Preoperative Period Research Articles

Assessing the outcomes of subinguinal microsurgical varicocelectomy: pulling technique compared to the conventional method.

The positive effect of varicocelectomy on sperm parameters (sperm morphology, concentration, motility) and fertility and pregnancy rates has been proven. Although various techniques have been defined for varicocele treatment, varicocelectomy with the pulling technique was first defined in 2017. The aim of this retrospective study is to compare the effectiveness and reliability of subinguinal microsurgical varicocelectomy with the "pulling" technique and conventional subinguinal varicocelectomy. A total of841 patients who underwent subinguinal microsurgical varicocelectomy using the "pulling" or conventional technique between January 2015 and January 2024 were examined retrospectively. Patients with missing and/or inaccessible data, who were using empirical treatments, were excluded from the study. Demographic data, laboratory and imaging results, and peroperative and postoperative 3rd and 6th month semen analysis results of the remaining 231 patients were evaluated. The mean age of 231 patients who underwent varicocelectomy was 31.1 ± 5.5years. 202 of the patients (87.4%) were primary infertile. Conventional technique was applied to 124 (53.7%) of the 231 patients, while pulling technique was applied to 107 (46.3%) patients. No significant difference was found between the demographic and clinical data of the patients. The median number of ligated pampiniform plexus veins in the patient group who underwent pulling technique was statistically significantly less than that in the patient group that underwent the conventional method (4 vs 5, p = 0.03). In all patients who underwent varicocelectomy, semen volume, spermatozoa concentration, and progressive motile spermatozoa proportion increased significantly in the postoperative period (p = 0.002, p = 0.006, p = 0.001, respectively). No significant change was found in the proportion of spermatozoa with normal morphology (p = 0.617). The changes in semen analysis data from the preoperative period to the third and sixth postoperative months after varicocelectomy with conventional and pulling techniques were compared. No significant difference was found between the two techniques. Subinguinal microsurgical varicocelectomy with the "pulling" technique may be a safe and effective treatment option with fewer vein ligations compared to the standard surgical method.

Cirrhosis associated with increased complications and healthcare utilization following total shoulder arthroplasty

Introduction Cirrhosis is a known risk factor for morbidity and mortality following surgical procedures and has been associated with increased complications, hospital length of stay (LOS), and cost of admission following total joint arthroplasty. However, a paucity of literature exists evaluating the effect of cirrhosis on postoperative outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to evaluate the short-term outcomes following elective primary TSA in patients with cirrhosis compared to matched controls. Methods The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients with a diagnosis of cirrhosis ( n = 627) were matched in a 1:1 proportion to patients who did not have cirrhosis. Bivariate statistical analyses were performed to compare preoperative demographic and comorbidity data, postoperative outcomes, and hospital utilization metrics between the two groups. Following Bonferroni correction, an alpha value of 0.003 defined significance. Results Patients with cirrhosis exhibited higher rates of postoperative medical and implant-related complications following primary TSA, including acute renal failure (6.3% vs 1.1%: p < 0.001), urinary tract infection (3.5% vs 0.6%; p < 0.001), transfusions (3.0% vs 0.2%; p < 0.001), acute respiratory distress syndrome (2.9% vs 0.2%: p = 0.002), surgical site infection (2.0% vs 0.2%: p = 0.001), dislocation (2.1% vs 0.0%: p < 0.001), and prosthetic loosening (1.5% vs 0.0%; p = 0.002). These patients also exhibited higher rates of all-cause complications (32% vs 9.2%: p < 0.001) and mortality (1.5% vs 0.0%; p = 0.002) within 180 days of surgery and had an increased cost of admission ($24,633 vs $18,500; p < 0.001) and LOS (2.6 vs 1.5 days; p < 0.001). Conclusion Patients with cirrhosis were found to have increased risk of medical and surgical complications, higher costs, and longer LOS following TSA. These findings can assist orthopedic surgeons in developing strategies in the preoperative period to mitigate complications in this at-risk patient group. Level of evidence Level III – Retrospective cohort study.

A prospective study of the effect of laparoscopic splenectomy and azygoportal disconnection on liver synthetic function and liver cirrhosis

Objective: To investigate the effect of laparoscopic splenectomy and azygoportal disconnection (LSD) on liver synthesis and development of liver cirrhosis. Methods: This is a prospective case series study.The clinical data of liver cirrhotic patients with portal hypertension who received LSD at the Department of Hepatobiliary Surgery of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from September 2014 to January 2016 were included. This study analyzed the diameter of the portal vein, the velocity of portal blood flow, the routine blood parameters, the liver function, the synthetic proteins of liver (antithrombin Ⅲ (AT-Ⅲ), protein S, protein C), and the serum content of liver fibrotic markers(collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase). Repeated measures ANOVA was used for comparison between multiple groups, and least significance difference was used for post-hoc multiple comparison. Results: A total of 106 patients were included in the study, including 70 males and 36 females, aged (51.8±9.8) years(range: 28 to 75 years).Compared with the preoperative results, the diameter of portal vein and the velocity of portal vein decreased after surgery (F=14.03, 12.15, respectively, both P<0.01). Compared with the preoperative results, the total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score and classification were improved (F=17.96, 56.01, 66.63, 35.83, 33.49, and 27.50, respectively, all P<0.01), and the AT-Ⅲ, protein S, protein C,collagen type Ⅳ, procollagen type Ⅲ, laminin and hyaluronidase levels were also improved (F=47.87, 36.26, 18.02, 2.79, 14.58, 44.35, and 14.38, respectively, all P<0.01). Compared with the preoperative period, the diameter of portal vein was reduced from the first week to the 24th month after surgery (t=5.45 to 9.39, all P<0.01). Compared with the preoperative period, the velocity of portal vein blood from the first week after surgery to the 24th month after surgery was decreased (t=4.02 to 8.43, all P<0.01). Compared with the preoperative period, routine blood parameters (white blood count, hemoglobin, platelet count), liver function (total bilirubin, albumin, prothrombin time, international normalized ratio, Child-Pugh score), liver synthetic protein (AT-Ⅲ, protein S, protein C) and liver fibrotic markers (collagen type Ⅳ, procollagen type Ⅲ, laminin, hyaluronidase) were improved to varying degrees at the 24th month after surgery (t=-20.46 to 11.93, all P<0.01). Conclusion: Preliminary findings show that LSD can reduce portal vein pressure, restore blood cell number, and improve liver synthesis function and the degree of liver fibrosis in patients with portal hypertension in liver cirrhosis.

Blood laboratory parameters can predict relapse-free survival of patients with advanced squamous cell lung cancer and adenocarcinoma

The aim of the work was to study the relationship between the concentration of cells and proteins in the blood of patients with Stage III squamous cell lung cancer (SCLC) and adenocarcinoma (AC) before surgical treatment and the duration of the relapse-free period after tumor resection to develop prognostic models for relapse-free survival in these diseases. Using logistic regression equations, the models incorporated variables included cytokeratin 19 fragment antigen 21-1 (CYFRA 21-1) concentration, the proportion of lymphocytes expressing the C-X-C motif chemokine receptor 1 (CXCR1), and monocytes expressing the C-X-C motif chemokine receptor 2 for SCLC. For AC, the models included the CYFRA 21-1 concentration, lymphocytes expressing the CXCR1 receptor, and the eosinophil-to-monocyte ratio. These models can predict the probability of tumor recurrence based on measurements of blood parameters in the pre-operative period, with a prediction efficiency of 87.7% for SCLC and 89.0% for AC.

Evaluation of the Impact of Functional Hypogonadism in Body Composition and Weight Loss in Men Undergoing Bariatric Surgery.

Obesity and hypogonadism are linked in a vicious cycle: low testosterone levels favor weight gain and adiposity induces hypogonadism. We aimed to investigate if low levels of testosterone in pre-operative of bariatric surgery impacts postoperative weight loss (WL) and body composition (BC). A prospective, observational study included male patients who qualified for bariatric surgery. Patients underwent clinical evaluation, hormonal evaluation and assessment of body composition measured by dual energy X-ray absorptiometry in both pre-operative and postoperative periods. We evaluated 36 patients, mean age 37.1±10.2 years, weight 131.3±14.3 kg and BMI 44.4±4.95 kg/m2. Considering total testosterone (TT) <264 mg/dL and free testosterone <6.5 mg/dL (when TT was borderline), hypogonadism was found in 18 patients (50%). Among the 20 patients who underwent the total evaluation in the pre-operative period, the excess of weight was greater in hypogonadal men (58.1±1.,6 vs 51.1±13.5 kg) as well as the body fat percentage (BFP) (46.1±4.3 vs 45.1±4.5%), however, without statistical significance. After surgery, TT returned to normal in all hypogonadal patients, and patients showed similar WL and BFP. Regarding the relationship between visceral fat and testosterone, it was observed a moderate correlation between the change in TT levels and the reduction in visceral fat. Although frequently observed, low levels of TT in the pre-operative period do not impact post-surgical outcomes, in terms of WL or BC. The normalization of TT levels in the postoperative period is probably due to the gonadal function improvement provided by the WL after bariatric surgery.

Оценка результатов хирургического лечения детей с деформацией позвоночника и грудной клетки с применением навигационной установки

Idiopathic scoliosis (IS) accounts for 2% to 5% of cases in orthopedic pathology. Surgical treatment of severe, rigid IS forms remains an important and pressing problem. The purpose of this research was to evaluate the efficacy and safety of the surgical correction method of severe kyphoscoliotic deformity of the thoracic spine in children with the use of the active optical three-dimensional computer navigation technology. Materials and methods used: a retrospective, single-center cohort study of the surgical treatment results of 30 children aged 14 to 18 y/o with grade 4 IS was conducted with V (C) Level of Evidence. The inclusion criteria were as follows: the scoliotic deformity magnitude of over 80°, simultaneous discopphysectomy, mobilizing dorsal osteotomies and deformity correction with a multi-support metal structure. Results: the scoliosis magnitude in the preoperative period was 100.5° (min 82; max 130; SD=13.21), after surgery 27° (min 4; max 47; SD=12.53). Pairwise comparison demonstrated statistically significant differences (p=0.013). The kyphosis magnitude in the preoperative period was 39.4° (min 3; max 61; SD=16.61), after surgery - 37.7° (min 3; max 49; SD=6.59). The abovementioned data comparison demonstrated the absence of statistically significant differences (p=0.154). The vertebral rotation magnitude in the preoperative period was 35.5° (min 20; max 60; SD=8.73), after surgery - 20° (min 9; max 32; SD=6.54). When comparing the results, statistically significant differences were revealed (p=0.010). Neurological disorders after the surgical interventions were not noted in patients included in the study. Conclusion: the use of the method of surgical correction of severe kyphoscoliotic deformity of the spine from a combined approach using active optical three-dimensional computer navigation technology allows the complete correction of the spinal deformity, indirectly improving both the shape and the size of the chest and restoring the frontal and sagittal profiles of the spine.

Perioperative Management of Hemophilia A: An Uncommon Inherited Blood Disorder

Hemophilia A is a rare hematological disorder caused by an inherited X-linked factor VIII deficiency. It can be responsible for significant perioperative bleeding with fatal consequences if not diagnosed and managed correctly in the preoperative phase. We report the case of a 6-month-old infant scheduled for a cure for bilateral inguinal hernia. During the pre-anesthetic consultation, given that the child was uncircumcised and had not yet reached walking age, a blood workout was made, which revealed a prolonged aPTT with a patient/control aPTT ratio of 3.27, without hemorrhagic signs. An activity work-up of clotting factors showed less than 1% of normal levels of active clotting factor VIII. Thus, the diagnosis of a severe form of hemophilia A was made. Recombinant factor VIII was administrated in the preoperative period, with an activity factor VIII control over 60%. The surgical procedure was uneventful, with minimal intraoperative bleeding. Our case emphasizes the importance of prophylactic treatment and a proper pre-anesthetic assessment, which are essential to establish an appropriate management strategy and avoid complications, most of which are fatal.

Effect of submucosal dexamethasone on postoperative pain, swelling and trismus after periodontal surgery: a randomized clinical study.

The aim of this study is to evaluate the effectiveness of submucosal 8mg (2 mL) dexamethasone (DEX) on postoperative pain, swelling, chewing efficiency, trismus, healing, and discomfort after periodontal flap surgery (PFS). In this randomized controlled split-mouth study, 25 patients underwent PFS in the mandible, whereby postoperative, submucosal DEX was injected to the surgical field to the test group and submucosal normal saline was applied to the control group. Pain was evaluated using the Visual Analogue Scale (VAS) and the 101-point numeric rate scale in the first 8h after PFS and on the 2nd, 3rd, 4th, and 7th days, whereas swelling, chewing efficiency, trismus, healing, discomfort and analgesic consumption were evaluated preoperatively on the 1st, 2nd and 7th days. In the intergroup evaluation, the VAS-7th hour value of the test group was lower than the control group(p < 0.05). On the 1st day, it was observed that there was less swelling and more chewing efficiency in the test group than in the control group(p < 0.05). When time-dependent changes were examined, the decrease in mouth opening due to trismus in the control group was greater than that in the test group on the 1st and the 2nd days compared to the preoperative period(p < 0.05). Finally, postoperative healing, discomfort, and analgesic consumption were similar between groups. Within the limits of this study, the submucosal DEX may be an effective protocol in the management of pain, swelling, and trismus after PFS. Our findings shed light on the possible effects of DEX after PFS. This study was registered on ClinicalTrials.gov (NCT06119893).

REABILITAÇÃO E AUTOCONFIANÇA: O PAPEL DA FISIOTERAPIA NA VIDA DE AMPUTADOS DE MEMBROS INFERIORES

Physiotherapy plays a fundamental role in the rehabilitation and adaptation process of amputees. By providing physical, emotional and educational support to amputees, multidisciplinary work enables patients to recover by promoting lost functionality until they adapt to the physical and emotional transformations and are able to live fully and actively again. In addition, the physiotherapeutic approach is multifaceted and involves several techniques, including gait training, strengthening exercises, manual therapy and psychological support. These interventions are essential to help patients overcome the challenges related to the use of the prosthesis and the recovery of functionality. Thus, the main objective of this study is to analyze the importance of physiotherapy in the rehabilitation of patients using lower limb prostheses, highlighting the gains in mobility, adaptation to the prosthetic device and quality of life, emphasizing as a focus of the problem what are the impacts of physiotherapy on the rehabilitation of lower limb amputees in terms of mobility, adaptation to the prosthesis and quality of life? This study is characterized as a mixed approach (quantitative and qualitative) field research, carried out in a rehabilitation center specialized in lower limb prostheses in Brazil. This mixed approach allowed a more comprehensive analysis, combining numerical data with subjective perceptions of the participants. Thus, continuous and personalized physiotherapy monitoring based on measurements and field research reiterated the beneficial benefits of adaptation to the prosthesis in the lower limbs when considering the fit, comfort and functionality, and when taking into account the gait training and the established strengthening exercises. Transtibial and femoral amputation has represented not only a surgical intervention, but also a long readaptation treatment, that is, a milestone in the lives of affected individuals, which brings significant challenges. Rehabilitation begins in the preoperative period, progresses to the prosthesis fitting, and continues beyond these events, being crucial for the functional/emotional recovery of patients. Understanding the various stages of treatment and having a comprehensive rehabilitation plan are essential factors for promoting a new quality of life, which is possible for amputees, as demonstrated in the evaluations completed by patients portrayed in the various graphs representing responses to the questionnaires applied. The aim is therefore to carry out continuous and personalized physiotherapy monitoring to promote significant improvements in mobility, self-confidence and quality of life of amputee patients who use lower limb prostheses; and through treatment, a key factor for successful adaptation to the prosthesis, to facilitate the return to daily activities and promote greater functional independence. The research should also demonstrate improvements in the emotional well-being of patients, with a reduction in symptoms of depression and anxiety when considering the necessary psychological monitoring.

Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

Fluid therapy is an integral component of perioperative management. In light of emerging evidence in this area, the Perioperative Quality Initiative (POQI) convened an international multiprofessional expert meeting to generate evidence-based consensus recommendations for fluid management in patients undergoing surgery. This article provides a summary of the recommendations for perioperative fluid management of surgical patients from the preoperative period until hospital discharge and for all types of elective and emergency surgery, apart from burn injuries and head and neck surgery. Where evidence was lacking, recommendations for future research were generated. Specific recommendations are made for fluid management in elective major noncardiac surgery, cardiopulmonary bypass, thoracic surgery, neurosurgery, minor noncardiac surgery under general anaesthesia, and critical illness. There are ongoing gaps in knowledge resulting in variation in practice and some disagreement with our consensus recommendations. Perioperative fluid management should be individualised, taking into account the type of surgery and important patient factors, including intravascular volume status and acute and chronic comorbidities. Recommendations are made for further research in perioperative fluid management to address important gaps.

A STUDY TO DETERMINE THE SHORT TERM OUTCOME OF INFRAINGUINAL BYPASS FOR CRITICAL LIMB ISCHEMIA

Introduction: Critical limb ischemia is defined as persistent, recurring ischemic rest pain requiring opiate analgesia for at least 2 weeks, or ulceration or gangrene of the foot or toes and ankle systolic pressure lower than 50 mm Hg or toe systolic pressure lower than 30 mm Hg. CLI is a clinical diagnosis and it should be confirmed early and objectively through ABI, toe systolic pressure or transcutaneous partial pressure of oxygen (TcPO2). Once the diagnosis is confirmed, the goals of treating CLI are to relieve ischemic pain, heal ischemic ulcers, prevent limb loss, improve patient function and QOL and prolong survival. Revascularization will help to achieve these goals. The aim of the study is to assess the outcome of infra-inguinal bypass surgery in all PVD patients who presented to our General Surgery department with CLI. Objectives: To assess the following in CLI after infra-inguinal bypass surgery: 1) Wound healing 2) Limb salvage 3) Self assessed degree of ambulation 4) Primary patency of graft-using arterial doppler Methods: This is a single directional cohort study conducted in 48 patients who presented to Amala General Surgery Department with critical limb ischemia, who underwent infra-inguinal bypass surgery with reversed saphenous vein graft. PVD patients with CLI were assessed preoperatively. Periodic assessment was also done during postoperative period at 1 month and 6 months. Primary graft patency was checked at 6 months using arterial doppler. These patients were monitored closely during the pre-operative period, during surgery and postoperative period. They were also followed up at 1 and 6 months. The study duration is 18 months, from January 2018 to June 2019. Results and Discussion: From January 2018 to June 2019, 48 patients (37 males, mean age of 65 years) underwent infrainguinal bypasses (37 femoropopliteal, 11 femorodistal) for CLI (12 Fontaine III and 36 Fontaine IV).There was no perioperative mortality. The mean duration of hospitalization was 10.542 with standard deviation of 3.2809.Wound healing observed at 1 month is 39.58%, which was increased to 77.08 % at the end of 6 months (Mc Nemar Test p value=0.0001).Limb salvage attained at the end of 6 months is 87.5%.Ambulatory status of the patients were assessed at the end of 1 month after surgery and only 2% were ambulatory outdoors, 90 % were ambulating indoors and 8% were non-ambulatory. Total ambulatory status post-surgery (indoor and outdoor combined), came around 92% at 1 month. At 6 months post-surgery, 19 % of patients were ambulating outdoors, 60 % were ambulating indoors and 21 % were non-ambulatory. Total ambulatory status at 6 months (indoor and outdoor combined) post-surgery came around 79 % (Mc Nemar Test p value = 0.001) and primary patency of the graft at 6 months for our cohort is 79.2%. Conclusion: This Study includes 48 patients with CLI who has undergone infrainginal bypass with reversed saphenous vein graft. 87.5% limb salvage, 77.08% wound healing at 6 months, 79% was ambulatory status at 6 months and 79.2% primary graft patency were attained.. 7 out of 8 CLI patients treated surgically has limb salvage and good functional status.

Effectiveness of Virtual Reality Glasses on Surgical Fear and Anxiety in Patients Before Open-heart Surgery: A Double-blind Randomized Controlled Trial

PurposeFear and anxiety in open-heart surgery patients can adversely affect their physiological well-being and recovery. Although virtual reality glasses (VR-G) have been advanced for preoperative anxiety management, their effectiveness specifically for open-heart surgery patients remains under-researched. This study aims to evaluate the efficacy of watching a video through VR-G on surgical fear and anxiety levels of patients undergoing open-heart surgery. DesignA randomized controlled and double-blind study. MethodsIn total, 90 patients were randomly assigned to the VR-G intervention group or control group. On the surgery morning, intervention group patients watched a 360-degree video with nature sounds through VR-G before being transferred to the operating theater. The surgical fear and anxiety levels of the patients were evaluated at three stages using the Surgical Fear Questionnaire and Visual Analog Scale-Anxiety: initial evaluation in the morning, second evaluation before being transferred, and third evaluation in the waiting room of the operating theater. FindingsThe surgical fear level of the intervention group at the third evaluation was significantly lower than the control group (P < .000). There was no significant difference between the anxiety levels of the study groups (P > .05). ConclusionsWatching a 360-degree video with nature sounds through VR-G is an effective intervention in reducing surgical fear levels of patients before undergoing open-heart surgery. Use of VR-G interventions may be a practical and fast-resulting nursing strategy to manage patients’ surgical fear in the preoperative period. RegistrationNCT06165861

Arthroscopic ligament debridement combined with tendon repair benefits lateral collateral ligament lesions in recalcitrant lateral epicondylitis patients: A retrospective comparative study

BackgroundUntreated lateral collateral ligament (LCL) lesions in recalcitrant lateral epicondylitis (RLE) may cause residual pain and progressed to elbow instability. However, there is not enough research on the effect of arthroscopic treatment of combined LCL degenerative lesions without instability in RLE patients. The purpose of this study was to 1) evaluate the clinical and radiological results of RLE patients with LCL degenerative lesions without instability who received arthroscopic LCL débridement and ECRB repair, and 2) compare clinical outcomes between RLE patients with LCL degenerative lesion and those without, which received ECRB repair alone. MethodsA retrospective study was performed in which 31 RLE patients with LCL degenerative lesions without instability, who underwent arthroscopic LCL débridement with shaver and radiofrequency combined with ECRB repair with suture anchor arthroscopically between September 2014 and September 2022, comprised the LCL group. The control group (N=31) was matched 1:1 for age (+/- 5 years), sex, involved side, hand dominance, body mass index (BMI), working status, duration of symptoms, steroid/ platelet-rich plasma (PRP) injections and follow-up time. 31 matched RLE patients without LCL lesions, who underwent arthroscopic ECRB repair with suture anchor alone. The visual analog scale (VAS), the Patient-Rated Tennis Elbow Evaluation (PRTEE), the Mayo Elbow Performance Score (MEPS) and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire were evaluated and compared between two groups at preoperative and follow-up periods (at 3, 6, 12 months follow-up). The time duration of back to work was also compared between two groups. Magnetic resonance imaging (MRI) in LCL group were collected. ResultsThere were no significant differences in any clinical outcome at each follow-up time between the two groups(P>0.05 for all). There were no significant differences in time duration of return to work between LCL group and control group (9.4±3.0 weeks vs 8.9±3.4 weeks; p=0.529). There were 26 patients showed abnormal MRI signal of LCL in LCL group preoperatively. At 12 months follow-up, none of them showed abnormal MRI signal. Additionally, there was no complication found in LCL group at the 12 months follow-up. ConclusionIn patients with RLE and degeneration of an intact LCL without instability, débridement of the LCL lesion while repairing the ERCB does not seem to impair outcomes in short-term follow-up when compared to patients with RLE treated by repair of the ERCB with intact LCLs.

Risk factors and prognostic analysis of vitreous cavity opacification after silicone oil removal.

This study aims to investigate the risk factors for postoperative vitreous cavity opacification following pars plana silicone oil removal and its impact on prognostic visual acuity. A retrospective case-control study was conducted. A total of 66 eyes from 66 patients were enrolled in the study. On the first postoperative day, all patients underwent a scanning laser ophthalmoscopy to assess the turbidity of the vitreous cavity. 42.42% (28/66) were categorized as Grade 0, 36% (24/66) as Grade I, and 21% (14/66) as Grade II, based on the visibility of posterior pole blood vessels. Ordered multiple classification logistic regression analysis was employed to investigate the impact of surgical and baseline factors on the occurrence and severity of vitreous cavity opacification. The presence of high myopia and the intraoperative combination of epiretinal membrane peeling exhibited significant correlations with the development of postoperative vitreous cavity opacification (OR = 3.424, 95% CI 2.326-31.643, P = 0.023; OR = 3.612, 95% CI 1.263-14.676, P = 0.031, respectively). The best corrected visual acuity (BCVA) on the first day post-surgery was significantly reduced across all degrees of opacification compared to the preoperative level (p < 0.001). However, no significant difference in BCVA was detected between the preoperative period, one-week post-operation, and the last follow-up (P > 0.05). High myopia and intraoperative epiretinal membrane peeling may be associated with the development of more severe vitreous cavity opacity following silicone oil removal. This opacity generally resolves within one week post-surgery and does not appear to increase the risk of retinal re-detachment.

Personalized nutrition after discharge for pancreatic surgery: A study protocol.

Background: Pancreatic cancer has an increasing incidence and prevalence trend. Its prognosis is negatively affected by poor/altered nutritional status. Therefore, nutritional interventions play a critical/pivotal role at any stage. Despite being included in the prehabilitation items of Enhanced Recovery After Surgery (ERAS) protocols for pancreatic surgery, nutritional recommendations concerning early post-discharge period are lacking. Aim: To assess the acceptability and feasibility of a personalized and standardized food plan for patients following pancreatic surgery. A secondary aim is to determine if adherence to a personalized food plan is linked to improved postoperative outcomes. Methods: A prospective monocentric cohort study will be performed, including 180 patients undergoing pancreatic surgery. Body composition, nutritional, muscular, and hydro-electrolyte status will be assessed with bio-impedance analysis (BIA). Patients will receive a personalized nutritional plan after discharge for the following 45 days. Summary: Detailed nutritional indications have been formulated with broad consensus for the pre-operative (prehabilitation) and postoperative period. No previous study has specifically formulated or validated a nutritional intervention focused on the early post-discharge period. The results of this study might contribute to paving the way for future research and to broaden nutritional recommendations within the ERAS protocol.

Relationship between Preoperative Aspartate Aminotransferase-To-Platelet Ratio Index (APRI) and Gamma Glutamyl Transpeptidase (GGT) With Early Postoperative Jaundice Clearance and Native Liver Survival in Biliary Atresia

Purpose: The purpose of this study was to observe the relationship between Preoperative Aspertate Aminotransferase to Platelet Ratio Index (APRI) and Gamma-Glut amyl Transpeptidase (GGT) with early postoperative jaundice clearance and native liver survival that were operated in this institution. This study will help to identify the children who are likely candidates for early liver transplantation. Methods: This Observational Longitudinal study was conducted in the Department of Paediatric Surgery, BSMMU with the study period of24 months. Total 25 patients of biliary atresia were included in this study. 3 patients were excluded for death in early post operative period. All the patients were categorized according to age at operation as Group A(&lt;60 days), Group B(61-90 days), Group C(&gt;90 days). Measurement of serum bilirubin, Gamma-glutamyl transpeptidase (GGT), Aspertate aminotransferase to platelet ratio index (APRI)was done in preoperative and postoperative period (at 14-day, 1 month, 3 month and 6 month). Results: Total 3 patients were in Group A, 11 in Group B, 8 in Group C. Mean age atoperation was 86.2(±18.8SD) days and range was 57days to 140 days. Total 10 (45.5%) patient was jaundice free at 3 months after extended KPE and they were also remained jaundice free at 6 months while 12 (54.5%) patients had persistent jaundice. Mean preoperative Gamma-Glutamyl Transpeptidase (GGT) in persistent jaundice group was1208.42 (±855.82 SD) U/L and at 6 month after operation it was 711.3(±446.4 SD) U/L while in Jaundice free group preoperative Gamma-Glutamyl Transpeptidase (GGT) value was 900.40(±582.81SD) U/L and 6 month after operation it was 213.1(±89.1SD), (P=0.003) which is statistically significant. Mean preoperative APRI in persistent jaundice was1.95 (±1.52SD) and at 6 month it was 1.22(±0.53SD) while in Jaundice free group preoperative value was 1.10(±0.54SD) and 6 month of operation it was 0.39(±0.14SD), (P=0.004) which is statistically significant. ...

Spinal cord conduction disorders among neurological complications of degenerative dystrophic diseases of the cervical spine

Neurological complications of degenerative dystrophic diseases of the cervical spine depend on the involvement of functionally significant structures of the cervical spine in the pathological process. Current diagnostic techniques do not always accurately diagnose the involvement of these structures in the pathological process. This fact requires constant study and development of the novel methods for diagnosing degenerative dystrophic diseases of the cervical spine. In this regard, the purpose of the study is to identify various clinical and pathogenetic forms of the clinical course of degenerative dystrophic diseases of the cervical spine with the presence of manifestations of spinal cord conduction disorders based on the study of clinical symptoms and neuroimaging data of the cervical spine. The work is based on the study of clinical manifestations and magnetic resonance imaging of the cervical spine in the preoperative period in 457 patients with degenerative diseases of the cervical spine aged from 22 to 64 years. Among the patients, women predominated: 271 cases (59.3 %). Men made up 40.7 % (186 cases). Pathology in the form of a herniated intervertebral disc was detected at the levels of CV–CVI in 192 cases (42.0 %), CVI–CVII in 179 cases (39.2 %), CIV–CV in 45 cases (9.8 %), and CVII — ThI in 41 cases (9.0 %). Disc herniation at two levels simultaneously was diagnosed in 6.7 % (31 cases). The complex of patient examination included general clinical, neurological, and neuroimaging studies using MRI of the cervical spine. Damage to one of the functionally significant anatomical structures of the cervical spine occurred in 48.4 % (221 cases). Simultaneous involvement of two or more of these structures in the pathological process was diagnosed in 51.6 % (236 cases). Comparison of the neurological symptoms of the disease with magnetic resonance imaging data of the cervical spine makes it possible to diagnose five forms of degenerative dystrophic diseases of the cervical spine: 46.8 % — radicular, 1.5 % — myelic, 38.1 % — combined myelo-radicular, 7.5 % — combined radicular angiocerebral, and 6.1 % — combined myelo-radicular and angiocerebral. Notably, symptoms of spinal cord conduction disorders were identified in myelic, combined myelo-radicular, and combined myelo-radicular and angiocerebral forms. Due to the possible presence of a combination of spinal cord conduction disorders with symptoms of compression or irritation of the spinal cord roots and vertebral artery among neurological complications, the clinical manifestations of the disease acquire a significant polymorphism of symptoms, which is always associated with difficulties in diagnosing degenerative dystrophic diseases of the cervical spine. The identified clinical and radiological criteria for myelic, combined myelo-radicular, and combined myelo-radicular and angiocerebral forms of the course of this pathology of the cervical spine are decisive in the differential diagnosis with any other pathology of the spinal cord and for determining the feasibility of individual medical rehabilitation measures.

Controlled Study of Tanito Microhook (TMH) ab interno trabeculotomy combined with phacoemulsification for POAG/ PACG

Abstract. To evaluate the efficacy of Tanito Microhook (TMH) ab interno trabeculotomy combinated with phacoemulsification in treating primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). A retrospective comparative study was conducted to analyze 16 patients with primary open-angle glaucoma (POAG) who underwent phacoemulsification and TMH at the Second People's Hospital of Changshu from December 2021 to December 2022, along with 19 patients with primary angle-closure glaucoma (PACG) who underwent phacoemulsification, goniosynechialysis, and TMH. The follow-up period ranged from 12 to 24 months. The average preoperative IOP in the POAG group was (26.504.52) mmHg, and the average IOP was (18.001.67) mmHg at 12 months postoperatively, which was significantly lower than the preoperative value (P&lt;0.05). The average preoperative IOP in the PACG group was (34.1114.90) mmHg, and the average IOP was (18.670.87) mmHg at 12 months postoperatively, which was lower than the preoperative value (P&lt;0.05). The average number of anti-glaucoma drugs used by the POAG group before surgery was (2.060.21) types, and the average number of types was (0.180.10) at 12 months postoperatively, which was significantly reduced compared with the preoperative value (P&lt;0.05). The PACG group used an average of (1.890.15) kinds of anti-glaucoma drugs preoperatively, (0.680.17) kinds of drugs postoperatively, and the difference in the number of drugs used between preoperative and postoperative periods was not statistically significant (P&gt;0.05). The complete success rate of the POAG group was 81.3% (13/16), and the conditional success rate was 18.7% (3/16). The complete success rate of the PACG group was 47.4% (9/19), and the conditional success rate was 52.6% (10/19). The intraoperative and postoperative complications in the POAG group mainly included one case of hyphema in the anterior chamber and one case of transient intraocular pressure elevation, while the intraoperative and postoperative complications in the PACG group included one case of shallow anterior chamber after surgery, four cases of hyphema in the anterior chamber, and three cases of transient intraocular pressure elevation. No serious complications occurred in either group. The combination of TMH with cataract phacoemulsification and intraocular lens implantation demonstrates a safe and effective approach for treating POAG. Additionally, when combined with goniosynechialysis (GSL), it may be a safe and effective treatment for PACG. However, the long-term efficacy still requires further investigation through large-scale prospective controlled studies.

Twenty year outcomes following short-segment posterior instrumentation and fusion for thoracolumbar burst fractures: A retrospective observational study.

This study reviews the long-term efficacy of short-segment posterior instrumentation and fusion (SSPIF) in treating thoracolumbar burst fractures. Authors retrospectively reviewed the radiographic results of single-level thoracolumbar burst fractures treated by SSPIF. Vertebral body height and wedge angles were measured on the preoperative, postoperative, and follow-up radiographic images. The degree of pain and work ability was measured using the Denis scale. The analysis consisted of 12 patients with a mean age of 39.7 years (range 21-60) and a mean follow-up of 225.6 ± 20.3 months. There were significant differences among the wedge angles at preoperative and other periods of time, but there was no significant difference between the early postoperative and all other time periods afterwards (P < .001, P = .567, P = .937, P = .879). SSPIF effectively restored the anterior and middle vertebral body height and wedge angle deformities, and the improvement was maintained for almost 20 years after the surgery. Therefore, SSPIF is a safe and effective modality of treatment for thoracolumbar burst fractures.

AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation

Abstract Background The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate. The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely. Method The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications. Results There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2). A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation. Conclusion These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.