Potential Surgical Complications Research Articles

Refractive surgery for the patient with autoimmune diseases.

Autoimmune and immune-mediated diseases are considered contraindications for laser refractive surgeries according to the US Food and Drug Administration's guideline. This guideline, however, is based on limited case reports or complications reported during other intraocular procedures. There have been only a handful of new clinical studies that evaluate the efficacy and safety of refractive surgery in this specific patient population. The aim of this article is to review currently available research and offer updated recommendations for the evaluation and management of laser refractive surgery (LRS) in patients with autoimmune diseases. More recent retrospective studies have reported good refractive outcomes in patients with well controlled autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, seronegative spondyloarthropathy, among others. No severe sight-threatening complications have been reported in these reports. Although postoperative complications occur, the risk of refractive surgery is comparable with those without autoimmune diseases. With the exception of primary Sjogren's syndrome, patients with autoimmune diseases may be good candidates for LRS if diseases are well controlled and have minimal ophthalmic manifestation. Patients should be made aware of the potential surgical complications and be informed of the currently available data. More multicenter and larger prospective studies are needed to compare the refractive outcomes and surgical complications in patients with and without autoimmune diseases. This will help patients make better informed medical decisions.

Subpectoral Biceps Tenodesis of the Shoulder: Indications and Technique Options

Subpectoral biceps tenodesis of the shoulder may be a useful tool that can address a wide range of disorders in the setting of pathology of the long head of the biceps tendon. Primary indications include (1) zone 2 or zone 3 tendon pathology and (2) failed previous proximal tendon tenodesis. Secondary indications include (1) an overhead athlete or thrower, (2) chronic tendinopathy, and (3) surgeon preference. A subpectoral technique allows tendon fixation directly posterior (deep) to the pectoralis tendon high in the bicipital fossa or in the mid fossa or fixation low in the fossa inferior to the pectoralis tendon (infrapectoral). Fixation technique options include an onlay suture anchor, onlay unicortical button, inlay bicortical button, or inlay interference screw. Potential surgical complications include humeral fracture, loss of fixation, tendon pullout or rupture, and neurovascular injury. Regardless of the specific location or technique used, subpectoral tenodesis is a valuable tool for the treatment of proximal biceps tendon pathology.

Medical Malpractice Trends in Thyroidectomies among General Surgeons and Otolaryngologists.

ObjectivesThis study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018.MethodsWe used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes.ResultsThe most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, P = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis.ConclusionRLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.

A review of cervical spine alignment in the normal and degenerative spine.

With recent advancements in surgical spine technology and techniques, the importance of regional and global spine alignment has become an important factor in surgical planning. Our review aims to consolidate the current literature on cervical and global alignment parameters and its relationship to cervical symptomatology, quality of life (QOL), requirements for surgery, potential surgical complications and health-related quality of life (HRQOL) outcomes.

Surgical approach for venous malformation in the head and neck.

BackgroundTreatment for venous malformations of the head and neck includes sclerotherapy, surgical resection, or a combination of both. Surgical resection can remove or reduce the volume of vascular lesions; however, surgery can cause postoperative scarring and potential surgical complications. This study sought to determine the effectiveness of surgery for the treatment of venous malformations of the head and neck.MethodsA retrospective review of the medical records of patients who received surgeries for venous malformations of the head and neck from January 2011 to July 2019 was performed. Using clinical photographs, preoperative and postoperative Doppler ultrasonography, outpatient clinic records, and operation records, the postoperative result and complications were evaluated for each case.ResultsAmong patients who visited our vascular anomalies clinic, 43 patients (ratio of male to female= 24:19) received surgeries for venous malformations of the head and neck. Twenty-nine patients had undergone surgery only, five patients received sclerotherapy after surgery, and nine patients received surgery after preoperative sclerotherapy. In postoperative evaluations, the result was excellent in 24 patients, good in 18 patients, and poor in one patient. Four patients experienced a recurrence of lesions with lagophthalmos, drooping of the corner of the mouth, partial wound necrosis, and scar widening found in one patient each.ConclusionBecause the head and neck region is the most exposed area in the body, more active implementation of surgical treatments with or without sclerotherapy is essential to reduce the functional and cosmetic impairments associated with venous malformations.

A modified proximally based nail bed flap approach for benign subungual bone tumors in the distal phalanx.

Complete tumor removal and damaged nail bed repair are critical factors that determine the success of subungual tumor excision. We examined a modified proximally based nail bed flap approach for excision of subungual bone tumors of the distal phalanx and present cases where this approach was used, along with postoperative functional and cosmetic outcomes. Twenty-four benign subungual bone tumors, identified from 23 patients (9 males and 14 females), were included in this study. All patients underwent tumor excision by the modified proximally based nail bed flap approach. Pain was assessed using a numeric rating scale, and cosmesis was self-assessed using a visual analog scale preoperatively and 1 year postoperatively. We measured sensation of the involved digit tip, relative to opposite-side sensation, using static and moving two-point discrimination and Semmes-Weinstein monofilament tests 1 year postoperatively. Lastly, we assessed postoperative nail deformities and tumor recurrence as potential surgical complications. Mean pain severity and cosmesis were significantly improved 1 year postoperatively. There were no significant differences in the digit tip sensation between the involved and the opposite-side digits 1 year postoperatively. We observed one case of tumor recurrence and four cases of postoperative nail deformities. The modified proximally based nail bed flap approach showed satisfactory functional and cosmetic outcomes. This approach enables a low rate of recurrence after removal of benign subungual bone tumors in the short term and cosmetically superior nail bed repair. Level of evidence: Therapeutic, IV.

A study on effectiveness of selective nerve root blocks in lumbar radiculopathies

Background: Low back pain is one of the most common reason for visit to a doctor & young age morbidity, disability, work absenteeism constitutes almost 40% of all occupational risk factors. Lumbar radiculopathy with or without neurological deficits are managed with variety of conservative or operative measures, and generally recovers well. Selective nerve root blocks (SNRBs) having diagnostic or therapeutic use, are popular and advantageous to avoid uncertain potential surgical complications. Aim of this study is to establish therapeutic efficacy and evaluate complications following selective nerve root blocks.Materials and Methods: The present study was a randomized, prospective study carried out from August 2016 to March 2018, on 50 cases satisfying the inclusion criteria following complete assessment, received selective nerve root blocks. Patients were assessed for pain relief and disability reduction.Result: Evaluated with VAS and ODI score. In study, immediate improvement of VAS score was 33.04%, 45.3% at 1week, 59.8% at 4weeks and 66.9% after 3months. Reduction in ODI score was 37.7% till 1week, 54.8% till 4weeks and 66.8% till 3months follow up periods.Conclusion: SNRB is an important, effective, less expensive and less invasive treatment modality to provide lasting therapeutic benefit, allowing the patient to participate in life style modifications, physiotherapies and early resumption of routine activities.

Transplantation of adult-size kidneys in small pediatric recipients: A single-center experience.

RTx of adult-size kidneys presents a size mismatch in small pediatric recipients, and there are potential surgical complications. This study reveals the outcomes of intra- and extraperitoneal RTx in low-weight (less than 15kg) pediatric recipients. We studied 51 pediatric patients weighing less than 15kg who received a living-related donor renal transplant between 2009 and 2017. The intraperitoneal (group A, n=24) and extraperitoneal (group B, n=27) approaches were compared. In group A, the mean age, Ht, and weight were 3.8±1.6years, 83.7±6.5cm, 10.5±1.8kg; in group B, 5.0±1.9years, 95.3±7.3cm, and 13.0±1.4kg. Single renal artery grafts (21 in group A and 16 in group B) and double renal artery grafts (three in group A and 11 in group B) were performed. Of the patients with double renal artery transplants, one in group A and six in group B underwent ex vivo arterial reconstruction. The eGFR (mL/min/1.73m2 ) at 1-week post-transplant in group A was significantly higher than that in group B; the eGFRs at 4weeks post-transplant did not differ. One graft was lost in group B because of vascular thrombosis. Post-transplant complications included ileus and transplant ureteral stenosis. There was no significant difference in 5-year graft survival rate (group A 100%, group B 91.7%). Both transplant approaches are feasible to adapt to a size mismatch between the adult-size donor kidney and low-weight pediatric recipients.

A concept for a 3D-printed patient-specific stereotaxy platform for brain biopsy -a canine cadaver study-

The treatment of intracranial lesions requires a precise diagnosis with subsequent identification of an adequate therapeutic approach. Stereotactic tumor biopsy may be considered the safest neurosurgical procedure in terms of anticipated results and potential surgical complications. The aim of the present paper was to demonstrate a new method of stereotactic biopsy, based on a patient-specific 3D printed platform in dogs.The system was tested on two canine cadavers, a small (Shih Tzu) and a large (Labrador) breed. Imaginary biopsy targets were defined in a superficial (caudate nucleus) and a deep (piriform lobe) position. Based on 3 Tesla MRI, individualized stereotactic platforms were designed using a semi-automatic approach, and manufactured additively using ABS M30. A pre- and intra-operative CT was performed to compare the planned vs. the realized needle position for precision analyses of the procedure.The target points varied with a precision between 0.09 mm and 0.48 mm. Manufacturing time required 480 to 700 min per platform.The presented patient-specific stereotactic system seems a suitable instrument for application in small animal neurosurgery. In particular, the implementation of relevant stereotactic data may help performing the procedure in rapid sequence and with higher precision than currently-used systems. Required adjustments and adaptions to the respective anatomical conditions are omitted and make the procedure reliable and safe.

Management of Subtrochanteric Proximal Femur Fractures: A Review of Recent Literature.

Subtrochanteric femur fractures are an uncommon injury in orthopedics, but when they are encountered they may present difficulties in management. The purpose of this paper is to examine the recent literature on the epidemiology, classification, initial evaluation, and definitely treatment for these injuries. These will assist the physician to determine the optimal treatment strategy and avoid potential surgical complication.

Radical Surgery in Advanced Cervical Cancer Patients Receiving Bevacizumab-Containing Chemotherapy: A "Real Life Experience".

Platinum-based chemotherapy plus bevacizumab is the new standard of care in stage IVB cervical cancer (CC) patients. In this new scenario, radical surgery could be offered in selected cases with an optimal clinical response. Potential surgical complications related to previous bevacizumab treatment have never been described before in this type of setting. This is a single-institutional retrospective study on women with CC who received radical pelvic surgery after platinum-based chemotherapy (platinum-taxol) plus bevacizumab. Between April 2016 and September 2017, 15 patients with CC underwent radical surgery after bevacizumab-containing chemotherapy (platinum-taxol) at the Division of Gynecologic Oncology, Catholic University of the Sacred Heart in Rome, Italy.All patients received at least 3 cycles of treatment. Fourteen (93.4%) patients underwent radical hysterectomy, whereas 1 patient received pelvic anterior exenteration. Median operating time was 290 minutes (range, 220-400), and estimated blood loss was 250 mL (range, 50-1500). Median time of hospitalization was 5 days (range, 2-21). Pathological response in the cervix was complete in 3 cases and microscopic in 1 patient (26.7%). Intraoperative complications occurred in 3 cases: 2 vascular injuries and 1 ureteral injury. Three patients (20.0% of the whole series) experienced grade 3 complications.At last follow-up (median time, 9 months), the median overall survival is 13 months (range, 6-31): 7 (46.7%) women were free of disease, 8 (53.3%) patients progressed, and 3 of them died of disease. Radical surgery can be performed in women with CC previously treated with a bevacizumab-containing regimen.

A Novel Bridging Strategy for Patients Undergoing Emergent Non-Cardiac Surgery with a Recent Coronary Stent.

IntroductionNot infrequently, patients undergoing dual antiplatelet therapy for a recent cardiac stent develop a need for a non-cardiac surgery. Most of these surgeries can be delayed while the antiplatelet treatment is stopped and normal platelet function returns in order to avoid potential surgical complications and excessive bleeding. However, there are a number of patients who require urgent surgery where the procedure cannot be postponed. To date, no agents have been proven to bridge the patient off dual-antiplatelet therapy.MethodsA 46-year-old man was admitted to the hospital with an acute anterior wall myocardial infarction. He was urgently taken to the catheterization lab where he was found to have a totally occluded proximal left anterior descending coronary artery (LAD). He was successfully stented with a drug-eluting stent of the LAD, but subsequently developed a sarcoma 2 months later that required urgent surgery. The novel direct-acting, reversible P2Y12 receptor inhibitor cangrelor was used to bridge this patient followed by ongoing antiplatelet treatment, allowing surgery for the removal of a soft tissue sarcoma.ResultsCangrelor was successfully used to bridge a patient with a recent stent placement and current antiplatelet treatment undergoing the removal of a soft tissue sarcoma.ConclusionThis case report demonstrates the use of a novel, now currently available, short-acting antiplatelet agent that can be used for bridging patients undergoing non-cardiac surgery who had a recent myocardial infarction and stent placement.

Design and Evaluation of Haptic Constraints for Laparoscopic Instrument Handling.

Learning and mastering laparoscopic skills is an involved and complicated process, especially in the case of pediatric surgery due to extremely fragile tissues and small spaces. Given these constraints, precise, controlled, and gentle laparoscopic tool motions are essential. Proper handling and ergonomics of laparoscopic tool handling are often overlooked when training novice surgeons. Novice surgeons tend to overgrip the tool, which may lead to applying excessive amounts of force and potential surgical complications. We have developed two constraint mechanisms to enable proper tool handling: one mechanism is a passive kinematic constraint which physically prevents the user from over-gripping the tool. The second mechanism operates under dynamic resistive control. An elastic silicone membrane, secured by a hard plastic clip to the finger loop of the laparoscopic tool, actively resists the user's overgrip. These constraint devices were tested in a series of human subject studies with novice learners. The resulting data shows a both a significant reduction in over-grip and overall task completion time when using the passive constraint. The left index, right middle, and right ring fingers are shown to have the least amount of over-grip, as well as the lowest time of non-contact with the tool, indicating the importance of these fingers for laparoscopic tool control.

Quantitative analysis of the safety and efficacy of microvascular decompression for patients with trigeminal neuralgia above and below 65 years of age

For medically-refractory trigeminal neuralgia (TN), microvascular decompression (MVD) is the first-line treatment, and has demonstrated the greatest efficacy and durability. However, due to potential surgical complications, a bias may exist against performing MVD in elderly patients. We sought to determine through a quantitative analysis whether MVD in the elderly is a safe and effective procedure for TN. We completed a Pubmed/SCOPUS literature search up to 12/2016 for eligible studies on MVD for TN. Only research articles with age stratification of results were included. In this quantitative analysis, we analyzed the data for the six articles identified in the literature comparing MVD for a group of patients ≥65 years with an elderly group <65 years. A total of 1483 were included. 455 patients were ≥65 years (mean 70.8 years, range 65–89 years) and 1028 patients were <65 years (mean 53.4 years, range 19–64 years). Composite mean follow-up time was 51.6 months for the elderly group, and 55.1 months for the young group. Following MVD, each group had 1 mortality (p = 0.43). There were 21 serious morbidities in the elderly group (4.62%) and 32 in the young group (3.11%) (p = 0.11). In addition, 15 patients (1.46%) in the elderly group and 24 patients (1.62%) in the young group experienced a cerebrospinal fluid leak (p = 0.23). TN recurrence rates 9.23% in the young group and 13.33% in the elderly group (p = 0.070). In conclusion, for properly-selected surgical candidates, MVD should not be ruled out on the basis of age ≥65 years.

Evaluation of the bone anatomy of the anterior region of the mandible using cone beam computed tomography

Abstract Background Hemorrhages, mouth floor edema and tongue elevation are complications related to surgical procedures in the anterior region of the mandible. Objective The objectives of this study were to evaluate the presence and location of the lingual foramen in the anterior region of the mandible and to evaluate mandibular morphology using cone beam computerized tomography (CBCT). Material and method The mandible’s morphology and the location, diameter and height of the lingual foramina were analyzed using the midline and the mental foramen as references, in 278 CBCT. Result 88% of the sample had a midline lingual foramen, totaling 408 foramina, with a mean diameter of 0.93 mm. Foramina in the lingual region between the midline and mental foramina were detected in 75% of the sample, with a mean diameter of 0.807 mm. There was no positive correlation between the presence of lingual foramina in the lateral or in the midline regions (r = -0.149; p = 0.013). In the midline region, the type I mandibular shape was predominant (96%), and type III was predominant in the lateral regions. Conclusion Considering the prevalence of these structures and their clinical relevance in potential surgical complications, it is important to carefully analyze the anterior region of the mandible during surgical planning.

Update on upper eyelid blepharoplasty

Upper eyelid blepharoplasty is among the most frequent oculoplastic surgical procedures. It is often performed as one of the first esthetic surgical interventions by surgeons of various disciplines. While there is ahigh probability of happy and satisfied patients postoperatively, there are important potential surgical complications that should be prevented. This requires acareful preoperative, perioperative and postoperative approach. This synopsis presents the basic considerations concerning upper eyelid blepharoplasty to serve as practical surgical guidelines. This is acompendium of important preoperative, perioperative and postoperative contemplations derived from the medical literature, expert opinions and the authors' personal experiences. Careful examination and documentation of eyelid and periorbital findings are required in order to identify additional pathologies to dermatochalasis and plan the surgical approach accordingly. There is atrend in the literature and in expert opinions away from large tissue resection and towards volume preserving and volume reconstructing surgical techniques. Correct placement of the skin fold as well as maintaining lid symmetry are crucial points in order to achieve anatural appearance and patient satisfaction. Careful and realistic patient information, state of the art surgery including cautious tissue resection and correct symmetrical formation of the skin fold as well as postoperative assistance and availability increase the likelihood of satisfied patients after blepharoplasty.

Intelligent Planning for Laser Refractive Surgeries

Refractive error is one of leading ophthalmic diseases for both genders all over the world. Laser refractive correction surgery, e.g., laser in-situ keratomileusis (LASIK), has been commonly used worldwide. The prediction of surgical parameters, e.g., corneal ablation depth, depends on the doctor’s experience, theoretical formula and surgery reference manual in the preoperative diagnosis. The error of prediction may present a potential surgical risk and complication. Being aware of the surgery parameters is important because these can be used to estimate a patient’s post-operative visual quality and help the surgeon plan a suitable treatment. Therefore, in this paper we discuss data mining techniques that can be utilized for the prediction of laser refractive correction surgery parameters. It can provide the surgeon with a reference for possible surgical parameters and outcomes of the patient before the laser refractive correction surgery.

Hemisferectomía funcional: seguimiento a largo plazo en una serie de cinco casos

Functional hemispherectomy consists in palliative epilepsy surgical procedure usually performed in patients with pharmaco-resistant epilepsy and hemispheric syndromes. It is based on the neural disconnection of the affected hemisphere with preservation of the vascular supply. To analyze long-term prognosis and safety of the hemispherectomies performed in our institution. Retrospective analysis collecting the following variables: age, gender, age of epilepsy onset, type of seizures, etiology, age of epilepsy surgery, prognosis and potential surgical complications. All patients had a minimum of five years of follow up. Five patients (60% females) underwent hemispherotomy between 1999 and 2010. Age of epilepsy onset was 36 months and time of evolution until surgery was 7 years. The most frequent type of seizures were simple motor seizures with secondary generalization (n = 5). Three patients remained seizure free persistently after surgery and another patient had a more than 90% improvement. Time of follow up was 13 years. One patient suffered a bacterial meningitis without sequelae. Six years after surgery a patient suffered hydrocephalous requiring ventriculoperitoneal shunt. Functional hemispherectomy constitutes an effective method to treat patients with pharmaco-resistant epilepsy, extensive unihemispheric pathology and seizures limited to that hemisphere. Late complications may occur thus long-term follow-up is needed.

Coarctation of Aorta With Valvular Heart Disease: A Hybrid Approach

We describe the management of three patients with coarctation of aorta (COA) associated with valvular heart disease. All the three patients underwent initial balloon dilatation following which they underwent surgical correction of the valvular pathology. Staged approach in such diseases has better outcome in terms of morbidity and mortality. Both single-stage and two stage operations can be used. As surgical correction of COA is frequently associated with potential complications, we adopted the staged approach for better results. Background COA with valvular heart disease is generally a rare combination. Both these entities require correction which can be done simultaneously or as staged procedure. Objective To study the outcome of staged procedures in such patients. Materials and Methods We managed 3 patients with COA associated with valvular heart disease. Results All the 3 patients had uneventful post operative recovery. At the time of discharge gradients were Conclusion Simultaneous surgical correction of COA along with valvular heart disease is associated with potential surgical and anesthetic complications. Hence staged procedures are preferred if the anatomy of coarctation is feasible for endovascular correction.

Office-Based Needle Arthroscopy: A Standardized Diagnostic Approach to the Knee

Surgical knee arthroscopy is among the most commonly performed procedures in the United States. The decision to treat is often based on clinical examination and magnetic resonance imaging. Equivocal results frequently require patients to undergo surgical arthroscopy, exposing the patient to inherent risks and potential surgical complications. Office-based needle arthroscopy provides an alternative approach to visualizing intra-articular anatomy and pathology in real time. The purpose of this article is to provide a standardized diagnostic approach to needle arthroscopy of the knee.