Preoperative CT Scan Research Articles

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables.

Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40-60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients. A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien-Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed. A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60-0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25. The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.

Increased risks of vertebral fracture and reoperation in primary spinal fusion patients who test positive for osteoporosis by Biomechanical Computed Tomography analysis

Background ContextWhile osteoporosis is a risk factor for adverse outcomes in spinal fusion patients, diagnosing osteoporosis reliably in this population has been challenging due to degenerative changes and spinal deformities. Addressing that challenge, biomechanical computed tomography analysis (BCT) is a CT-based diagnostic test for osteoporosis that measures both bone mineral density and bone strength (using finite element analysis) at the spine; CT scans taken for spinal evaluation or previous care can be repurposed for the analysis. PurposeAssess the effectiveness of BCT for preoperatively identifying spinal fusion patients with osteoporosis who are at high risk of reoperation or vertebral fracture. Study DesignObservational cohort study in a multi-center integrated managed care system using existing data from patient medical records and imaging archives. Patient SampleWe studied a randomly sampled subset of all adult patients who had any type of primary thoracic (T4 or below) or lumbar fusion between 2005 and 2018. For inclusion, patients with accessible study data needed a preop CT scan without intravenous contrast that contained images (before any instrumentation) of the upper instrumented vertebral level. Outcome MeasuresReoperation for any reason (primary outcome) or a newly documented vertebral fracture (secondary outcome) occurring up to 5 years after the primary surgery. MethodsAll study data were extracted using available coded information and CT scans from the medical records. BCT was performed at a centralized lab blinded to the clinical outcomes; patients could test positive for osteoporosis based on either low values of bone strength (vertebral strength ≤ 4,500 N women or 6,500 N men) and/or bone mineral density (vertebral trabecular bone mineral density ≤ 80 mg/cm3 both sexes). Cox proportional hazard ratios were adjusted by age, presence of obesity, and whether the fusion was long (four or more levels fused) or short (3 or fewer levels fused); Kaplan-Meier survival was compared by the log rank test. This project was funded by NIH (R44AR064613) and all physician co-authors and author 1 received salary support from their respective departments. Author 6 is employed by, and author 1 has equity in and consults for, the company that provides the BCT test; the other authors declare no conflicts of interest. ResultsFor the 469 patients analyzed (298 women, 171 men), median follow-up time was 44.4 months, 11.1% had a reoperation (median time 14.5 months), and 7.7% had a vertebral fracture (median time 2.0 months). Overall, 25.8% of patients tested positive for osteoporosis and no patients under age 50 tested positive. Compared to patients without osteoporosis, those testing positive were at almost five-fold higher risk for vertebral fracture (adjusted hazard ratio 4.7, 95% confidence interval = 2.2–9.7; p<.0001 Kaplan-Meier survival). Of those positive-testing patients, those who tested positive concurrently for low values of both bone strength and bone mineral density (12.6% of patients overall) were at almost four-fold higher risk for reoperation (3.7, 1.9–7.2; Kaplan-Meier survival p<.0001); the remaining positive-testing patients (those who tested positive for low values of either bone strength or bone mineral density but not both) were not at significantly higher risk for reoperation (1.6, 0.7–3.7) but were for vertebral fracture (4.3, 1.9–10.2). For both clinical outcomes, risk remained high for patients who underwent short or long fusion. ConclusionIn a real-world clinical setting, BCT was effective in identifying primary spinal fusion patients aged 50 or older with osteoporosis who were at elevated risks of reoperation and vertebral fracture.

Psoas muscle mass index as a predictor of long-term mortality and severity of complications after major intra-abdominal colorectal surgery – A retrospective analysis

Study objectiveDetermine if psoas muscle area measured in routine preoperative computed tomography scans (CT) can be used to identify patients at increased risk of adverse postoperative outcomes after major elective abdominal surgery. DesignRetrospective analysis of data from a single-centre cohort study conducted in York Hospital between the 1st August of 2015 and the 31st of august of 2020. SettingPreoperative clinic. Patients639 patients who attended the preoperative assessment clinic prior to major elective colorectal surgery and had an abdominal CT scan done up to 120 days before surgery. InterventionsNone. MeasurementsPsoas muscle area at the L3 level was measured in preoperative CT scans and normalised to patient height (psoas muscle index). The lowest sex-stratified tertile of psoas muscle index (PMI) was classed as sarcopenic.The primary outcome was 2-year mortality. Secondary outcomes included postoperative complications assessed using Clavien-Dindo graded major and minor complications, comprehensive complication index (CCI), and length of stay. Main resultsMultivariable regression analysis showed that sarcopenia was associated with 2-year mortality (aOR 1.79, 95% CI 1.03–3.10; p = 0.037) and survival at 2-years was significantly reduced in sarcopenic patients (log-rank test, p = 0.012). Sarcopenia was the only statistically significant predictor of major complications in multivariable logistic regression analysis (aOR 1.69, 95% CI 1.04–2.74, p = 0.034) and associated with an estimated increase of 16.6% in the comprehensive complication index (CCI) score of patients that had complications in multivariable linear regression analysis. Sarcopenia was not associated with length of stay. ConclusionsSarcopenia defined by psoas muscle mass is an independent predictor of 2-year mortality, major complications and severity of complications after major colorectal surgery and may be used for preoperative risk assessment.

Cortical screw placement with a spinous process clamp guide: a cadaver study accessing accuracy

Background and objectiveThe Cortical Bone Trajectory (CBT) technique provides an alternative method for fixation in the lumbar spine in patients with osteoporosis. An accuracy CBT screw placement could improve mechanical stability and reduce complication rates.PurposeThe purpose of this study is to explore the accuracy of cortical screw placement with the application of implanted spinous process clip (SPC) guide.Methods and materialsFour lumbar specimens with T12-S1 were used to access the accuracy of the cortical screw. The SPC-guided planning screws were compared to the actual inserted screws by superimposing the vertebrae and screws preoperative and postoperative CT scans. According to preoperative planning, the SPC guide was adjusted to the appropriate posture to allow the K-wire drilling along the planned trajectory. Pre and postoperative 3D-CT reconstructions was used to evaluate the screw accuracy according to Gertzbein and Robbins classification. Intraclass correlation coefficients (ICCs) and Bland–Altman plots were used to examine SPC-guided agreements for CBT screw placement.ResultsA total of 48 screws were documented in the study. Clinically acceptable trajectory (grades A and B) was accessed in 100% of 48 screws in the planning screws group, and 93.8% of 48 screws in the inserted screws group (p = 0.242). The incidence of proximal facet joint violation (FJV) in the planning screws group (2.1%) was comparable to the inserted screws group (6.3%) (p = 0.617). The lateral angle and cranial angle of the planned screws (9.2 ± 1.8° and 22.8 ± 5.6°) were similar to inserted screws (9.1 ± 1.7° and 23.0 ± 5.1°, p = 0.662 and p = 0.760). Reliability evaluated by intraclass correlation coefficients and Bland–Altman showed good consistency in cranial angle and excellent results in lateral angle and distance of screw tip.ConclusionsCompared with preoperative planning screws and the actually inserted screws, the SPC guide could achieve reliable execution for cortical screw placement.

Homogeneous Chronic Subdural Hematoma with Diverse Recurrent Possibilities.

Background: Evidence suggests that hyperdense (HD) chronic subdural hematomas (CSDHs) have a higher recurrence than hypodense (LD) chronic subdural hematomas. The value of mean hematoma density (MHD) has been proven to be associated with postoperative recurrence. The MHD levels in homogeneous CSDHs likely underestimate the risk of recurrence in HD homogeneous subtypes. Methods: This study investigated 42 consecutive CSDH cases between July 2010 and July 2014. The area of the hematoma was quantified to determine the MHD level using computer-based image analysis of preoperative brain CT scans. Results: In terms of the MHD distribution of the four types of CSDHs (homogeneous, laminar, separated, and trabecular), wide 95% CI (11.80-16.88) and high standard deviation (4.59) can be found in homogeneous types, reflecting a high variability in the MHD levels between cases (from low to high density). The categorization of homogeneous types into LD and HD (type five) displayed a minor standard deviation in the MHD levels for LD and HD subtypes (1.15, and 0.88, respectively). MHD values demonstrated concentrated distributions among the respective five types, compared to the four-type setting. Conclusions: In the current research, we provide a consideration that if LD and HD hematomas are separated from homogeneous CSDHs, the variability of the MHD quantification can potentially be reduced, thereby avoiding the possibility of undetected high-risk groups.

Factors associated with favorable visual outcome after surgery of clinoidal meningiomas

BackgroundThe anatomical relationship between clinoidal meningiomas and the optic nerve accounts for their frequent finding on visual disturbances. The goal of the surgery is to perform complete resection and obtain visual recovery. The aim of this study is to determine the factors associated with favorable visual outcome. MethodsWe recorded clinical (including ophthalmological), imaging and surgical data of all patients operated on for clinoidal meningiomas between 2010 and 2020 in 2 French neurosurgical departments and we analyzed their impact on visual outcome. ResultsA total of 34 patients were included. At 3–4 months after surgery, 23 patients (68%) had favorable visual outcome. Factors associated with favorable visual outcome were duration of ophthalmologic symptoms < 6 months, preoperative visual acuity > 0.5, absence of optic atrophy, meningioma in high signal intensity on T2-weighted or FLAIR MRI, absence of optic canal involvement and absence of bone hyperostosis on pre-operative CT scan. A soft tumor and a clear brain/tumor border were intra-operative factor associated with favorable ophthalmological outcome. ConclusionsIn clinoidal meningiomas, an early surgery should be performed to optimize visual improvement. Hyperintense lesion on T2-weighted/FLAIR preoperative MRI is correlated with a soft consistency which allows an easier surgery associated with a favorable visual outcome. Invasion of the optic canal and bone hyperostosis should reserve the visual prognosis.

Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant.

IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.

An Evolutionary Random Forest to measure the Dworak tumor regression grade applied to colorectal cancer

In order to optimize a patient’s cancer treatment, the prediction of the tumor’s response to a planned radiotherapy is vital. For patients with rectal cancer, the quality of life depends heavily on the surgery leaving some patients with a stoma or other problems. If we would be able to predict the response upfront, we would be able to personalize the treatment and therefore preserve the QOL as much as possible. The Dworak tumor regression grade is a typical diagnostic tool to assess the tumor response of colorectal cancer patients. However, the Dworak grade is determined by a pathologist by inspection of the tumor biopsy without a dedicated measurement instrument. The measurement of the Dworak grade in an automated way by using the pre-operative CT scans, is a challenge. In this paper, we propose a novel methodology to measure the Dworak grade based on a customized random forest.We created a new random forest based on the methods from Breiman and Ho. These methods are further enhanced by evolutionary computation. We give the results of both our new method and other classical classification methods and highlight that the choice of classifier and knowledge is crucial.We extracted 111 radiomic features from 141 patients with colorectal cancer, of which 97 bad and 44 good responders. The evaluation gave a 77.507% accuracy and the cross-validation used for validation, gave a 67.081% accuracy. Our results were the best compared with the some other classification methods showing the need of a new method.

Diverticulitis and Diverticulosis of the Appendix: A Case Series.

Introduction Diverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung's disease, cystic fibrosis and adult age, where some reports claim that they arealso associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitisand one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methods A total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied.The demographic details and clinicaldata including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. Results The study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptomswere right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. Conclusion Appendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula - this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.

Relating Metopic Severity to Mid-term Aesthetic Outcomes: A Machine Learning Approach

PURPOSE: Aesthetic deterioration after surgical treatment of metopic craniosynostosis may manifest as bitemporal hollowing (TH), lateral orbital retrusion (LOR), or frontal bone irregularities (FBI). Patients with these complications have reoperation rates of 18-46%. To date, there have been few longitudinal studies assessing the effect of pre-operative dysmorphology on aesthetic outcomes in this cohort. This study evaluates the relationship between metopic severity, including the use of CranioRateTM, a novel metopic synostosis severity measure, and mid-term aesthetic outcomes. MATERIALS AND METHODS: Patients with non-syndromic metopic craniosynostosis who underwent bi-frontal orbital advancement and remodeling (BFOAR) between 2012 and 2017 were reviewed. Metopic synostosis severity was determined based on pre-operative CT assessment of IFA and CranioRateTM. CranioRateTM is a machine learning algorithm trained to recognize morphologic features of metopic synostosis and generate quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Frontal and lateral photographs of patients with at least four years post-operative follow-up were assessed by attending craniofacial surgeons using masked three-rater aesthetic grading of clinical photos (n=39). Graders assessed Whitaker score as well as the presence of TH, LOR, FBI, or a ‘catch-all’ category of visible irregularities. Binary logistic regression was used to assess predictors of TH, LOR, FBI, and VI. Multinomial logistic regression was used to assess predictors of Whitaker classification. RESULTS: The average age at preoperative CT scan was 7.7 ± 3.4 months and the average age at BFOAR was 9.9 ± 3.1 months. The average MSS was 6.3 ± 2.7 out of 10 and average CMD was 200.4 ± 44.7 out of 300. Average IFA for the cohort was 116.8° ± 13.8° (range 93° - 138°). The average time from operation to aesthetic assessment was 5.4 ± 1.0 years (range 4.1 – 7.8 years). ‘Any visible irregularity’ was present in 87.2% (n = 34) of patients, temporal hollowing in 76.9% (n = 30), frontal bone irregularities in 61.5% (n = 24), and lateral orbital retrusion in 20.5% (n = 8). Most patients received a median Whitaker classification of II (61.5%, n =24), followed by class III (23.1%, n = 9). There was a significant association between MSS and age at CT scan, with younger patients having more severe metopic severity scores (r = -.451, p = .004). Similarly, MSS and IFA were negatively associated, with a higher MSS correlating to a lower IFA (r = -.371, p = .034). MSS was found to be the only independent predictor of visible irregularities (OR 2.18, B = .780, p = .024). Decreased age at surgery (OR, 1.08; 95% CI, 1.05 to 2.6, p = .002) and increased length of follow up (OR, 1.59; 95% CI, 1.59 to 3.54, p <.001) were significantly associated with a worse median Whitaker score. No impact of surgical technique, including parietal bone graft use or interpositional bone graft size, was demonstrated (p > .05 for both). CONCLUSION: More severe cases of metopic craniosynostosis show increased rates of cumulative aesthetic dysmorphologies. Measures of pre-operative metopic severity are predictive of mid-term aesthetic outcomes.

Preoperative CT Scanning in Hemodynamically Stable Thoracoabdominal Gunshot Wounds: Outcomes from a Long-Term Single-Institution Pilot Study

INTRODUCTION: Emergent operative exploration is the standard of care for penetrating thoracoabdominal trauma. With advanced CT imaging, preoperative scans may be obtained efficiently for operative planning. This study aims to determine if CT imaging before operative exploration for hemodynamically stable thoracoabdominal gunshot wound injuries adversely affects patient outcomes. METHODS: This was a retrospective chart review was performed between 2014 and 2019 at an urban trauma center to identify hemodynamically stable patients who suffered penetrating thoracoabdominal gunshot wound and had operative intervention. Patients were then stratified into 2 groups: (1) those who received CT imaging before operative intervention, and (2) those who went straight to the operating room (OR). RESULTS: A total of 113 patients were identified. A total of 64 (56.6%) received CT imaging, and 49 (43.4%) went straight to the OR (Table). There were no differences in mortality (p = 0.25), hospital length of stay (p = 0.17), ICU length of stay (p = 0.14), ventilator days (p = 0.37), and postoperative complications (p > 0.05). Time spent in the OR and time from emergency department to end of operation were similar between groups (p = 0.051). Multivariable analysis demonstrated risk factors for time greater than 150 minutes includes Injury Severity Score, age, sex, and blood product administration. Multivariate regression displayed that for each unit of PRBC given, OR time were more likely to increase (p < 0.001). Table. - Patient Demographics and Outcome Data Demographics Overall Sample (N = 113) Group A: CT Scan before Going to the Operating Room (N = 64) Group B: Straight to the Operating Room (N = 49) p Value Age, y, mean (SD) 25.57 (7.60) 24.30 (6.74) 27.22 (8.38) 0.042 Race, % (White, Black, other, unknown) 8.0, 86.7, 1.8, 3.5 3.1, 92.2, 1.6, 3.1 14.3, 79.6, 2.0, 4.1 0.175 Sex, % (male, female) 92, 8 90.6, 9.4 93.9, 6.1 0.530 Injury Severity Score, mean (SD) 16.95 (9.42) 16.34 (8.76) 17.73 (10.26) 0.220 Hospital days, mean (SD) 11.06 (8.12) 10.42 (7.87) 11.90 (8.44) 0.142 Ventilator days, mean (SD) 2.07 (4.15) 1.95 (4.65) 2.22 (3.43) 0.370 MTP activation, n (%) 31.9% 17.2% 51% <0.0001 Total number of blood products, mean (SD) 4.00 (6.24) 2.09 (3.26) 6.49 (8.11) <0.0001 Mortality, n (%) 0.9% 0% 2.0% 0.251 CONCLUSION: Obtaining a CT scan before operative intervention in hemodynamically stable patients with thoracoabdominal gunshot wound did not affect mortality, hospital length of stay, or ventilator days, indicating that obtaining CT scans before operative intervention may be safe in select patients. This pilot serves as the basis for an ongoing regional multi-institutional study.

Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection

The objective of this study was to evaluate the role of regional lymph node (LN) metastasis detected on preoperative CT and/or 18F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scans in the prediction of early tumor recurrence after curative surgical resection of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 137 patients who underwent upfront surgery with R0 resection of PDAC between 2013 and 2016. Regional LN metastasis was identified using two criteria: positive findings for regional LN metastasis on either preoperative CT or FDG-PET scans (LNOR), or on both preoperative CT and FDG-PET scans (LNAND). A total of 55 patients had early tumor recurrence within 12 months after curative resection. Univariable and multivariable Cox proportional hazard regression analysis showed that preoperative carbohydrate antigen 19–9 (CA19-9) levels, preoperative locally advanced status, and regional LN metastasis (both LNOR and LNAND criteria) were significant risk factors for early recurrence. Positive LNOR and LNAND showed significantly poorer recurrence-free survival compared to negative regional LN metastasis groups (p = 0.048 and p = 0.020, respectively). Compared with the LNAND criteria, the LNOR criteria provided higher sensitivity (22.4% vs. 15.5%, p = 0.046) and a higher negative predictive value (61.9% vs. 59.8%, p = 0.046). The LNOR definition provided more sensitive and accurate performance in diagnosing preoperative regional LN metastasis.

V-044 ABDOMINAL WALL RECONSTRUCTION OF A POST-HEMIPELVECTOMY INCISIONAL HERNIA: AT THE LIMITS OF WHAT IS POSSIBLE

Abstract Incisional hernias in patients with bone defects are a real challenge. There is very little evidence of how to repairing them. Clinical Case 56-year-old patient. He underwent a left external hemipelvectomy for osteosarcoma of the iliac bone in 2012 and a left nephrectomy in 2013. The patient presents an inguinal and right thigh root bulge of progressive growth with severe pain and limited mobility. In the past month, he was unable to walk. Physical examination: inguinal defect, defect in the right thigh root and a large lateral bulge. Preoperative CT scan: atrophy of the left abdominal musculature, absence of the left hemipelvis, left hip prosthesis with a pseudocapsule, a large lumbar defect, and a large defect in the inguinal area. Surgery Dissection of hernia sacs and retroperitoneal/preperitoneal dissection was performed, cranially to the retrodiaphragmatic area, medially to the linea alba, posteriorly to the spine and caudally to the pelvis. The abdominal wall is reconstructed with a polyglycolic acid and trimethylene carbonate mesh to reinforce the abdominal wall and a large polypropylene mesh that envelops the visceral sac and is fixed to the right pubis and the pseudocapsule of the hip prosthesis. In the postoperative period, the patient presented pulmonary thromboembolism and surgical wound infection. He was discharged on the 17th postoperative day. One year after surgery, the patient is asymptomatic, and has a continent wall with discrete lateral bulging. Preperitoneal dissection makes it possible to solve very complex wall defects, even with very large bone defects.

OC-036 DEVELOPMENT OF NOVEL IMAGE-BASED DEEP LEARNING MODELS (DLMS) TO PREDICT OUTCOMES IN ABDOMINAL WALL RECONSTRUCTION (AWR) WITH IMBALANCED DATA SETS

Abstract Aim The development of DLMs with imbalanced datasets represents a major challenge in the fields of artificial intelligence and surgery. The aim of this study was to develop and compare DLMs that predict mesh infection and pulmonary failure following AWR. Methods A prospectively maintained institutional database was used to identify AWR patients with preoperative CT scans. Standardized axial cuts of CT scans were rendered to DLMs. Conventional DLMs (CDLM) were developed two-class training system (i.e., learns negative and positive outcomes). CDLMs were compared to DLMs that were developed using a Generative Adversarial Network Anomaly (GANomaly) framework, which utilizes image augmentation and anomaly detection. The primary outcomes were receiver operating characteristic (ROC) values for predicting mesh infection and pulmonary failure. Results CT scans from 510 patients were utilized (10,004 images). Mesh infection and pulmonary failure occurred in 3.7% and 5.6% of patients, respectively. The CDLMs were less effective than GANomaly for predicting mesh infection (ROC 0.61 vs 0.73, p&amp;lt;0.01) and pulmonary failure (ROC 0.59 vs 0.70, p&amp;lt;0.01). Although the CDLMs had higher accuracies/specificities for predicting mesh infection (0.93 vs 0.78, p&amp;lt;0.01/0.96 vs 0.78, p&amp;lt;0.01) and pulmonary failure (0.88 vs 0.68, p&amp;lt;0.01/0.92 vs 0.67, p&amp;lt;0.01), they were substantially compromised by decreased model sensitivity (0.25 vs 0.68, p&amp;lt;0.01/ 0.27 vs 0.73, p&amp;lt;0.01). Conclusions Compared to CDLMs, GANomaly DLMs showed improved performance on imbalanced datasets, predominantly by increasing model sensitivity. Understanding patients who are at-risk for postoperative complications can improve risk stratification.

P-025 USE OF PREOPERATORY PNEUMOPERITONEUM FOR GIANT INGUINOESCROTAL HERNIA TREATMENT WITH LOSS OF DOMAIN. A GREAT RESOURSE

Abstract Introduction Recently, the use of neoadjuvant therapies such as preoperative progressive pneumoperitoneum has favored the treatment of large ventral hernias with loss of domain. Despite this, there are only few cases described in the literature. Materials &amp; Methods We present a case of a 69-year-old male affected by giant inguinoescrotal hernia of years of evolution with loss of domain. A preoperative CT scan with volumetric quantification is performed where giant left inguinal hernia with mesenteric fat content, small intestine, sigma, descending colon, as well as splenic angle of the colon, with a relationship between the volumes greater than 0.67. (VSH of 11,502cc and VABD of 17,061cc). We decided to perform preoperative progressive pneumoperitoneum. In the following 15 days up to 8L are administered without complications. Results Surgical repair of the inguinal hernia is performed according to the Lichtenstein technique modified by the size of the hernial sac with evidence of unstructured but intact structures of the inguinal canal. Placement of self-adhesive ProGrip TM retroaponeurotic mesh is performed with attachment of this to the inguinal ligament and pubis. After surgery, the patient presented a good postoperative recovery without complications, without evidence of recurrence more than 6 months after surgery. Discussion The use of prehabilitating techniques in patients affected by large hernias can reduce the morbidity and mortality of patients, with the less aggression. In our case it allowed us to completely reduce all the hernia contents without visceral injury and perform an anatomical repair, which would not have been possible without this resource.

V-010 LAPAROSCOPIC TAPP APPROACH OF A GRYNFELLT HERNIA

Abstract Aim To describe our laparoscopic transabdominal preperitoneal approach of a Grynfellt hernia. Material &amp; Methods A female patient 69 years of age with no previous medical history came to our consultation with a chronic right lumbar bulge that produced local pain and discomfort. Preoperative CT scan showed a primary lumbar hernia with a defect estimated at 11cm. Laparoscopic approach seemed feasible and was accepted. Results The patient was placed on a left decubitus with the OR bed at a 45° angle. 3 trocars were used, one slightly lateral of the umbilicus for the camera, and for triangulation a subcostal 5mm and an 11mm trocar in the left flank. We started opening the peritoneum and performing preperitoneal space dissection. The hernia sac was identified and its contents were reduced. We closed the defect using a monofilament absorbable barbed suture with a running stitch. Once the defect was closed, we placed a medium-weight polypropylene mesh in a 3D “taco” configuration covering the defect with sufficient overlap. Both the mesh and the peritoneum closure were done using cyanoacrylate glue. No complications occurred and discharge was the next day. Conclusions Primary lumbar hernias are rare. Symptomatic hernias should be treated as they can lead to pain, discomfort, and a decrease in quality of life. Laparoscopic TAPP is a safe and simple way to access and repair these hernias, allowing an adequate space of dissection that permits the placement of a mesh tension-free with sufficient overlap, with a quick recovery time and minimal morbidity.

Ретроспективный анализ результатов оперативного лечения пациентов с остеохондральными повреждениями блока таранной кости

Introduction Differences in the reported results lead to the lack of comprehension of whether the size of osteochondral lesion of talar dome is too big for successful usage of arthroscopic microfracturing and osteochondral autologous transplantation would be more preferrable. Aim To elicit the rate and causes of poor results after using two most common methods of operative treatment of patients with osteochondral lesions of the talus (OCLT) for elaboration of indications for surgical method of choice for this category of patients. Materials and methods This was a retrospective study that included analysis of archive data and subsequent examination of 80 patients (80 ankle joints), who underwent treatment for symptomatic OCL of the talus from 2014 to 2020. Mean time from the operation to examination was 20.5 ± 19.8 months. Results A significant increase in the results of FAOS, AOFAS and VAS scales after operative treatment were observed, as well as a significant decrease in lesion sizes (р &lt; 0.05). Overall patient satisfaction and intensity of preoperative pain syndrome showed strong positive correlation with the sizes of lesions on preoperative CT scans, especially with relative sizes. The data analysis revealed the borderline values of relative OCLT sizes, thus allowing us to divide the results of treatment into predictably poor and predictably good. Discussion The elicited borderline values of relative OCLT sizes as well as elicited correlations can be used to specify indications for choosing the method of operative treatment for this group of patients, but further prospective evaluation should be carried out. Conclusion The borderline values of the relative OCLT sizes were found that allow for division into predictably good and poor treatment outcomes.

Coxa valga and antetorta increases differences among different femoral version measurements : potential implications for derotational femoral osteotomy planning.

To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in young patients with hip pain. First, femoral version was measured in 50 hips of symptomatic consecutively selected patients with hip pain (mean age 20 years (SD 6), 60% (n = 25) females) on preoperative CT scans using different measurement methods: Lee et al, Reikerås et al, Tomczak et al, and Murphy et al. Neck-shaft angle (NSA) and α angle were measured on coronal and radial CT images. Second, CT scans from three patients with femoral retroversion, normal femoral version, and anteversion were used to create 3D femur models, which were manipulated to generate models with different NSAs and different cam lesions, resulting in eight models per patient. Femoral version measurements were repeated on manipulated femora. Comparing the different measurement methods for femoral version resulted in a maximum mean difference of 18° (95% CI 16 to 20) between the most proximal (Lee et al) and most distal (Murphy et al) methods. Higher differences in proximal and distal femoral version measurement techniques were seen in femora with greater femoral version (r > 0.46; p < 0.001) and greater NSA (r > 0.37; p = 0.008) between all measurement methods. In the parametric 3D manipulation analysis, differences in femoral version increased 11° and 9° in patients with high and normal femoral version, respectively, with increasing NSA (110° to 150°). Measurement of femoral version angles differ depending on the method used to almost 20°, which is in the range of the aimed surgical correction in derotational femoral osteotomy and thus can be considered clinically relevant. Differences between proximal and distal measurement methods further increase by increasing femoral version and NSA. Measurement methods that take the entire proximal femur into account by using distal landmarks may produce more sensitive measurements of these differences.Cite this article: Bone Jt Open2022;3(10):759-766.

Calcaneus Fracture Fixation: Assessing the Adequacy of the Sinus Tarsi Surgical Fixation Technique

Category: Trauma; Hindfoot Introduction/Purpose: Intra-articular calcaneus fractures are devastating injuries, and life-changing for patients that develop post-traumatic arthritis, a common outcome. Debate exists as to whether non-operative symptomatic management, or operative treatment, best manages these injuries, partially due to the difficulty of achieving anatomic subtalar joint reduction. Traditionally, a large, lateral extensile incision has been used, plagued with soft tissue complications quoted at rates upwards of 22%. A less invasive incision, the limited sinus tarsi approach (ST-a), has become more common, proposed to lower complication rates without compromising radiographic nor clinical outcomes. The primary purpose of this study was to objectively assess the adequacy of joint reduction along with the associated soft tissue complications using the ST-a and compare it to the standards of the lateral extensile incision. Methods: All calcaneus fractures fixated through the ST-a at our institution were reviewed between March 2017 and Jan 2020. Inclusion criteria included the presence of preoperative and post-operative X-rays and CT scans. Primary outcomes were radiographic measures, including Bohler's angle on X-ray, and the maximum summative step deformity at the posterior facet of the subtalar joint in all three planes on CT scan. Secondary clinical outcomes included soft tissue complications (infection, delayed wound healing) and the need for reoperation. Results: Thirty patients were included with an average age of 48.9 +- 13.9 (n=24 males, n=6 females) and Sanders classification of 2.8. Pre-operatively, the mean Bohler's angle and summative posterior facet step deformity were 5.8 +- 16.6° and 17.2 +- 9.3mm, respectively. These radiographic outcomes were significantly improved postoperatively to 27.2 +- 7.7° and 5.3 +- 2.9mm. Soft tissue complication rates were half that of the comparative extensile approach. Conclusion: Using the ST-a, radiographic joint reduction was acceptable compared to literature standards. There was subsequently a lower incidence of soft tissue complications than previously quoted for the lateral extensile approach. Although technically more demanding, the ST-a is a valuable method for the treatment of intra-articular calcaneal fractures and should be considered when planning operative management of intra-articular calcaneus fractures.

Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position? : short-term radiological results.

The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation.Cite this article: Bone Joint J2022;104-B(10):1110-1117.