Postsurgical Quality Of Life Research Articles

The role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as second-line debulking in advanced ovarian cancer patients. A meta-analysis

Purpose: Ovarian cancer, as a type of gynecological cancer with one of the highest morbidity and recurrence rates, has been the burning issue for modern research. With new therapeutic methods coming to light, the focus on the promising Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has raised questions about its efficacy on patients’ overall survival (OS) and post-surgical quality of life. Methods: A meta-analysis was performed in order to estimate the role of HIPEC in advanced ovarian cancer, concentrating, among others, on the following quality of life. After thorough research on the PubMed and Cochrane databases, using the terms ‘HIPEC, ovarian cancer’, as well as decoding the results on the last decade, a total of nine articles were selected for this purpose. Results: Data decoding revealed a notorious improvement of OS of the cytoreductive surgery (CRS) plus HIPEC versus the CRS arm at 1, 3, 4 and 5 years respectively; (OR 1.10; 95% CI, 0.85-1.43), (OR 1.53; 95% CI, 1.12-2.10), (OR 1.70; 95% CI, 1.03-2.81), (OR 1.22; 95% CI, 0.77-1.95). At 2 years, the collected data depicted a small worsening in OS (OR 0.92; 95% CI, 0.70-1.19). Conclusion: HIPEC, in spite of its recent innovative nature, has already given positive signs for ovarian cancer therapeutic mapping. Objective of the conducted study focuses on investigating its reflection in advanced stages and recurrent ovarian cancer lesions, respectively.

Gender Differences in Quality-of-Life Outcome in Patients Undergoing Endoscopic Endonasal Skull Base Surgery.

Background Prior studies showed that female patients with chronic rhinosinusitis (CRS) suffer a worse disease-specific quality of life (QoL). Goal The aim of this study is to investigate gender differences in sinonasal QoL outcomes in patients requiring endoscopic endonasal skull base surgeries (EESBS). Methods Cross-sectional analysis of patients presenting to our clinic from August 2020 to December 2022 with skull base tumors, spontaneous cerebrospinal fluid (CSF) rhinorrhea, or Grave's orbitopathy (for orbital decompression) was performed. Baseline and postsurgical QoL were measured using the 22-item Sinonasal Outcome Test (SNOT-22). Patients' demographics and comorbidities were reviewed. Patients with concomitant CRS were excluded. Results Eighty-six patients were included (54 with skull base tumors, 17 Grave's orbitopathy, and 15 spontaneous CSF rhinorrhea). The mean age of the patients was 52 years (range: 12.4-81.5 years), and 51.6% of the patients were females. There was no age difference between female and male patients. Smoking history, asthma, and allergic rhinitis were also similar between the two groups. Female patients had a significantly higher incidence of depression (58.3 vs. 32.4%, p = 0.018) and migraine (50.0 vs. 21.6%, p = 0.007). Female patients had a significantly worse overall SNOT-22 scores at baseline (33.6 vs. 18.2, p = 0.001), at the 3-month follow-up (29.7 vs. 15.5, p = 0.002), and at the 6-month follow-up (33.5 vs. 14.9, p = 0.005). This worse QoL was seen mainly in the ear/facial, sleep, and psychological domains. Linear regression of the SNOT-22 scores and its subdomains adjusting for comorbidities showed that migraine was found to be the most significant determinant of gender differences in the QoL. Conclusion Female patients who undergo EESBS show higher overall SNOT-22 scores secondary to higher incidence of migraine.

Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications

The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, both of which contribute its to high inter-rater reliability. It has been validated for use in many specialties due to strong correlation with key outcome measures including length of stay, postsurgical quality of life and case-related renumeration. Limitations of the classification include concerns over differentiating grade III and IV complications and not classifying intraoperative complications. The Comprehensive Complication Index is an adaptation of the CD classification which generates a morbidity score from 0 to 100. It has been proposed as a more effective method of assessing the morbidity burden of surgical procedures. However, it remains less popular as calculations of morbidity are complicated and time-consuming. In recent years there have been suggestions of adaptations to the CD classification such as the Clavien-Dindo-Sink classification, while in some specialties, completely new classifications have been proposed due to evidence the CD classification is not reliable. Similarly, the Surgical Expertise and Validity Evaluation project aims to determine benchmarks against which surgeons may compare their own practice.

Clinical Findings in a Pati ent with Large B-Cell Lymphoma andNeuroniti s: A Case Study.

Given the multifaceted nature of the balance system, an interdisciplinary approach to patient care is imperative. For surgical patients with complex medical histories, comprehensive vestibular evaluations provide information on baseline vestibular function and identify possible surgical risks and outcomes. This case study follows a patient diagnosed with probable right vestibular neuronitis immediately preceding surgical resection of a left brainstem lesion, later diagnosed as a B cell lymphoma (BCL) and provides details regarding pre- and postsurgical outcomes. This case study expands on the importance of the inclusion of vestibular audiologists on the interdisciplinary team for related surgical procedures to provide insight into possible surgical risks and subsequent effects on patients' postsurgical quality of life. Case report. A 68-year-old female patient evaluated within the Henry Ford Health System for management of diffuse large BCL. Standard neuro-otology, neuro-surgical, audiological, and vestibular evaluations were conducted to evaluate the patient's complex symptomology. This case report outlines a patient hospitalized for a left brainstem mass, later diagnosed as an aggressive form of lymphoma, with a concurrent episode of vestibular neuronitis on the contralesional side. Functional outcomes are discussed following surgical intervention to remove the mass. Postsurgical vestibular testing revealed a bilateral vestibular hypofunction. Vestibular audiology plays an essential role in the multidisciplinary team for complex dizzy patients with related surgical procedures, as this subset of the field can offer critical insight into postsurgical recommendations and patient expectations.

Evaluation of the usefulness of the Clavien-Dindo classification of surgical complications

The Clavien-Dindo (CD) classification is widely used in the reporting of surgical complications in scientific literature. It groups complications based on the level of intervention required to resolve them, and benefits from simplicity and ease of use, both of which contribute its to high inter-rater reliability. It has been validated for use in many specialties due to strong correlation with key outcome measures including length of stay, postsurgical quality of life and case-related renumeration. Limitations of the classification include concerns over differentiating grade III and IV complications and not classifying intraoperative complications. The Comprehensive Complication Index is an adaptation of the CD classification which generates a morbidity score from 0 to 100. It has been proposed as a more effective method of assessing the morbidity burden of surgical procedures. However, it remains less popular as calculations of morbidity are complicated and time-consuming. In recent years there have been suggestions of adaptations to the CD classification such as the Clavien-Dindo-Sink classification, while in some specialties, completely new classifications have been proposed due to evidence the CD classification is not reliable. Similarly, the Surgical Expertise and Validity Evaluation project aims to determine benchmarks against which surgeons may compare their own practice.

Different Endotracheal Intubations for Non-Small Cell Lung Cancer Surgery: A Retrospective-Case-Matched Study on Postoperative Complications and Quality of Life.

Lung isolation and separation is still controversial in thoracic surgery. Preferences of the surgeon can drive the decision to use single- vs. double-lumen endotracheal intubation. We aimed to compare complications and quality of life (QOL) after radical lung cancer resection with a single-lumen tube (ST) and a double-lumen tube (DT) for patients with non-small cell lung cancer (NSCLC). A total of 309 patients who underwent radical lung cancer resection with video-assisted thoracoscopy-lobectomy were subsequently included in the study. Based on the type of endotracheal intubation tube used during surgery, we divided all the patients into a single-lumen tube group (ST-G) and double-lumen tube group (DT-G). Then, we applied propensity score matching (1:1) to balance the baseline characteristics between the two groups. The Analysis of Variance (ANOVA) of two-factor repeated measures data was performed to compare postoperative complications at three and six months after surgery and postsurgical QOL at baseline at one month, three months, six months, and twelve months. Within three months after surgery, patients in the ST-G presented less cough symptoms in Lung Cancer Symptom Scale (LCSS), lower cough symptom scores (CSS) (one month and three months, p < 0.05) and better performance of Leicester Cough Questionnaire (LCQ) scores in physical part (one month, three months and six months, p < 0.05) with better overall QOL (one month and three months, p < 0.05) than those in the DT-G. Patients with STs displayed less postoperative cough symptoms and higher overall QOL than those with DTs. Although DT is the gold standard for thoracic surgeries, we suggest that postoperative cough symptoms should be given sufficient attention by surgeons.

Post-Surgical Quality of Life After Laparoscopic Heller Myotomy with Fundoplication for the Treatment of Achalasia

Post-Surgical Quality of Life After Laparoscopic Heller Myotomy with Fundoplication for the Treatment of Achalasia

Cognitive decline and quality of life after resective epilepsy surgery

ObjectivesThe objectives of this study were to examine the association between cognitive decline and quality of life (QoL) change in a large sample of individuals with drug-resistant epilepsy who underwent resective surgery and to examine whether the association between cognitive decline and QoL is differentially affected by seizure classification outcome (Engel Class 1 vs. 2–4) or side of surgery (left vs. right hemisphere). Materials and methodsThe sample comprised 224 adults (ages ≥ 18) with drug-resistant focal epilepsy treated with resective surgery who underwent comprehensive pre-operative and post-operative evaluations including neuropsychological testing and the Quality of Life in Epilepsy Inventory - 31 between 1991 and 2020. Linear mixed-effects models were fit to examine subject-specific trajectories and assess the effects of time (pre- to post-operative), cognitive decline (number of measures that meaningfully declined), and the interaction between time and cognitive decline on pre- to post-operative change in QoL. ResultsIncreases in QoL following resection were observed (B = −10.72 [SE = 1.22], p < .001; mean difference between time point 1 and time point 2 QoL rating = 8.11). There was also a main effect of cognitive decline on QoL (B = −.85 [SE = .27], p = .002). Follow-up analyses showed that the number of cognitive measures that declined was significantly associated with post-surgical QoL, (r = −.20 p = .003), but not pre-surgical QoL, (r = −.04 p = .594), and with pre-to post-surgery raw change in QoL score, (r = −.18 p = .009). A cognitive decline by time point interaction was observed, such that those who had greater cognitive decline had less improvement in overall QoL following resection (B = .72 [SE = .27], p = .009). Similar results were observed within the Engel Class 1 outcome subgroup. However, within the Engel Class 2–4 outcome subgroup, QoL improved following resection, but there was no main effect of cognitive decline or interaction between cognitive decline and time point on QoL change. There was no main effect of resection hemisphere on overall QoL, nor were there interactions with hemisphere by time, hemisphere by cognitive decline, or hemisphere by time by cognitive decline. ConclusionsQuality of life improves following epilepsy surgery. Participants who had cognitive decline across a greater number of measures experienced less improvement in QoL post-operatively overall, but there was no clear pattern of domain-specific cognitive decline associated with change in QoL. Our results indicate that cognitive decline in a diffuse set of cognitive domains negatively influences post-operative QoL, particularly for those who experience good seizure outcomes (i.e., seizure freedom), regardless of the site or side of resection.

8118 A Conservative Tailor-Made Approach on Treating Bowel Endometriosis

<h3>Study Objective</h3> To display how the surgical inclination to perform a sub-radicle shaving procedure in place of resection and Anastomosis in cases of non-mucosal colonic involvement of endometriosis can lead to significantly better outcomes for the patient's quality of life. <h3>Design</h3> Based on empirical understanding of the authors following 1000+ surgeries of colonic involvement of endometriosis, they have formed their opinions around radicalization of procedures in cases of DIE involving the colon. <h3>Setting</h3> The patient is positioned in the dorsal lithotomy in Trendelenburg position. Primary tracer is through the umbilicus, 3 operative ports are used, 2 at respective right and left flank and middle at supra pubic port. <h3>Patients or Participants</h3> The learnings presented in this video have been compiled over several years with observations from numerous surgeries following close observations of patient recovery curves and reports on quality of life. For the purpose of simplicity, the author presents a single case of colonic involvement to elucidate the argument. <h3>Interventions</h3> The surgery displayed in this video presentation is a laparoscopic surgery for a case of colonic involvement in deep infiltrating endometriosis <h3>Measurements and Main Results</h3> Surgical excellence and an inclination to perform sub-radical procedures can help with the same level of disease minimization while ensuring the patient a far better outcome and post-surgical quality of life <h3>Conclusion</h3> Recent trends in surgery have led to an increase in resection procedures even in candidates that could undergo rectal shaving. While it is easy to believe that resection is a more total procedure and reduces the risk of diseases recurrence, it comes at the cost of long recovery times and often longer lasting repercussions, both of which can be avoided with almost equal recurrence avoidance in some candidates that qualify for rectal shaving.

Quality of life after epilepsy surgery: How domain-specific cognitive changes impact QOL within the context of seizure outcome

PurposeNeurosurgery is an effective treatment option for pharmacoresistant epilepsy. Although post-surgical seizure freedom is considered the primary goal of epilepsy surgery, other factors that impact Quality of Life (QOL) are also important to consider, including post-surgical cognitive changes. This study aimed to examine the impact of post-surgical cognitive changes on QOL in the context of seizure outcomes. MethodsParticipants were 196 adults with focal epilepsy who underwent either frontal (n = 27) or temporal (n = 169) lobe resection. Each participant completed pre- and post-surgical neuropsychological evaluations, and cognitive composites were constructed for the following domains: language, attention/processing speed, memory, executive function, and visuospatial skill. The Quality of Life in Epilepsy (QOLIE-10) questionnaire was used to assess QOL. Seizure outcome was determined by seizure status six months post-surgery. ResultsEighty-one percent of patients were seizure-free post-surgery and generally reported improved QOL. While a significant portion of patient’s demonstrated declines in language and verbal memory following surgery, only a decline in verbal memory was associated with worse QOL; however, this relationship was no longer significant after controlling for seizure outcome. Instead, reduced post-surgical QOL was primarily observed in those who experienced both seizure recurrence and a decline in executive function. Notably, depression was a significant covariate in all of the models. ConclusionsThe findings from this study improve our ability to counsel patients about the trade-off between cognitive decline and seizure remittance in the greater context of overall QOL. Reassuringly, it appears that QOL is improved regardless of cognitive changes when patients have good seizure outcomes. However, for those that experience a “double hit” (i.e., cognitive decline without seizure remission), post-surgical QOL may be reduced. Changes in depression also appear to play a crucial role in QOL outcomes.

Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy

Purpose To assess whether performance in attention and executive functions evaluated with the Epitrack screening tool before surgery can differentiate memory and quality of life (QOL) profiles, and detect different post-surgical change patterns in these variables in patients with epilepsy. Methods This is a longitudinal study. Seventy-seven patients with drug-resistant epilepsy (mean age = 37.91) underwent a neuropsychological assessment before and one year after surgery. Epitrack, a screening tool that exclusively evaluates attention and executive functioning, was administered in the pre-surgical assessment, and verbal and visual memory and QOL were assessed before and after surgery. Results Patients with impaired Epitrack performance had poorer verbal and visual memory than those with intact Epitrack performance, regardless of the time point (for all, p < 0.0001). They also showed a post-surgical decline in immediate verbal recall (p = 0.04) and discriminability (p = 0.001). Patients with intact Epitrack performance did not exhibit this decline. Epitrack total score significantly contributed to 13 and 11% of the variance of post-surgical changes in immediate verbal recall and discriminability, respectively. Epitrack groups did not differ in QOL profiles or changes, but post-surgical immediate verbal recall improvements were related to post-surgical QOL improvements. Conclusion Our findings underline the utility of Epitrack screening tool to detect different patterns of verbal and visual memory dysfunction, as well as to predict post-surgical verbal memory decline in patients with drug-resistant epilepsy. Patients with lower pre-surgical Epitrack scores appear to be at increased risk for post-surgical memory decline.

Early-Stage Lung Cancer Patients' Perceptions of Presurgical Discussions.

BackgroundPatients with early-stage non–small-cell lung cancer (NSCLC) have high survival rates, but patients often say they did not anticipate the effect of the surgery on their postsurgical quality of life (QoL). This study adds to the literature regarding patient and surgeon interactions and highlights the areas where the current approach is not providing good communication.DesignSince its start in 2016, the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study, has enrolled 543 patients who underwent surgery for stage I NSCLC within the Mount Sinai Health System. Presurgical patient and surgeon surveys were available for 314 patients, postsurgical surveys for 420, and both pre- and postsurgical surveys for 285.ResultsOf patients with presurgical surveys, 31.2% said that their surgeon recommended multiple types of treatment. Of patients with postsurgical surveys, 85.0% felt very well prepared and 11.4% moderately well prepared for their postsurgical recovery. The median Functional Assessment of Cancer Therapy–Lung Cancer score and social support score of the patients who felt very well prepared was significantly higher than those moderately or not well prepared (24.0 v. 22.0, P < 0.001) and (5.0 [interquartile range: 4.7–5.0] v. 5.0 [IQR: 4.2–5.0], p = 0.015).ConclusionsThis study provides insight into the areas where surgeons are communicating well with their patients as well as the areas where patients still feel uninformed. Most surgeons feel that they prepare their patients well or very well for surgical recovery, whereas some patients still feel that their surgeons did not prepare them well for postsurgical recovery. Surgeons may want to spend additional time emphasizing postsurgical recovery and QoL with their patients or provide their patients with additional avenues to get their questions and concerns addressed.HighlightsPretreatment discussions could help surgeons understand patient priorities and patients understand the anticipated outcomes for their surgeries.There is an association between feeling prepared for surgery and higher quality of life and social support scores after adjustment for confounders.Despite these pretreatment discussions, patients still feel that they are not well prepared about what to expect during their postsurgical recovery.

SURGICAL CORRECTION OF JUVENILE IDIOPATHIC SCOLIOSIS. OUR PATIENTS’ PERCEPTION OF THEIR QUALITY OF LIFE

ABSTRACT Objective: To report the results of our patients who underwent scoliosis correction surgery in relation to their quality of life. Introduction: Juvenile idiopathic scoliosis affects between 1 and 3% of the population during puberty. Treatment will be conservative in most cases. The goal of surgical treatment is to improve coronal and sagittal alignment. The SRS 22 questionnaire is a useful tool for assessing quality of life in these patients. Methods: A retrospective study of 22 patients submitted to corrective surgery for juvenile idiopathic scoliosis between October 2017 and January 2020 was conducted. All of them had curves greater than 45 degrees managed through instrumentation and arthrodesis. Post-surgical quality of life was assessed using the SRS 22 questionnaire. Results: The average age of our patients at the time of the intervention was 15.5 years with a predominance of female patients. The application of the SRS 22 questionnaire generated the following mean scores: pain 4.6, function 4.3, self-image 4.41, mental health 4.89, and satisfaction 5.0. Conclusions: The development of surgical techniques has allowed good results to be achieved in the treatment of scoliosis. The evaluation of our patients using the SRS 22 questionnaire reflects a good quality of life in the 5 parameters evaluated. The main limitations of this study were the small sample size and its retrospective nature. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

Outcomes of Esophageal Cancer after Esophagectomy in the Era of Early Injection Laryngoplasty.

(1) Background: severe weight loss was reported to be related to unilateral vocal fold paralysis (UVFP) after esophagectomy and could thus impair survival. Concomitant radical lymph node dissection along the recurrent laryngeal nerve during esophageal cancer surgery is controversial, as it might induce UVFP. Early intervention for esophagectomy-related UVFP by administering intracordal injections of temporal agents has recently become popular. This study investigated the survival outcomes of esophagectomy for esophageal squamous cell carcinoma (ESCC) after the introduction of early injection laryngoplasty (EIL). (2) Methods: a retrospective review of patients with ESCC after curative-intent esophagectomy was conducted in a tertiary referral medical center. The necessity of EIL with hyaluronic acid was comprehensively discussed for all symptomatic UVFP patients. The survival outcomes and related risk factors of ESCC were evaluated. (3) Results: among the cohort of 358 consecutive patients who underwent esophagectomy for ESCC, 42 (11.7%) showed postsurgical UVFP. Twenty-nine of them received office-based EIL. After EIL, the glottal gap area, maximum phonation time and voice outcome survey showed significant improvement at one, three and six months measurements. The number of lymph nodes in the resected specimen was higher in those with UVFP than in those without UVFP (30.1 ± 15.7 vs. 24.6 ± 12.7, p = 0.011). The Kaplan–Meier overall survival was significantly better in patients who had UVFP (p = 0.014), received neck anastomosis (p = 0.004), underwent endoscopic resection (p < 0.001) and had early-stage cancer (p < 0.001). Multivariate Cox logistic regression analysis showed two independent predictors of OS, showing that the primary stage and anastomosis type are the two independent predictors of OS. (4) Conclusion: EIL is effective in improving UVFP-related symptoms, thus providing compensatory and palliative measures to ensure the patient’s postsurgical quality of life. The emerging use of EIL might encourage cancer surgeons to radically dissect lymph nodes along the recurrent laryngeal nerve, thus changing the survival trend.

Prosthodontic Pathways in the Interdisciplinary Management of a Patient with an Ameloblastoma in the Maxilla

Ameloblastoma is a benign and locally aggressive neoplasm. The treatment of choice is surgical resection, which, although removing tumour, will often result in aesthetic and functional problems for the patient. CPD/Clinical Relevance: For patients with ameloblastoma in the maxilla, careful planning with the involvement of a multidisciplinary team is essential for improving post-surgical quality of life.

The impact of cataract surgery upon visual acuity and quality of life in patients with cataract in Tripura

Background: The major cause of blindness in India is cataract. Blindness leads to poverty due to reduced productive activity and this leads to reduced quality of life. This study was aimed at evaluating the visual acuity (VA) change pre and post cataract surgery, the post-surgical quality of life (QOL) outcomes and level of satisfaction estimation.Methods: This was a cross sectional, hospital based study carried out in a tertiary care centre in Tripura. It included 200 patients over a period of 1.5 years to compare the VA, QOL, psychosocial status and satisfaction level pre and post cataract surgery. Indian vision function questionnaire 33 (INDVFQ33) was used to assess QOL.Results: Out of 200 patients, in 53% preoperative VA ranged from &gt;20/400 - &lt;20/200 while in 5% patients it was only perception of light. Postoperatively 80% of the patient achieved best corrected VA (BCVA) of 20/30 or better, 18% patient attained BCVA ranging from 20/40 to 20/60. Only 2% had a BCVA of 20/60 or worst. QOL parameters like mean pre and post -operative general function score, psychosocial scale and visual function scale showed improvement following cataract surgery. 69% of the patients were satisfied with the cataract surgery, whereas 31% were not completely satisfied.Conclusions: The study revealed that there was a marked improvement in VA post cataract surgery and it also influenced the QOL in all scales.

Quality Of Life Of Prostate Cancer Men Undergoing Pre-surgical Exercise Prior To Prostatectomy.

Exercise interventions in prostatectomy patients have generally focused on the post-surgical period and enhancement of pelvic floor musculature to reduce incontinence. However, quality of life (QOL) and psychological distress are also impacted in the pre- and post-surgical period in this patient group. PURPOSE: To evaluate the efficacy of exercise undertaken before surgery to enhance pre- and post-surgical QOL and psychological distress in men scheduled for prostatectomy. METHODS: Twenty-three men with localised prostate cancer (50-73 years) scheduled for surgery were randomised to exercise (EX = 13) or usual care (UC = 10). EX underwent 6 weeks of pre-surgical exercise (resistance and aerobic) thrice weekly. Self-reported QOL was assessed using the EORTC QLQ-C30) and psychological distress using the Brief Symptom Inventory-18 (BSI-18) which includes anxiety, somatization, depression, and the global severity index (GSI). Measures were undertaken at baseline, pre-surgery, within 2 weeks post-surgery and 6 weeks post-surgery. Data were assessed for normality and analysed using two-way repeated-measures ANOVA. RESULTS: There were no differences between groups at baseline. Following exercise, there was a significant interaction (p < 0.05) for somatization with somatization increasing in EX 2 week’s post- surgery and returning to pre-training values 6 weeks post-surgery, with no change in anxiety, depression or the GSI. There was a significant time effect (p < 0.05) for global health, physical, role, cognitive and social function, as well as for fatigue, pain, insomnia, appetite loss and diarrhoea, with QOL generally improving over the study period. CONCLUSION: A pre-surgical exercise program improves components of quality of life prior to surgery, however, EX patients group had higher symptoms after surgery but then did return to pre-training level at 6 weeks post-surgery. Pre-surgery exercise may have a role in managing quality of life and psychological distress in this patient cohort.

Psychosocial Predictors of Weight Loss and Quality of Life at 1 Year Post-Bariatric Surgery: A Cohort Study.

Background:Psychosocial factors, identified in pre-bariatric surgery evaluation, may affect surgical outcomes, as well as defer surgery, making it important to identify psychosocial predictors of surgery outcomes.Methods:Baseline depressive and social anxiety symptom scores were analyzed as predictors of post-surgical weight loss (WL) and quality of life (QOL) following Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB). Eighty-nine (82F, 7M) participants underwent surgery and completed depression, anxiety and QOL questionnaires 3-weeks pre-surgery and 1-year post-surgery.Results:Depressive scores and QOL scores improved post-surgery (P < 0.001), whereas social anxiety scores did not (P = 0.20). Baseline depressive (P = 0.90) and social anxiety (P = 0.20) scores did not predict % weight loss (WL) at 1 year, but higher baseline depressive (P = 0.04) and social anxiety (P = 0.005) scores predicted lower post-surgical QOL at 1 year. RYGB showed greater improvement in %WL (P < 0.001) than AGB, but no difference between the groups in QOL (P = 0.10). Improvement in QOL correlated with %WL (P < 0.001), whereas improvement in depressive scores did not correlate with %WL (P = 0.70) but did correlate with improvement in QOL (P = 0.01).Conclusions:Baseline depressive and social anxiety scores predicted QOL but not %WL. Depressive and QOL scores improved post-surgery, but social anxiety scores did not. The findings suggest that patients who present with depressive or social anxiety symptoms pre-surgery perhaps should not be deferred; however, more studies are needed to confirm this. Patients with pre-operative social anxiety symptoms may benefit from counseling.

Minimally Invasive Surgical Considerations for the Obese Patient

Video Objective This objective of this video is to review surgical considerations for the obese patient undergoing minimally invasive surgery. Setting The obese patient is the patient considered. This video addresses risks of laparoscopic surgery, differences in patient counseling, prophylactic measures, patient positioning, laparoscopic entry, management of the panniculus, and prevention of conversion to an open procedure. Interventions Interventions for prophylactic measures include placement of an orogastric/nasogastric tube prior to intubation, increased dose of antibiotic prophylaxis, and optimization of hemoglobin A1c for diabetic patients. Interventions for optimizing patient positioning include allotting extra time for procedures, utilizing bariatric beds and stirrups, anti-skid material and padding during surgery, tucking the patient's arms, and applying a chest strap. Interventions for laparoscopic entry include utilization of bariatric trocars, placing trocars more laterally and cephalad, left upper quadrant or supraumbilical entry, and inserting ports at a 90 degree angle to the abdomen. Interventions for panniculus management and prevention of conversion to an open procedure include limiting the use of steep Trendelenberg, decreasing the insufflation pressure, mechanically retracting the panniculus, and performing a tilt test. Conclusion Gynecologic surgeons will inevitably be operating on more obese patients with coming years given the rising prevalence of obesity. Thus, they should be prepared for preoperative evaluation of the obese patient, surgical preparation, patient counseling, and surgical optimization to prevent conversion to an open procedure, all of which are addressed in this video. Preventing conversion is a balancing act between improving surgical visualization and maintaining stable cardiac and respiratory status of the patient. With increasing volume of cases, gynecologic surgeons can become proficient at minimally invasive surgery for the obese patient, thus, decreasing their operative morbidity and post-surgical quality of life.

Quality of life and patient satisfaction after submandibular gland transplantation in patients with severe dry eye disease

PurposeSubmandibular gland (SMG) transplantation improves the tear film and other ocular-surface features for patients with severe dry eye disease (DED). Using the dry eye-related quality of life (QOL) questionnaire, we aimed to evaluate whether DED patients' QOL would benefit from SMG transplantation and determine whether preoperative ophthalmologic and QOL measurements could predict which patients would be most satisfied with this surgery. MethodsThis prospective study included DED patients with successful SMG transplantation. Using the Chinese version of the Dry Eye Related Quality of Life (CDERQOL) instrument, QOL was measured before and 1-year after surgery. ResultsThe QOL data of 51 consecutive patients were analyzed. Before surgery, all the patients had a poor QOL. One year after surgery, all five QOL domains (Dry Eye Symptom Bother, Impact on Daily Activities, Emotional Impact, Impact on Work, and Satisfaction with Treatment) showed significant improvement (P < 0.01). Unsuccessful treatment experience with cyclosporin eyedrops as well as pre-surgical low scores of visual acuity and all five QOL domains (except for “Satisfaction with Treatment”) were found to significantly increase the post-surgical QOL scores (P < 0.01); however, pre-surgical Schirmer's test, break-up times of tear-film, and corneal fluorescein staining measurements showed no effects or contradictory correlations with post-surgical QOL scores. ConclusionThe life quality and satisfaction of DED patients showed significant improvement after SMG transplantation. Patients with severe and refractory DED could reap the benefits of surgery. A subjective QOL questionnaire is very valuable for predicting and evaluating the treatment effect.