambu® AuraGain™ (Ambu A/S, Ballerup, Denmark) is a newer phthalate-free, single-use supraglottic device with the advantage of a facility for tracheal intubation if necessary intraoperatively. We compared the oropharyngeal leak pressures and other performance variables between the AMBU AuraGain and the LMA® Supreme™ (Teleflex Medical, Athlone, Co. Westmeath, Ireland) in patients undergoing laparoscopic cholecystectomy and preperitoneoscopic inguinal herniorrhaphy with carbon dioxide insufflation under controlled ventilation. We recruited 120 American Society of Anesthesiologists physical status class I-3 patients between the ages of 21 and 80 years undergoing laparoscopic cholecystectomy or preperitoneoscopic inguinal herniorrhaphy into this single-centre randomised controlled trial. The primary outcome measure was the oropharyngeal leak pressures. Secondary outcomes included insertion parameters, ventilatory characteristics and postoperative sequelae. The AuraGain had slightly but significantly higher oropharyngeal leak pressures than the LMA Supreme (mean (standard deviation) 26.1 (6.9) versus 21.4 (4.7) cmH2O, P < 0.010). The overall insertion success of the AuraGain was comparable to the LMA Supreme (AuraGain 58/60 (96.7%); LMA Supreme 56/59 (94.9%), P = 0.679). The AuraGain was deemed more difficult to insert than the LMA Supreme, with 26/60 (43.3%) of AuraGain insertions graded easy versus 48/59 (81.4%) of LMA Supreme, P < 0.001. The mean time to insertion of the AuraGain was slightly longer than the LMA Supreme, 32.2 (10.5) versus 28.3 (12.0) s, P < 0.001. Intraoperative device failure occurred following carbon dioxide insufflation in one AuraGain and three LMA Supremes, bringing the perioperative success rate of AuraGain and LMA Supreme to 95% and 89.8%, respectively, P = 0.322. No cases of regurgitation and aspiration occurred, and minor postoperative complications were similar. The AuraGain exhibited higher oropharyngeal leak pressures than the LMA Supreme, but was slightly more difficult to insert. The higher oropharyngeal leak pressures suggest that ventilation might be less affected by high peak inspiratory pressures when using the AuraGain than the LMA Supreme.

Wandering parasite: endoscopic management of hydatid cysts of abdomen encroaching thorax.

Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy. Present prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax. Patients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale. A total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120min. Mean hospital stay was 10days. Pleural effusion being the commonest postoperative sequelae. This endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.

Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial

BackgroundSurgical extraction of the impacted mandibular third molar is commonly associated with postoperative pain, swelling, and trismus. Usually, rotatory instruments like burs have been used for osteotomy, while Piezosurgery is an innovative technique introduced to overcome the weaknesses related to the conventional technique. In addition, Dexamethasone administration before the extraction of impacted third molars is an efficient way to reduce postoperative pain due to robust anti-inflammatory activity. The purpose of the study is to evaluate the effect of piezo-surgery and dexamethasone injection on postoperative sequelae after the surgical extraction of impacted mandibular third molars, and ultimately to compare their effect on reducing postoperative pain.MethodsA randomized controlled clinical trial was conducted with a sample of 80 patients. Participants were divided into four groups: Group 1 (Conventional rotatory), Group 2 (Conventional rotatory with 8 mg dose of dexamethasone 30 min before surgery), Group 3 (Piezo-surgery), and Group 4 (Piezo-surgery with 8 mg dose of dexamethasone 30 min before surgery). The outcome variables were surgical working time calculated in minutes, maximal mouth opening measured in millimeters using Vernier Caliper at baseline and day 3 and postoperative pain assessed using a Visual Analog Scale (VAS) on days 1, 3, and 7.ResultsThe surgical working time was longer in piezo-surgery groups compared with the conventional rotatory instruments groups (15.82 ± 3.47 vs 23.33 ± 2.54; p value < 0.0001). The lowest reduction in mouth opening between baseline and 3rd-day post-op was found in the Piezo-surgery with Dexamethasone group (mean difference = 5.0, SD = 3.9, p value < 0.0001) followed by the Piezosurgery without Dexamethasone group (mean difference = 5.8, SD = 4.5, p value < 0.0001) and the highest average was reported by the Conventional rotatory without Dexamethasone (mean difference = 9.7, SD = 4.5, p value < 0.0001. In the four groups, the mean pain score was highest on the 1st day and gradually decreased over the following days. Comparison of the 1st and 3rd postoperative pain between groups revealed a lowest mean pain score in the Piezo-surgery with Dexamethasone group, followed by Conventional rotatory with Dexamethasone group and a highest mean score in the Conventional rotatory without Dexamethasone group (p value < 0.0001).ConclusionThe association of Piezosurgery osteotomy and Dexamethasone intramuscular injection could be an effective combination to reduce postoperative pain and trismus after impacted third molar surgery.Trial registration: NCT04889781 (https://clinicaltrials.gov/), Date of Registration: 17/05/2021 (retrospectively registered), https://clinicaltrials.gov/ct2/show/NCT04889781?term=NCT04889781&draw=2&rank=1

English

BACKGROUND Surgical removal of impacted third molar is widely carried out in general dental practice and is usually associated with postoperative inflammatory sequelae like pain, swelling, and trismus. The objective of the study was to assess and compare the efficacy of oral bromelain and Serratiopeptidase for the control of post-operative sequelae following surgical removal of impacted third molar. METHODS A randomized, comparative clinical study was conducted on sixty patients who were undergoing impacted third molar surgery, and were allocated into two groups each comprising 30 patients. Conventional drugs included Cap amoxicillin 500 mg bid, Tab. metronidazole 200 mg tid, and Tab. diclofenac sodium 50 mg bid that were given to both the groups. Group I was treated with Tab. bromelain 200 mg tid along with conventional treatment for 5 days. Group II received a combination of conventional treatment and Tab. Serratiopeptidase 10 mg bid for 5 days. The parameters such as measurement of pain, facial width and trismus were analysed on postoperative days 1, 2 and 7. RESULTS The study comprised of totally 60 otherwise healthy patients. The group of patients who received bromelain along with diclofenac sodium seemed to be effective in controlling post-operative sequelae like pain (P &lt; 0.05), swelling (P &lt; 0.05) but not trismus (P &lt; 0.05) when compared to the group who received Serratiopeptidase with diclofenac sodium. CONCLUSIONS The intensified anti-inflammatory action of bromelain, was possibly by inhibiting the generation of bradykinin and negative action on the prostaglandin pathway. The present study assessed the clinical effect of bromelain and serratiopeptidase on pain, facial swelling and trismus. KEY WORDS Bromelain, Oral Bromelain, Serratiopeptidase, Proteolytic Enzyme, Third Molar Surgery

Cement-Augmented Carbon Fiber–Reinforced Pedicle Screw Instrumentation for Spinal Metastases: Safety and Efficacy

To investigate the complication rates and long-term implant failure rates in a monocentric study of a consecutive cohort of patients with thoracolumbar spinal metastases after posterior instrumentation with a fenestrated carbon fiber-reinforced poly-ether-ether-ketone (CFRP) pedicle screw system. We retrospectively reviewed demographics, Karnofsky Performance Status Scale scores, complications, and implant failure rates. Between June 2016 and November 2019, 51 consecutive patients underwent cement-augmented CFRP pedicle screw instrumentation at our institution. Mean age was 68 years (standard deviation 10.5), the median preoperative Karnofsky Performance Status Scale of 80 increased to 90 postoperatively (P= 0.471). Most common primary entities were breast (25.5%), lung (15.7%), and prostate (13.7%) cancers. Of 428 placed screws, 293 (68.5%) were augmented with polymethylmethacrylate, a mean 6 per patient (standard deviation ±2). Screws were inserted via a minimally invasive system technique in 54.9% of cases. In total, 11.8% of patients had immediate postoperative sequelae related to the cement. Pulmonary cement embolisms were noted in 3 patients, 2 had paravertebral extravasation, and 1 had an embolism into a segmental artery. Of these 6, 2 patients with pulmonary embolisms reported related symptoms. Follow-up was available for 80.4%. After a mean 9.8 months, screw loosening was noted in 11.8% of cases on computed tomography, although it was asymptomatic in all but 1 patient. Screw pull-out did not occur. Neither cement-related (P= 0.353) nor general complication rates (P= 0.507) differed significantly between open and minimally invasive system techniques. Percutaneous cement-augmented CFRP pedicle screw instrumentation facilitates artifact-reduced postoperative imaging, while maintaining a risk profile and implant failure rates comparable to conventional metallic instrumentation.

Post-operative complications following apocrine gland anal sac adenocarcinoma resection in dogs.

Describe the complications associated with surgical resection of primary apocrine gland anal sac adenocarcinoma (AGASACA) tumours study design multi-institutional retrospective cross-sectional cohort study Animals Client owned dogs with spontaneous disease using the Clavien-Dindo classification system, post-operative events were assigned and described. Logistic regression analysis was used to analyse for risk factors for a significant association with complications. One hundred sixty-one dogs were included in the analysis. The post-operative sequelae, complication, and failure to cure rates specific to the anal sac site was 14%, 17% and 1%, respectively. The majority (68%) of complications were grade II or higher, therefore requiring some form of intervention. Intra-operative complications were identified in 11 cases (7%) with anorectal wall perforation being most common. An intra-operative complication was significantly associated with post-operative complications (p < 0.001; OR 7.4) while anorectal wall perforation was the only significant risk factor on regression analysis (p < 0.001; OR 19). Surgical site infection was identified in 20 of 161 (12%) of cases. Local recurrence (LR) occurred in 18% of cases at a median of 374 days (95% CI: 318-430). The only risk factor significantly associated with LR was the presence of vascular or lymphatic invasion (p=0.008; OR 3). Post-operative complications were relatively infrequent but the risk was significantly increased when there was an intraoperative complication during resection of a primary AGASACA tumour. This study provides information for the clinician regarding risk factors for post-operative complications.

Study of prevalence and pattern of impacted mandibular third molar in a tertiary care centre

Aim: To study the prevalence, pattern and postoperative complications of impacted third molars based on Pell and Gregory and Winter's classification. Methods: This retrospective study was undertaken on 300 patients in the Thoothukudi Government medical college hospital in the department of dental surgery. Patients diagnosed with impacted mandibular third molars and treated surgically under local anesthesia were included in the study. Patients with incompletely formed roots, absence of adjacent second molar were excluded. The data collected were analyzed by applying descriptive statistics. Results: The most common type of impaction was mesioangular (n=135, 45%) followed by vertical (n=100, 33.3%) and horizontal impaction (n=34, 11.3%).The majority of the cases were class II A (n=98, 32.6%), class I A (n=72, 24%), while there were minimal cases in class III B and III C. Conclusion: Recurrent pericoronitis was the most frequently reported reason for surgical removal of mandibular third molars. The postoperative infection rate was 3.6%, though the patient had undertaken antibiotics postoperatively. The use of corticosteroids can decrease the severity of postoperative sequelae in many patients.

Differential Hypothermic Arrest with Double-Arterial Cannulation

Thoracic aortic aneurysm (TAA) is a dilation of the aorta of &gt;150% of its normal diameter for a given segment. Weakening of aortic walls results in saccular, fusiform, or diffuse dilation. The incidence of TAA is about 10 for every 100,000 adults, with 20% being of familial origin. TAA carries a high risk of morbidity and mortality, with surgery and thoracic endovascular aortic repair being the definitive treatment. In this case report, we present an innovative approach for addressing concomitant coronary artery disease and TAA repair using double-arterial cannulation and differential hypothermic circulatory arrest without any postoperative neurological sequelae.

Long-term outcome of 18 years single-center study of surgical treatment of choledochal cyst patients

There are not many reports of postoperative long-term malignant risk or postoperative sequelae after surgery on choledochal cyst (CC). The purpose of this study was to report the long-term results of operated CC. The patients who underwent surgical treatments for CC between 2003 and 2020 at the Seoul National University Hospital were enrolled. Clinicopathologic factors and pre/postoperative CT or MRI were reviewed. Of the 153 patients, the female was 85%, and the mean age was 41 years old. The most common symptom was abdominal pain. According to the Todani classification, the most common type was 1c (36.6%). APBDU was 85.6% and C-P type, P-C type APBDU were observed at 43.8%, 41.8% respectively. Fourteen patients (9.2%) had biliary tract cancer including 8 cholangiocarcinomas and 8 gallbladder cancer. Two patients had both cancers. A comparison of patients with and without malignancy showed that age, operative time, EBL were significantly higher in the malignant group, while the diameter of the cyst is significantly smaller in the malignant group. There was no significant difference in APBDU type and Todani classification type between the two groups. The incidence of long-term complication was 14.3% and the median time interval was 30 months. The two most common complication was cholangitis or stricture (5.9%). There were 2 cases (1.3%) of new cancer near the intrapancreatic remnant bile duct. The 9.2% of resected CCs had combined malignancy on biliary tracts. Long-term complications such as cholangitis, anastomosis stricture, and new cancer may occur. Therefore continuous surveillance is required.

The Effect of Flurbiprofen Lozenge on Pain, Oedema, and Trismus after Impacted Third Molar Surgery: A Prospective Randomized, Double-Blinded, Placebo-Controlled Study

Background: The postoperative sequelae after third molar surgery include pain, swelling and trismus, Flurbiprofen is a non-steroidal anti-inflammatory drug (NSAID), and the anti-inflammatory mechanism of Flurbiprofen is thought to involve inhibition of prostaglandin biosynthesis, in common with other NSAIDs. Prostaglandins such as prostaglandin E2 (PGE2) and other inflammatory mediators released in response to pain or non-infectious stimulants trigger a complex inflammatory cascade that contributes to inflamation symptomsThis study was aimed to evaluate the efficacy of oral Flurbiprofen lozenge given 30 min before surgery on reducing postoperative sequelae. Method: We recruited 70 patients, randomly assigned to two groups: Flurbiprofen and Control group, groups received 100mg Flurbiprofen lozenge, placebo lozenge 30 min before surgery respectively and every 6h till 72h after surgery. Third molar extraction was performed under local anesthesia. After extraction, pain, swelling, and mouth opening in both groups observed till 72h. Statistical Analysis: Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, was analyzed using Student t test or ANOVA, Chi-square or Mann-Whit-ney U test was performed for non-parametric samples. P &lt; 0.05 was considered as statistically significant. Results: The overall incidence of Pain in the Flurbiprofen group was 18% compared to 43% in the Control group (P = .003) Incidence of Pain, swelling, and mouth opening at different time intervals 6h, 24h, 48h and 72h were significantly (P &gt;0.05) better in Flurbiprofen group. Conclusion: Oral Flurbiprofen lozenge administered 30 minutes preoperatively can significantly reduce postoperative sequelae after third molar extraction.

MACULAR OCT OUTCOMES OF PHACOEMULSIFICATION CATARACT SURGERY IN DIABETIC VERSUS NON DIABETIC PATIENTS

Background: Cataract surgery with phacoemulsification is one of the most common surgical procedures performed today .Compared to people without diabetes, diabetic patients have been shown to have an elevated risk of developing cataracts. Cataract surgery in diabetics is indicated not only to improve visual acuity, but also to allow assessment and treatment of fundus changes. Even in the absence of diabetic retinopathy, diabetes mellitus has been found to have about twice the occurrence rate of pseudophakic CME. Objectives: This study was done to document any subsequent post-phacoemulsification macular edema (PPME) as postoperative sequelae in the diabetic versus non-diabetic nuclear senile cataract patients. Methods: This study was conducted on patients complained from visually significant immature senile cataract in ophthalmology department at Sohag university hospital between January 2018 and December 2020.Corrected distance visual acuity, Keratomerty, refraction, slit-lamp examination, macular optical coherence tomography (OCT) and biometry. Phacoemulsification was performed to all patients by stop and shop technique. The macular OCT changes were documented preoperatively and at postoperative month 1, 3, 6. Results: 64 eyes of 64 patients with visually significant senile cataract were included 32eye of them were diabetics, (33 males, and 31 females), our study documented four cases of the entire 64 eyes (6%) complicated with PPME in groups A and B at the postoperative month 1. Both A and B groups exhibited the same incidence of postoperative macular edema i.e. two (6%) cases in each group. Conclusion: Our outcomes confirmed that there was a similar probability of PPME occurrence in both non-diabetic and diabetic patients as this probability was mostly related to the surgical procedure itself. Meanwhile, the non-diabetic PPME exhibited rapid and complete recovery within one month in comparison to the diabetic PPME that exhibited gradual and incomplete recovery during the postoperative six months follow-up period.