Preoperative Preparation Of Patients Research Articles

A Decade of Insights into Bilateral Adrenal Masses: Epidemiology, Clinical Profiles, and Therapeutic Approaches

Bilateral adrenal masses (BAMs) are rare, accounting for 10-15% of adrenal masses. Their diagnostic and therapeutic approaches differ from those of unilateral masses. This study aimed to analyze the epidemiological, clinical, paraclinical, and therapeutic profiles of BAMs. It is based on a retrospective analysis of 30 patient records from the Endocrinology, Diabetology, and Nutrition Department at CHU Hassan II in Fez, over a 12-year period. The average age of the patients was 53 years, with a male predominance (53.3%). BAMs were symptomatically revealed in 46.7% of cases, incidentally discovered in 23.3%, identified during tumor staging in 20%, and associated with a genetic syndrome in 10% of cases. Clinical examination revealed hypertension in 23.3% of patients, an abdominal mass in 10%, signs of adrenal insufficiency in 10%, hypercortisolism in 6.67%, and hyperandrogenism in 16% of cases. Biological assessment showed elevated urinary or plasma metanephrine derivatives in 9 patients, hypercortisolism in 3 patients, adrenal insufficiency in 3 patients, 11-β-hydroxylase enzyme block in 3 patients, and primary hyperaldosteronism in 1 patient. Adrenal computed tomography (CT) was performed in 29 patients. A staging workup, including PET scan, was requested in 20% of cases. MIBG scintigraphy was performed in 23.3% of patients. The investigations revealed 53% of BAMs were secreting and 47% non-secreting. There were 9 cases of pheochromocytomas, including 5 associated with a syndrome (3 MEN2a, 1 MEN2b, 1 VHL), 8 cases of non-secreting adenomas, 3 cases of congenital adrenal hyperplasia due to 11-β-hydroxylase enzyme block, 2 cases of adrenal metastases, 2 cases of adrenocortical carcinoma, 2 cases of adrenal cysts, 1 case of Conn’s adenoma, 1 case of cortisol-secreting adenoma, 1 case of primary adrenal lymphoma, and 1 case of adrenal hematoma. Treatment included the management of emergencies and preoperative preparation for patients eligible for surgery. Bilateral adrenalectomy was performed in 33.3% of patients, and unilateral adenectomy in 1 case of cortisol-secreting adenoma. Medical treatment was initiated in 16.6% of cases, and palliative treatment in 13.33% of cases. Surveillance alone was implemented in the remaining 33.3%. Prognosis depends on the type of adrenal mass, with outcomes marked by the death of one case of malignant adrenocortical carcinoma and one case of primary adrenal lymphoma. Our study, involving 30 cases of BAMs, highlights their clinical, biological, radiological, therapeutic, and prognostic characteristics. Data in the literature are limited compared to unilateral adrenal masses. Future larger studies are desirable for optimal management.

Intraoperative hemodynamic instability during laparoscopic adrenalectomy for pheochromocytoma without preoperative medical preparation compared with nonsecreting tumor

BackgroundControl of hemodynamic features during adrenalectomy for pheochromocytoma is recommended to minimize perioperative cardiovascular complications. However, episodes of intraoperative hemodynamic instability have been observed during adrenalectomies with other indications than pheochromocytoma. The objective of this study was to compare the hemodynamic instability score assessed during unilateral adrenalectomy for pheochromocytoma without preoperative medical preparation to hemodynamic instability score in nonsecreting tumor. MethodsThis was an observational study with prospective intraoperative hemodynamic data collection (every 20 seconds) and retrospective analysis. ResultsDuring the study period, 60 consecutive patients (30 pheochromocytomas vs 30 nonsecreting tumors) were included with a median number of data collections during total procedure time of 318 (interquartile range, 257–388). Mean cumulative intraoperative time outside the target blood pressure range expressed as a percentage of total procedure time was 13.3% vs 6.8% for systolic blood pressure >160 mm Hg (P = .01) and 2.4% vs 2.8% for mean arterial pressure <60 mm Hg (P = ns), respectively. The median hemodynamic instability score during total procedure time was 33 (interquartile range, 27–43) and 20 (interquartile range, 11–26) in the pheochromocytoma and nonsecreting tumor group, respectively (P < .01). Hemodynamic instability score were similar in patients with compared with without long-term antihypertensive treatment in each patient group (P = ns). The mean length of hospital stay was 2.0 ± 1.5 days, and 30-day morbidity rate was 6.6% (4/60) with no significant difference observed between both groups. ConclusionAlthough intraoperative hemodynamic instability remains greater in the pheochromocytoma group without preoperative medical preparation, both groups have similar hypotensive episodes. These data highlight the need to better understand the role of preoperative medical preparation in pheochromocytoma patients.

THE ROLE OF PATIENT SCREENING AND RISK STRATIFICATION IN THE PREOPERATIVE PREPARATION OF PATIENTS WITH ANTERIOR ABDOMINAL WALL HERNIAS

Introduction. Lifestyle, poor physical condition, bad habits, malnutrition and adverse psychological factors reduce the body's resistance to overcome the physiological stress of surgery. Abdominal wall hernia repair is one of the most common surgical operations. A high body mass index, smoking, diabetes and immunosuppression are risk factors for the development of postoperative hernia, and in the case of its surgical correction, these factors significantly worsen the perioperative prognosis. Assessing the risk of serious complications and death during the perioperative period is crucial for the patient. Aim. To assess the role and necessity of patient screening and risk stratification in the complex of preoperative preparation of patients with anterior abdominal wall hernias. Materials and methods. In the research took part 91 patients who underwent surgical treatment of abdominal wall hernias. They were divided into 3 groups according to the type of anesthesia (general, neuraxial and fascial blocks of the abdominal wall). The analysis was carried out according to comorbidity, the presence of lifestyle risks, the risk of cardiovascular complications (LI index), the risk of anesthesia according to the ASA (American Society of Anesthesiologist's) scale and the risk of thromboembolic complications according to the Caprini scale, factors that affect the frequency postoperative nausea, vomiting and their prevention. Results and discussions. It was determined that the most common concomitant pathology in patients of 1, 2 and 3 study groups was arterial hypertension. Ischemic heart disease was most often observed in patients of group 3. Patients with a history of acute coronary syndrome dominated in the 3rd observation group. Patients were also noted to have diabetes mellitus, chronic obstructive pulmonary disease, and a history of impaired cerebral circulation. It was determined that many patients in the studied groups did not have additional risk factors, but all of them smoked and were overweight. Many patients had anesthetic risk according to ASA II or III. Patients received combined prophylaxis of postoperative nausea and vomiting. Conclusions. All groups were dominated by patients with an average and high risk of developing perioperative complications. Careful examination, identification of potential risk factors related to comorbidities and lifestyle are important to reduce the risk of complications in patients with abdominal wall hernias in the complex of preoperative preparation. Patients with a high risk of developing perioperative complications are recommended to choose neuraxial or regional anesthesia to prevent the development of postoperative complications.

Diagnosis and management of patients with pheochromocytoma/paraganglioma: Consensus of experts of the Russian Medical Society for Arterial Hypertension and the Multidisciplinary Group for the Diagnosis and Treatment of Neuroendocrine Tumors

The understanding of the nature of catecholamine-secreting tumors has changed significantly in recent years, affecting terminology and classification. Phaeochromocytoma/paraganglioma (PCC/PG) is a rare neuroendocrine tumor from chromaffin tissue that produces and secretes catecholamines. The incidence of PCC/PG is relatively low, with 2-8 cases per 1 million population per year; among patients with arterial hypertension, their prevalence is 0.2-0.6%. However, delayed diagnosis of PCC/PG is associated with a high risk of cardiovascular complications and a high mortality rate. The consensus presents the clinical manifestations of the disease with an emphasis on the course of arterial hypertension as the most common symptom in PCC/PG; modern ideas about the features of diagnosis, aspects of preoperative preparation, treatment, and follow-up of patients with PCC/PG are considered.

Functional and Radiological Outcomes Following Arthroscopic-Assisted Reduction and Fixation of Intra-Articular Distal Radius Fractures

Abstract Background: Intra-articular distal radius fractures (DRFs) are prevalent injuries that are usually difficult to treat and rehabilitate. These injuries may be associated with ligamentous injuries or intra-articular loose fragments. This study aims to assess the functional and radiological results of using arthroscopic-assisted reduction and fixation, which offers direct visualization of the joint surface, evaluation of intra-articular ligaments, and removal of loose fragments, potentially enhancing recovery outcomes. Patients and Methods: This quasi-experimental interventional study evaluated the functional and radiological outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs. The study included 26 patients who met specific inclusion criteria, and data collection involved preoperative assessment, patient preparation, operative measures, postoperative care, and follow-up evaluations using various scoring systems. Results: The range of motion showed a significant (P &lt; 0.001) improvement over the study duration: flexion increased from 42.81° ± 11.81° at 6 weeks to 54.23° ± 14.95° at 12 months, and extension improved from 56.88° ± 13.28° to 68.38° ± 13.43°. In addition, there was a significant reduction in disability and wrist-related symptoms, as indicated by improvements in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (6 weeks: 25.80 ± 15.85 vs. 12 months: 5.27 ± 8.61; P &lt; 0.01) and Patient-Rated Wrist Evaluation (PRWE) scores at the same follow-up intervals (6 weeks: 46.04 ± 22.49 vs. 12 months: 9.54 ± 12.03; P &lt; 0.001). Chronic illness and injuries like triangular fibrocartilage complex tears affected outcomes negatively. Age, ulnar variance, and palmar tilt were significantly correlated with DASH and PRWE scores. Conclusion: Arthroscopic-assisted reduction and fixation for intra-articular DRFs resulted in favorable outcomes regarding the range of motion, disability, and wrist-related symptoms. Further research and long-term follow-up studies are recommended to validate the positive outcomes of arthroscopic-assisted reduction and fixation for intra-articular DRFs, compare it with other surgical approaches, and assess its economic implications.

Syndrome of mutual buffering in patients with rectal fistulas in combination with diabetes mellitus

BACKGROUND: The results of surgical treatment of rectal fistulas (RF) directly depend on the accuracy of their diagnosis and the detection of a concomitant disease, such as diabetes mellitus (DM). To improve the results of surgical treatment, it is necessary to take into account the mutual influence of RF and DM, which can aggravate each other’s course.AIM: The study of the features of the course of RF against the background of DM and the assessment of their mutually aggravating influence.MATERIALS AND METHODS: 120 patients with RF were studied, which were divided into two groups: the main group (MG) included 60 patients with DM, the control group (CG) also included 60 patients without DM.RESULTS: In both groups, patients with transsphincteric RF dominated: 39 (65.0%) in the MG and 38 (63.3%) in the CG. Recurrent SPC prevailed in patients with DM (30.0% versus 15.0%), which indicates a more complex course of RF against the background of DM. It was found that in 17 (28.3%) patients, the stage of diabetes compensation after the formation of a fistula with a purulent cavity in the pararectal tissue passed into the stage of subcompensation and, due to an unstable decrease in blood sugar levels, it was necessary to replace tableted antidiabetic drugs with injectable insulin, which says about the deterioration of the course of diabetes against the background of chronic purulent inflammation in the pararectal tissue. The results of the study showed the presence of a direct correlation between the course of chronic paraproctitis and the stage of DM (r=0.50552, p&lt;0.001), which indicates the presence of a mutual burden syndrome.CONCLUSION: DM and chronic paraproctitis have a mutually aggravating effect on each other. Our results indicate the presence of a syndrome of mutual aggravation in patients with RF fistulas against the background of DM, which worsen the course of each other, which must be taken into account at the stages of diagnosis and preoperative preparation of patients to improve the immediate and long-term results of surgical treatment in this category of patients.

Efektivitas Pemberian Murottal Al-Qur’an Surat Ar-Rahman dan Relaksasi Nafas Dalam Terhadap Kecemasan Pasien Sectio Caesarea G1P0AO

Sectio caesarea (SC) is an important action to prevent the risk of death of the mother or baby during labor. However, the increasing number of operations raises concerns about the health and psychological impacts on mothers. Pre-operative anxiety is often experienced by CS patients and can have a negative impact on the labor process. This study used a case study with 1 intervention patient and 1 control patient. Nursing care is provided to G1P0AO pregnant women who experience anxiety before undergoing SC surgery. Intervention in the form of murottal of Al-Qur'an Surah Ar-Rahman and deep breathing relaxation was given for 45 minutes before the operation process. Scoring of reduced anxiety levels in intervention and control patients before and after therapy showed a significant effect. Patients who received the intervention experienced significant reductions in blood pressure and pulse, indicating decreased anxiety. In contrast, control patients had increased blood pressure and pulse, indicating increased anxiety. Conclusion: Murottal therapy of Al-Qur'an Surah Ar-Rahman and deep breathing relaxation significantly reduce anxiety levels in SC patients. Integration of these nonpharmacological therapies in clinical protocols may aid in the preoperative preparation of SC patients. Further research is needed to confirm these findings and explore their potential applications in other medical contexts.

Impact of comorbidity on surgical management of breast cancer in elderly patients.

e12596 Background: More than half of breast cancers are diagnosed above the age of 60 years, a quarter of which diagnosed with invasive breast cancer among those over 75 years of age. Treatment of breast cancer (BC) at this age remains a complex problem. Elderly patients often have various comorbidities that impose increased risks of complications with antitumor treatment. This leads to both excessive and insufficient treatment of BC. In patients over 75 years of age, an individual approach to treatment is recommended, taking into account their general health and life expectancy, the risk of death from breast cancer compared to other causes, as well as the advantages and disadvantages of treatment methods. Objective: To evaluate the influence of comorbidity on the risks of complications (early and delay) after surgical treatment in elderly and senile patients (pts). Methods: A retrospective analysis of the results of breast cancer treatment in 292 pts over 75 years of age, who underwent surgical treatment at the first stage in SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM from 2016 to 2019. The initial stages of breast cancer (I and IIA) were diagnosed in 257 (88.0%) pts, 35 pts (12.0%) has IIB and IIIA clinical stages. Radical mastectomy was performed in 171 (58.6%) cases, breast-conserving surgery was performed in the remaining 121 (41.4%). Forty-six (15.8%) patients had diabetes mellitus, 121 (41.4%) had cardiovascular disease, 36 (12.3%) had heart rhythm disorders, 38 (13.0%) had chronic cerebral ischemia, and the risk of grade 3 and 4 cardiovascular complications was found in 251 (86.0%) cases. Results: In the early postoperative period severe complications occurred in 1 (1.7%) patient (acute coronary syndrome) leading to death. No local recurrences were detected. The overall 3-year survival rate was 86.3% and the recurrence-free survival rate was 89.7%. In 10 (3.4%) cases, death was due to progression of RRMS, 30 (10.3%) patients died from other causes (acute cardiovascular failure, stroke, COVID-19). Conclusions: Comorbid conditions in elderly patients after surgery did not affect the development of complications in the early postoperative period. Preliminary preoperative preparation of elderly patients (correction and selection of drug therapy for concomitant chronic diseases) reduces the risk of early postoperative complications.

Pre-operative mechanical bowel preparation and prophylactic oral antibiotics for pediatric patients undergoing elective colorectal surgery: a protocol for a randomized controlled feasibility trial

BackgroundInfections after elective colorectal surgery remain a significant burden for patients and the healthcare system. Adult studies suggest that the combination of oral antibiotics and mechanical bowel preparation is effective at reducing infections after colorectal surgery. In children, there is limited evidence for either of these practices and the utility of combining oral antibiotics with mechanical bowel preparation remains uncertain.MethodsThis study aims to determine the feasibility of conducting a randomized controlled trial assessing the efficacy of oral antibiotics, with or without mechanical bowel preparation, in reducing the rates of post-operative infection in pediatric colorectal surgery. Participants aged 3 months to 18 years undergoing elective colorectal surgery will be randomized pre-operatively to one of three trial arms: (1) oral antibiotics; (2) oral antibiotics and mechanical bowel preparation; or (3) standard care. Twelve patients will be included in each trial arm. Feasibility outcomes of interest include the rate of participant recruitment, post-randomization exclusions, protocol deviations, adverse events, and missed follow-up appointments. Secondary outcomes include the rate of post-operative surgical site infections, length of hospital stay, time to full enteral feeds, reoperation, readmission, and complications.DiscussionIf the results of this trial prove feasible, a multi-center trial will be completed with sufficient power to evaluate the optimal pre-operative bowel preperation for pediatric patients undergoing elective colorectal surgery.Trial registrationClinicalTrials.gov: NCT03593252.

Impact of Geko Neuromuscular Stimulator on Preoperative Preparation in Ankle Fractures.

To explore the impact of the Geko neuromuscular stimulator on preoperative preparation in patients with ankle fractures. Quasi-experiment study. Place and Duration of the Study: Department of Foot and Ankle Surgery and Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China, between December 2020 and 2021. This quasi-experiment study included patients with ankle fractures treated with Geko neuromuscular stimulator before surgical fixation. The primary outcome was limb swelling at 24, 48, and 72 hours (h) after admission, and the secondary outcomes were pain according to visual analogue scale (VAS) at 12, 24, and 48 hours after admission, preoperative waiting time, and comfort 4 and 72 h after admission. A total of 60 patients were included in the study; 30 in the conventional treatment group (mean age 41.16 ± 2.01 years) and 30 in the Geko group (mean age 40.22 ± 2.68 years). The limb swelling in patients was significantly different between the Geko and conventional treatment groups (p = 0.004). Besides, the swelling values at 48 (p < 0.001) and 72 (p < 0.001) hours were significantly lower than those at 24 hours. The pain in patients was significantly different between the Geko and conventional treatment groups (p = 0.007). Besides, the swelling values at 24 (p < 0.001) and 48 (p < 0.001) hours are significantly lower than those at 24 hours. Comfort was significantly higher at 4 h (69.54 ± 2.18 vs. 67.22 ± 3.14, p = 0.002) and 72 h [(88.50 (84.00 - 94.00) vs. 82.14 ± 3.08, p < 0.001)] after admission. The preoperative waiting time (3.52 ± 1.8 vs. 5.15 ± 2.1 hours, p = 0.002) was significantly shorter in the Geko group. The Geko neuromuscular stimulator is a useful option for preoperative preparation in patients with ankle fractures to reduce local swelling and pain and improve patients' comfort. Ankle fractures, Lower extremity, Neuromuscular stimulator, Peroneal nerve, Pain.

Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review.

Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.

A discrete-event simulation model for assessing operating room efficiency of thoracic, gastrointestinal, and orthopedic surgeries.

In hospital management, pinpointing steps that most enhance operating room (OR) throughput is challenging. While prior literature has utilized discrete event simulation (DES) to study specific strategies such as scheduling and resource allocation, our study examines an earlier planning phase, assessing all workflow stages to determine the most impactful steps for subsequent strategy development. DES models real-world systems by simulating sequential events. We constructed a DES model for thoracic, gastrointestinal, and orthopedic surgeries summarized from a tertiary Chinese hospital. The model covers preoperative preparations, OR occupation, and OR preparation. Parameters were sourced from patient data and staff experience. Model outcome is OR throughput. Post-validation, scenario analyses were conducted for each department, including: (1) improving preoperative patient preparation time; (2) increasing PACU beds; (3) improving OR preparation time; (4) use of new equipment to reduce the operative time of a selected surgery type; three levels of improvement (slight, moderate, large) were investigated. The first three improvement scenarios resulted in a 1%-5% increase in OR throughput across the three departments. Large reductions in operative time of the selected surgery types led to approximately 12%, 33%, and 38% increases in gastrointestinal, thoracic, and orthopedic surgery throughput, respectively. Moderate reductions resulted in 6%-17% increases in throughput and slight reductions of 1%-7%. The model could reliably reflect OR workflows of the three departments. Among the options investigated, model simulations suggest that improving OR preparation time and operative time are the most effective.

Early Postoperative Complications after Pelvic Exenteration

Background. Radiation therapy is an integral part of the treatment of most malignant neoplasms of the pelvic organs, which in 25–30% of cases can cause the development of late radiation complications; in addition, 2–8% of patients have severe complications with an outcome in fistulas of various localization. Also, tumors of this localization are prone to local-regional recurrence, which can be combined with late radiation injuries. One of the most radical, and, often, the only method of treating this extremely severe and prognostically unfavorable pathology is to perform evisceration of the pelvic organs; however, its implementation against the background of radiation damage to normal tissues, leading to a significant decrease in the reparative potential, inevitably leads to a high risk of postoperative complications.&#x0D; Methods. A retrospective analysis of early postoperative complications on the Clavien–Dindo scale was carried out in 136 patients after pelvic evisceration performed at the A.F. Tsyba MRSC in 2019–2021. All patients in the perioperative period underwent complex conservative therapy, including nutritional support.&#x0D; Results. Pelvic evisceration was performed due to the progression of the underlying disease in 57% of cases, in 29% — due to the development of severe late radiation injuries with an outcome in the fistula, in 14% — due to a combination of local recurrence of the underlying disease with radiation complications). Complications of grade I on the Clavien–Dindo scale were noted in 50%; II — in 20.5%; III — in 3.6%; grade IV — in 3%. There were no cases of postoperative mortality.&#x0D; Conclusions. Conducting active preoperative preparation of patients aimed at correcting anemia, dysproteinemia, pain syndrome, etc.; as well as modifying surgical techniques and improving the management tactics of postoperative patients can minimize the risk of postoperative complications in patients after pelvic evisceration.

Clinical and pathogenetic justification for the use of therapeutic plasma exchange in the complex of preoperative preparation of patients with non-small cell lung cancer complicated by the inflammatory process

Purpose of the study. Determination of pathogenetic substantiation and indication criteria for the inclusion of extracorporeal detoxification methods in preoperative preparation of patients with non-small cell lung cancer (NSCLC) complicated by inflammation.Patients and methods. This study included the data on 222 patients with newly diagnosed stage I–IV NSCLC referred for elective surgical treatment to the Department of Thoracic Oncology, National Medical Centre for Oncology, in 2017–2019. Endogenous intoxication was evaluated in all patients depending on the leukogram results: leukocytic intoxication index (LII), body resistance index (BRI), reactive neutrophil response (RNR), and neutrophil-lymphocyte ratio (NLR). Indicators of the inflammatory response, i. e. interleukin 6 and procalcitonin, were also studied.Results. 36.5 % of NSCLC patients developed inflammation. That over 70 % of the NSCLC patients showed pronounced clinical and laboratory signs of endogenous intoxication and inhibited protective systems of homeostasis. Initial sub- or decompensated endotoxicosis together with reduced overall reactivity of the body poses a high risk of systemic inflammatory response to antitumor surgical treatment. This justifies the inclusion of extracorporeal detoxification into preoperative preparation of this category of patients as an active preoperative therapy.Conclusions. Simultaneous elevation of LII, RNR and NLR characterizing the presence of endotoxicosis in sub- and decompensation of endogenous intoxication by own physiological detoxification systems requires an active preoperative preparation with extracorporeal detoxification.

CONVERSION TO OPEN CHOLECYSTECTOMY - A SAFE ALTERNATIVE, NOT A FAILURE!

Background: Understanding factors that predict conversion in laparoscopic cholecystectomy (LC) to an open procedure is important as it allows better patient selection, preparation, operating list planning, referral, counseling and lowers the threshold for a safe conversion, thereby minimizing undue prolongation of attempts at laparoscopic completion and inadvertent complications.Methods: Records of 1010 consecutive patients who were taken up for LC, at a tertiary care teaching institute in northern India, were reviewed retrospectively. Preoperative and intraoperative characteristics of patients who underwent a successful LC were compared with those who required conversion to open surgery.Results: The conversion rate was 7.5% (76 patients). The most common reason for conversion was the inability to define the ‘Critical view of safety’ in 48, (63%) of patients. Other reasons included dense peri-cholecystic 9 (12%) and intra-abdominal 8 (11%) adhesions, suspicion of bile duct injury 4 (5%) or malignancy 3 (4%). Prior upper abdominal surgery, intraoperative finding of a contracted and thick-walled gallbladder (GB), empyema GB, Mirizzi’s syndrome, cholecysto-enteric fistula, and a prior endoscopic common bile duct stone clearance were significant predictors of conversion. Xanthogranulomatous cholecystitis was found more commonly (43% vs 5%) in the conversion group.Conclusion: Conversion to an open procedure during LC should always be treated as an integral component of sound judgement to achieve the safest outcome in a particular patient. Due consideration of pre-operative and intra-operative factors predictive of a higher chance of conversion assists pre-operative patient preparation and counseling as well as surgical planning, conduct and mentoring of residents-in-training.

Excellence in Surgical Care: A Review of Preoperative and Postoperative Management

A retrospective study aimed to analyze and identify the main components involved in patients' preoperative and postoperative management, recognizing the importance of knowledge in approaching the complexities inherent to surgical procedures. Search was conducted in the PubMed, Embase, SCOPUS, Web of Science, and Google Scholar databases to identify relevant studies. Patients with compromised organic functional reserve, when undergoing surgical procedures, often face an increased risk of morbidity and mortality. In this context, obtaining a comprehensive medical history and a meticulous physical assessment are crucial in decision- making. Laboratory tests are recommended only when clinical findings justify their performance. This review highlights fundamental aspects, including surgical indication, clinical history, physical examination, surgical risk assessment, continuous use medications, sedation approaches, antibiotic prophylaxis, unique preparations, and postoperative care. In conclusion, this comprehensive literature review significantly contributed to the in-depth and wellfounded understanding of the preoperative preparation and postoperative care of patients with surgical pathologies within a scientifically validated context.

Rationale for Increasing Oncological Vigilance in Relation to Clinical Findings in Accessory Parotid Gland-Observations Based on 2192 Cases of the Polish Salivary Network Database.

The accessory parotid gland (APG, Vth level) differs in histological structure from main parotid tissue. This gives rise to the hypothesis, mirrored in clinical observations, that the representation of tumours is different than in the rest of the gland. The aim of the study was to analyse the epidemiological and histological differences of parotid tumours located in regions I-V, with particular emphasis on the distinctiveness of region V. To define the epidemiological factors that will indicate the risk of histological malignancy from clinically benign appearance, multicentre prospective studies conducted between 2017-2021 by five Head and Neck Surgery University Departments, cooperating within the Polish Salivary Network Database 1929 patients (1048 women and 881 men), were included. The age, gender, patient occupation, place of inhabitation, tumour size, clinical features of malignancy, histology, and facial nerve (FN) paresis were analysed for superficial (I_II) and deep (III_IV) lobes and with special regard to the tumours affecting region V. Twenty eight tumours were located exclusively in region V (1.45% total) and seventy-two tumours were found in region V exhibiting extensions to neighbouring regions (3.7% total), characterised as significantly younger and less frequent in retirees. In I-IV regions, approximately 90% of tumours were benign, with pleomorphic adenoma (PA) and Whartin tumour (WT) predominance. In region V, PA exceeded 75% but WT were casuistic (2/28). Incidences of malignancies in region V was 40% but clinical signs of malignancy were evident only in tumours > 4 cm or in the presence of FN paresis. In 19% of patients with a benign appearance, imaging revealed malignancy; however, 38% of patients showed false negative results both in terms of clinical and radiological features of malignancy. Logistic regression models in 28 patients with tumours located exclusively in region V vs. 1901 other patients and in 100 patients with V extension vs. 1829 other patients showed no clinical symptoms of malignancy binding with final malignant tumour histology as a single variable or in combination with other variables. The logistic regression models obtained in this study show strong linkage between tumour location and predictors (age, male gender, and tumour diameter) and also aimed to function as a good classifier. Our conclusion is that, despite the very clear image of the mid-cheek tumour which is easily accessible in palpation and ultrasound examination, it is necessary to improve oncological vigilance and preoperative patient preparation.

Laxatives in Geriatric Practice: From Preoperative Bowel Preparation to Correction of Chronic Constipation

The first part of the article discusses the issues of preoperative bowel preparation in older and oldest-old patients, with a particular emphasis on the safest drugs. The second part of the article presents the problem of chronic constipation as a geriatric syndrome, including a description of age-associated changes in the structure and function of colon, causes of constipation and features of correction in geriatric practice.

POSTOPERATIVE EFFECTIVENESS OF PREOPERATIVE PREPARATION AND TREATMENT OF PATIENTS AT THE TIME OF THE THIRD STAGE OF RETRO AND PELVIC PROLAPSE IN WOMEN

Genital prolapse remains one of the unsolved problems of modern gynecology. The aimof the study is to improve the preoperative preparation and postoperative management of patients with grade III pelvic organ prolapse, using modern innovative technology in combination with drugs to reduce postoperative complications and relapses. Materials and methods of research.The object of the study was 217 patients with grade III pelvic organ prolapse who underwent surgical treatment. Results and discussion.110 women with grade III PG received an improved method of preoperative preparation, including irrigation with cavitated low-frequency ultrasound with an aqueous 0.05% chlorhexidine solution in the amount of 200.0, up to 4 times, locally conjugated estrogen, and in the presence of urinary tract infection, acute cystitis -once fosfomycintrimetabol 3.0 grams orally, in recurrent forms of phytopreparation (Canephron N) for 14.5 ±2.5 days. Conclusion:The improved method of preoperative preparation of patients with PTO of the III degree contributed to the reduction of the days of preoperative preparation by 6.0±0.5 days, reduced interoperative blood loss by 2.0 times, reduced the duration of the operation by 37.0±6.35 minutes, the hospital stay decreased by an average of 3.5±0.5 days, and postoperative recurrences after 1 year decreased by 2.4 times and after 2 years by 2.8 times.

Trophic ulcers of venous etiology and their treatment tactics by endovasal laser coagulation

The main goal of the study was to identify a unified and pathogenetically justified method of surgical treatment of patients with trophic ulcers of venous etiology, as well as an algorithm for preoperative preparation of such patients for minimally invasive intervention. The article presents the results of the treatment of trophic ulcers of venous etiology by endovenous laser coagulation. In a comparative aspect, modern data on its effectiveness are presented, the success of this operation is 93–100 %. When comparing the results of using lasers with different wavelengths and energies, the incidence of severe complications (deep vein thrombosis, thrombophlebitis, pulmonary embolism, skin burn) ranges from 0.1 to 2.4 %. In the analysis of the literature, no evidence was found that the wavelength affects the clinical outcome, but the power of the laser energy used matters. The main elements of preparation and performance of operative interventions aimed at elimination of venous blood reflux in lower extremities are indicated, and therapeutic tactics for healing of soft tissue defect in postoperative period are determined.