Previous Surgery Research Articles

Early safety and efficacy outcomes of the PAUL glaucoma implant in a Spanish population: A retrospective study

Abstract PURPOSE: The purpose of the study was to evaluate the efficacy and safety of the PAUL glaucoma implant (PGI) in refractory glaucoma patients, during the early postoperative period. METHODS: We conducted a retrospective, cohort study of patients that had received a PGI between February 2022 and December 2023. An intraluminal polypropylene suture was placed to prevent early hypotony in all cases. Demographics, intraocular pressure (IOP), and medication variation were evaluated for up to 6 months. The success rate was stratified into <18 mmHg and 30% from baseline or <15 mmHg and 40% IOP reduction. The safety outcomes were also analyzed. RESULTS: Sixteen eyes from 16 patients were included in the analysis. Fifteen of them had had a previous surgical glaucoma procedure. At 6 months, IOP decreased from 26.6 (±6.2) to 15.3 (±4.6) mmHg, with fewer glaucoma medications, from a median (interquartile range) of 3 (2–3) – 1.5 (0–2) (P < 0.005). Twelve (75%) and seven (43.8%) eyes met the qualified and complete success definition for the first category, and eight (50%) and four (25%) met the second criterion. One case with self-limiting choroidal detachments, but >6 mmHg IOP was found in our cohort. CONCLUSION: The PGI seems to be safe and effective from the early postoperative period. The IOP reduction rate could make it suitable for patients with refractory moderate-to-advanced glaucoma.

Guidelines and consensus: Jejunoileostomy for diabetes mellitus-surgical norms and expert consensus (2023 version)

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

Arthroscopic meniscal posterior root repair combined with centralization reduces medial menicus extrusion associated with posterior root tears: One-year clinical outcomes.

This study aimed to assess the short-term clinical efficacy of combining posterior meniscal root repair with meniscal centralization technology in the treatment of medial meniscus posterior root tears (MMPRTs) and notable meniscus extrusion. In this retrospective analysis, patients aged 43-76 years with only chronic posterior root tears of the medial meniscus and notable extrusion were followed up for 12-14 months. (1) persistent medial knee joint pain affecting daily life, presenting with joint space tenderness; (2) showing the ineffectiveness of conservative treatment for a minimum of 3 months; conservative treatment includes non-invasive methods such as nonsteroidal anti-inflammatory drugs, physical therapy and massage, but does not include intra-articular injections. (3) Kellgren-Lawrence Grades 0-II osteoarthritis (OA) of the knee joint; and (4) diagnosis of a posterior root tear of the medial meniscus with notable meniscus extrusion confirmed through knee-joint plain magnetic resonance imaging (MRI) scans, where coronal image revealed a meniscus body extrusion of ≥3 mm. (1) Kellgren-Lawrence Grades III-IV OA in the knee joint; (2) presence of knee joint infection or other structural damage to the knee joint; (3) history of previous knee joint surgery; (4) demonstrating joint instability or abnormal lower-limb alignment (varus deformity >5°); and (5) presence of severe mental illness, coagulation disorders, or other serious medical conditions. The Lysholms score, the Hospital for Special Surgery (HSS) knee score, the visual analogue scale (VAS) score and meniscal extrusion values were evaluated before and after surgery in 23 patients through a comparative analysis. The results of the follow-up conducted 12-14 months post-operatively indicated a significant improvement in the patients' conditions. In particular, the Lysholms scores (preoperative: 50.9 ± 10.2; 1-year post-surgery: 72.0 ± 8.4), HSS knee scores (preoperative: 45.9 ± 10.6; 1-year post-surgery: 79.1 ± 11.1) and VAS scores (preoperative: 4.0 ± 1.1; 1-year post-surgery: 0.9 ± 0.7) exhibited notable enhancements. Furthermore, compared to the preoperative values, the degree of meniscus extrusion measured by coronal MRI of the knee joint significantly improved post-operatively (preoperative: 3.7 ± 0.8 mm; 1-year post-surgery: 2.2 ± 0.6 mm). These findings all yielded a p < 0.05, signifying statistical significance. In patients with chronic MMPRTs and notable extrusion, a combination of posterior meniscal root repair and centralization technology can effectively restore meniscus function and rectify the medial meniscus displacement, resulting in favourable short-term clinical outcomes. Level IV.

Management of multiple valve replacement operations for a young patient with hypereosinophilic syndrome and valvular heart disease: a case report.

Hypereosinophilic syndrome (HES) is characterized by the overproduction of eosinophils and manifests as valvular disease and thrombogenesis. Herein, we report our experience with a patient with HES requiring multiple reoperations for prosthetic heart valve replacement via median sternotomy. The patient was a 54-year-old man who had undergone four valve replacement operations via median sternotomy (three mitral valve replacements and one double valve replacement) because of valvular diseases complicated by HES since he was 26years old. All the artificial valves were bioprosthetic to prevent thrombotic events. At presentation, he had developed structural deterioration of the artificial aortic valve with severe stenosis. His prosthetic mitral valve did not fulfil the criteria for intervention, as it exhibited only mild regurgitation and no stenosis. The explanted mitral prosthetic valve at the previous (fourth) surgery had exhibited eosinophilic infiltration, resulting in the introduction of cyclosporin for poorly controlled HES. We conducted re-aortic valve replacement via a fifth median sternotomy using a bioprosthetic valve, and no eosinophilic infiltration was observed in the explanted valve. The patient was discharged on postoperative day 15 without complications. Controlling eosinophil count during the pre- and postoperative course is vital in treating patients with HES after valve replacement surgery. A holistic management and therapeutic strategy, including prosthetic valve selection and medication for HES is required to improve outcomes of patients with HES and heart valve disease.

Neuroapraxia of Trigeminal Nerve Controlled by Neuromonitoring During Microvascular Decompression in Multiple Sclerosis Patients Affected by Drug-Resistant Trigeminal Neuralgia Recurrent After Previous Operations

BACKGROUND AND IMPORTANCE: Trigeminal neuralgia (TN) can complicate the clinical course of multiple sclerosis (MS) and can be very difficult to treat. Usually, these patients experience multiple recurrences after surgical procedures with a poor overall outcome. To the best of our knowledge, we report the first 3 cases of drug-resistant MS-related TN recurrent after previous operations in which intraoperative neuromonitoring controlled neuroapraxia of trigeminal nerve was performed. We describe the surgical technique, report the clinical outcomes of patients, and review the pertinent literature. CLINICAL PRESENTATION: Neuroapraxia of trigeminal nerve was conducted using a standard straight Yasargil temporary titanium aneurysm clip on the main trunk of the trigeminal nerve. Trigeminal somatosensory evoked potentials and cortico-bulbar motor evoked potentials registered from trigeminal and facial nerves were recorded during the procedure. The trigeminal nerve clipping was conducted for a maximum of 30 seconds or less in the case of a decrease in neurophysiological responses. The preoperative Barrow Neurological Institute score was V, IV, and IV for the 3 patients, respectively. We obtained acute pain relief in all patients after the procedure. All patients had a Barrow Neurological Institute I at the latest follow-up (10, 10, and 9 months, respectively). No complications were reported postoperatively and at follow-up. CONCLUSION: Intraoperative neuromonitoring controlled neuroapraxia of trigeminal nerve with temporary titanium aneurysm clip application during microvascular decompression is a promising and safe procedure in MS patients with recurrent MS-related TN. Further studies with longer follow-up are needed to confirm our encouraging results.

Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency

Purpose: To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD). Methods: Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes. Results: Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23–0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes. Conclusions: This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.

OGC SO41 - Omentopexy Technique in Robotic Assisted Minimally Invasive Oesophagectomy

Abstract Background Laparoscopic omentopexy has been shown to reduce the rates of post-oesophagectomy diaphragmatic hernia (PODH) in a retrospective cohort study in a UK specialist centre. We aimed to demonstrate the technique during robotic-assisted minimally invasive oesophagectomy (RAMIE) with video capture. Method The Versius (CMR Surgical) robotic system was used in the abdominal stage of RAMIE performed on a 63 year old male with a poorly differentiated oesophageal adenocarcinoma. No previous abdominal surgery had been performed on this patient. Video capture was used to record this part of the procedure. Results Ports were inserted in standard configuration to allow fashioning of a gastric conduit. Following this the greater omentum was secured to the anterior abdominal wall around the jejunostomy site. No immediate complications were observed. Conclusion The Versius system can be used to successfully perform omentopexy with standard port positioning. Omentopexy was successfully performed with no immediate complications, did not significantly prolong procedural time and may reduce risk of PODH. The authors support the use of this technique in robotic-assisted surgery for reducing risk of PODH and support further work to validate this technique in cohort studies.

BN SO60 - Oesophageal physiology studies: Conversion to surgery

Abstract Background This study aims to assess the proportion of patients that proceed to have hiatal surgery after oesophageal physiology studies. The results allow better planning in service development and workforce provision. Approximately 25% of the adult population suffer reflux symptoms (1), however not all patients benefit from surgical intervention. UK data show 1693 anti-reflux operations and 740 hiatal hernia repairs took place 2022-2023 (2). Oesophageal physiology studies, i.e. high resolution pH manometry and 24-hour pH monitoring, are the gold standard investigation in such patients to determine diagnosis and guide management. Method All patients who underwent oesophageal physiology studies between January 2021 and December 2023 were assessed by case note analysis. All patients considered for surgery were discussed in our hiatal MDT. Whilst achalasia is relatively rare, these patients also pass through oesophageal physiology and so are also considered here. Patients with previous hiatal surgery were excluded (20 patients). Results 182 patients attended; 137 underwent the tests, 22 tolerated manometry only, 5 underwent BRAVO. 78 were diagnosed with symptomatic/volume reflux, 3 with hiatus hernia. Mean DeMeester score was 47.63 (range 1.87-228.58) c.f. 20.2 (range 0.2-192.96) in the non-operative group. Ten patients had achalasia; two were referred for POEM, one Botox and one awaits further investigation. Six underwent Heller’s cardiomyotomy and Dor fundoplication. 76 patients were offered surgical intervention for reflux and/or hiatus hernia; 10 of whom declined. 3 patients underwent surgery privately. To date 39 procedures have been completed. 16 patients await further tests. Conclusion 42% of patients undergoing oesophageal studies were offered surgical intervention across a two-year period in our benign unit. A further 9% are awaiting outcome. The data suggest that when planning surgical services, finances and workforce we should anticipate approximately 40% of these patients will go on to require surgery.

BN SO05 - Risk Factors associated with Complications Post-Laparoscopic Common Bile Duct Exploration: A Comprehensive Literature Review

Abstract Background Gallstone-related diseases, particularly common bile duct (CBD) stones, present a significant global health issue. The adoption of laparoscopic common bile duct exploration (LCBDE) has revolutionized the management of these conditions by providing a minimally invasive alternative to open surgery. This literature review aims to identify and analyze the risk factors associated with complications in LCBDE, thereby offering insights to improve patient care and outcomes. Method comprehensive search for primary research studies, systematic reviews, and meta-analyses pertaining to risk factors for complications following LCBDE. The search was conducted on PubMed, focusing on English-language articles published within the last 20 years and encompassing all age groups. Peer-reviewed journal articles were prioritized. All relevant studies reporting complications after LCBDE were eligible for inclusion if available as full texts, structured abstracts, or conference reports. The initial search yielded 826 articles. Exclusion criteria : open surgery, non-English articles, lacking full-text. A total of 29 records were identified by the literature search. Results Laparoscopic common bile duct exploration (LCBDE) is generally safe and effective, with complication rates influenced by patient and procedural factors. Older age, comorbidities, previous abdominal surgeries, high BMI, narrow common bile ducts, and difficult stones increase risks. Experienced surgeons and shorter operative times reduce complications. The transcystic approach and primary suture closure have fewer complications compared to the transductal route and T-tube drainage, respectively. Intraoperative imaging significantly reduces risks by ensuring complete stone clearance and identifying anatomical variations. Tailoring surgical approaches to patient-specific factors and leveraging surgical expertise are crucial for minimizing complications in LCBDE. Conclusion LCBDE emerges as a safe and effective therapeutic modality for addressing conditions impacting the bile ducts (31). The success and utility of LCBDE can be significantly enhanced through the meticulous optimization of patient-related, surgeon-related, and procedure-related factors. By addressing and fine-tuning these key elements, the occurrence of complications associated with LCBDE can be mitigated, thereby reinforcing its potential as a primary choice for managing various bile duct conditions. This strategic approach not only underscores the clinical efficacy of LCBDE but also advocates for its expanded utilization as a frontline intervention in the comprehensive management of bile duct disorders.

Risk factors for wound complications after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared to repeated liver resection - a propensity score matching analysis.

Sufficient liver function is crucial in extracellular matrix growth, hemostasis, and wound healing. Repeated abdominal surgery is a known risk factor for the development of wound complications. This study aimed to evaluate this high-risk constellation in patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and repeated liver resections (RLR) in comparison to single liver resection (SLR). Forty patients who underwent ALPPS between 2011 and 2020 were evenly matched with patients undergoing RLR or SLR (n = 40 per group) using propensity scores. Postoperative outcomes were compared and factors associated with wound complications were analyzed. Postoperative wound complications were significantly more frequent in ALPPS group (p = 0.001). The reoperation rate was not significantly different between the three groups (p = 0.143). However, surgical reintervention due to wound complications occurred more frequently in the ALPPS group in relation to RLR and SLR (17.5% vs. 7.5% and 5% respectively). Length of stay was significantly longer in the ALPPS group (p = 0.033). ALPPS was an independent risk factor for postoperative wound complication (OR = 8.55, 95% CI:1.07-68.44, p = 0.043). Risk factor analysis identified age ≥ 60 years (OR = 27.64, 95% CI:3.09-246.75, p = 0.003), BMI ≥ 30kg/m2 (OR = 30.21, 95% CI:3.35-271.83, p = 0.002), and low postoperative albumin levels (OR = 168.41, 95% CI:7.76-3651.18, p = 0.001) as independent predictors of postoperative wound complications after major liver resection. Patients undergoing ALPPS and RLR are faced with a high risk of developing wound complications. Older age, obesity, a history of previous abdominal surgery, and a decreased postoperative albumin level were independent risk factors for wound complications.

BN SO16 - Gastro-gastric intussusception without any lead point – a case report and review of literature

Abstract Background Gastrogastric intussusception in a rare condition in adults. The underlying aetiologies include pathological lead points, anatomical abnormalities, previous foregut surgery or foreign body. The management of symptomatic gastrogastric intussusception in the absence of these aetiologies remains poorly defined and is highlighted by the paucity of evidence available for guidance. We present a case of idiopathic gastrogastric intussusception and a review of the literature. Method A 34-year-old male patient with a background of thrombocytopenia-absent radius (TAR) syndrome presented with recurrent episodes of upper abdominal pain and vomiting. Investigations with a CT abdomen revealed proximal gastrogastric intussusception. Subsequent endoscopy showed oedematous mucosa along the lesser curve and no pathological lead points or anatomical abnormalities. Histological findings were normal. Results The patient remained symptomatic despite a normal subsequent CT abdomen. A consensus decision was reached, and the patient was counselled for a laparoscopic gastropexy. Laparoscopic findings showed a central area of scar tissue circumferentially along the mid-body of the stomach highlighting the chronicity of the condition. No hiatal abnormalities were identified. A gastropexy was performed in two layers along the greater curvature of the stomach with non-absorbable interrupted sutures. The postoperative course was unremarkable. The patient remained asymptomatic on 6-week clinic follow up. Conclusion No previous case reports of idiopathic gastrogastric intussusception were identified on our literature search. It is our impression that this is the first such case-report to illustrate the diagnostic challenges of this rare, intermittently symptomatic condition and the successful management of it.

Best approach for incomplete colonoscopy: colon capsule endoscopy or repeat conventional colonoscopy?

Background: The most appropriate strategy for completing a previous incomplete colonoscopy (IC) is not standardized. We aimed to compare the efficacy and safety of two strategies for completing a previous IC: colon capsule endoscopy (CCE) versus repeat conventional colonoscopy. Methods: A retrospective cohort study that included consecutive adult patients referred to our center after IC under sedation due to irreducible loop formation or colonic fixed angulation was performed. Patients underwent CCE (PillCam COLON2 Medtronic®) or repetition of conventional colonoscopy under sedation. In this setting, an appropriate CCE progression was defined as the capsule reaching the segment achieved during the previous IC. Repeated conventional colonoscopy was considered complete when cecal intubation was accomplished. We compared the rate of appropriate CCE colon progression with the cecal intubation rate from repeated conventional colonoscopy. Quality of colon preparation, diagnostic yeld and rate of adverse events for CCE and colonoscopy was also analyzed. Results: A total of 192 CCE and 181 colonoscopies were performed for IC, primarily due to fixed angulation of the left colon (69.2%, n = 258). There were no significant differences between the two groups (CCE vs. colonoscopy) concerning age, sex, overweight/obesity status, previous abdominal surgery, and reasons for IC. The rate of appropriate colon progression with CCE was not significantly different from the cecal intubation rate of repeated colonoscopy (95.3% vs. 90.1%, P = 0.073, respectively), even after adjusting for the quality of colon preparation (P = 0.122), which differed significantly between the groups (76.0% vs. 92.8%, P &lt; 0.001, respectively). There were no significant differences in overall colorectal findings identified between the CCE and colonoscopy groups (55.2% vs. 62.4%, P = 0.172, respectively), and no adverse events were reported in either group. Conclusions: Our findings suggest that both CCE or repeat conventional colonoscopy are effective and safe options for completing a previous incomplete colonoscopy.

BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery

Abstract Background Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery. This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians. Method A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions. The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings. Results 74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced. Conclusion Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades. We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.

Abstract 4127681: Neutrophil-lymphocyte ratio as a marker of cardiovascular outcomes in patients with chronic coronary syndrome

Background: Inflammation is one of the pathophysiological processes involved in the genesis and progression of atherosclerosis and has been increasingly used as a therapeutic target in recent years. The neutrophil-lymphocyte ratio (NLR) is a promptly accessible inflammatory biomarker strongly associated with prognosis in the acute coronary setting. However, there are few data in patients with chronic coronary syndrome (CCS). Objective: Analyze the association between NLR and cardiovascular outcomes in patients with CCS. Methods: Patients with CCS, defined as a previous revascularization procedure (surgical or percutaneous), previous myocardial infarction (MI) or stenosis &gt; 50% in at least one epicardial coronary artery, were included and followed up on an outpatient basis. The NLR was calculated using the baseline blood count. The main outcome was the composite of death, non-fatal myocardial infarction and non-fatal stroke. Results: The study population consisted of 975 patients, with a median age of 65 years and 30% were women. Previous MI was present in 61%, 30% had undergone previous revascularization surgery and 46% had percutaneous coronary intervention. Diabetes was prevalent in 59% and hypertension in 95%. The median NLR was 2.15 (IQR 1.25 - 2.87). Patients with NLR ≥ 2.15, when compared to those with NLR &lt; 2.15, presented more left ventricular (LV) dysfunction (58% vs. 55%; p=0.003) and lower LDL-C serum levels (81 vs. 88 mg/dL; p=0.004). There was no association between NLR and coronary anatomical severity. NLR correlated with age, LDL-C and LV function (p &lt; 0.05 for all). During follow-up, 152 events of the composite primary outcome were registered, with an estimated 3-year incidence of 15.6% in the overall population – higher within patients with NLR ≥ 2.15 when compared to NLR &lt; 2.15 (20% x 14%, p = 0.002), as shown in the figure. In the multivariate analysis, the 3rd quartile of NLR had a 31% higher risk than the 1st quartile (p &lt; 0.05). Conclusion: In this study, the NLR, an easily available inflammatory biomarker, independently correlates with cardiovascular outcomes in a population with CCS.

First-in-Poland thoracoscopic left atrial appendage closure using Novel AtriClip® PRO-V device in patient with previous heart surgery and LAA thrombus.

First-in-Poland thoracoscopic left atrial appendage closure using Novel AtriClip® PRO-V device in patient with previous heart surgery and LAA thrombus.

Esophageal perforation in premature newborns

BACKGROUND: Esophageal perforation is a rare entity in newborns. This condition is most common in premature babies with very low and extremely low birth weight. The major cause of such pathology is considered to be iatrogenic trauma of either pharynx or esophagus, their soft tissues being delicate and tender enough to produce delamination and perforation of their wall. As a rule, this occurs as a complication of either a difficult tracheal intubation soon after birth or during some troubles with oro- or nasogastric tube insertion. AIM: To analyze our experience of revealing and treatment of esophageal perforation in preterm babies, and to demonstrate conservative approach as a possible as well as reasonable option in such cases. METHODS: A retrospective study of neonatal esophageal perforation cases was performed, including newborns without any congenital esophageal malformations or previous surgical procedures. During 2017–2022 9 newborns with esophageal perforation were treated at neonatal intensive care unit and neonatal departments of Childrens’ City Multidisciplinary Clinical Specialized Center of High Medical Technologies of Saint Petersburg. All of them were premature, 2 having very low, and 7 having extremely low birth weight. The incidence of that condition appeared to be 1:1320 live births. RESULTS: 8 patients were treated conservatively. This included adjustment of artificial lung ventilation, pain control, antibiotics, cancellation of gastric enteral feeding and administration of total parenteral nutrition. Babies with hydrothorax, pneumothorax or ascites underwent thoraco- or laparocentesis. 2 patients died, both being born at 23th week of gestation. In both cases death occurred from polyorganic insufficiency. The mortality rate appeared to be 22%. CONCLUSION: In most cases the esophageal perforation in premature babies can be treated conservatively, the efficacy of such treatment being largely dependent on early diagnosis of this complication. An important key-point in it is a radiologic control of gastric tube location.

SURG-25. PREOPERATIVE EMBOLIZATION IMPROVES LOCAL CONTROL AND REPROGRAMS GENE EXPRESSION IN ATYPICAL WHO GRADE 2 MENINGIOMAS

Abstract Preoperative embolization is hypothesized to reduce blood loss and surgical time for meningioma resection, but the impact of embolization on long-term clinical outcomes and molecular profiling of meningiomas is incompletely understood. To address this, we evaluated the impact of embolization on outcomes and molecular features of WHO grade 2 meningiomas. A series of patients with grade 2 meningiomas who underwent resection at our institution from 1997 to 2021 were identified and reviewed. Available DNA methylation profiling and bulk RNA sequencing data were analyzed (n=200). Univariate and multivariate analyses, Cox proportional hazards modeling, and propensity matching (sex, age at surgery, previous surgery, extent of resection, postoperative radiation) were used. A total of 357 patients with WHO grade 2 meningiomas were included, 129 (36.1%) of which underwent preoperative embolization. Mean age at diagnosis was 53.5 years and 61.4% of patients were female. There was no significant difference in time to recurrence with or without embolization for cases with gross total resection (229/357), but embolization was independently associated with improved local control for cases with subtotal resection even after accounting for postoperative radiotherapy (HR 0.49, 95% CI 0.32-2.20 p=0.028). The average time to recurrence of atypical WHO grade 2 meningioma was 3.3 years after subtotal resection and 6.7 years after embolization and subtotal resection (p&amp;lt;0.001, propensity matched). The distribution of Merlin-intact vs Immune-enriched vs Hypermitotic meningioma DNA methylation groups was equivalent with versus without embolization, but differential gene expression analysis of RNA sequencing data revealed enrichment of hypoxia related pathways after embolization that were unique to each DNA methylation group. In summary, these data show that preoperative embolization improves local control and reprograms gene expression in atypical WHO grade 2 meningiomas. Additional investigation into the impact of embolization on clinical outcomes and gene expression for meningiomas, especially for higher-grade tumors, is warranted.

Intraocular Pressure Reduction Following Phacoemulsification in Patients with Exfoliation: A Systematic Review and Meta-Analysis

Objectives: The objective of this systematic review and meta-analysis is to evaluate the existing evidence and estimate the impact of phacoemulsification and intraocular lens implantation on the intraocular pressure (IOP) of subjects with exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). Methods: In July 2024, an in-depth literature review across three databases was undertaken. This study focused only on adult patients with exfoliation who had not undergone previous ocular surgery. The primary outcome of interest was the mean IOP reduction at 6 and 12 months after uncomplicated phacoemulsification surgery. Results: This meta-analysis included one randomized controlled trial and eight observational studies, comprising 220 patients at 6 months and 430 patients at the 12-month time point, respectively. The mean IOP reduction after surgery was 3.43 mmHg (95% CI: −4.77 to −2.09) after 6 months and 2.75 mmHg (95% CI: −4.24 to −1.26) after 12 months. In both time points, there was no heterogeneity (I2 = 0), but the certainty of evidence following the GRADE evaluation was very low. Conclusions: The present meta-analysis demonstrates that phacoemulsification can significantly reduce IOP in exfoliation subjects 6 and 12 months after surgery. Nevertheless, significant limitations in included studies do not allow a precise and certain estimate of the magnitude of postoperative IOP lowering in exfoliation patients. Additional research is needed to confirm these results.

Prior Shoulder Arthroscopy is Associated with Inferior Clinical Outcomes Following Primary Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Background Various patient-related and condition-related factors can influence the clinical benefits of reverse shoulder arthroplasty (RSA). With the emergence of new potential joint-preserving arthroscopic interventions, understanding the impact of shoulder arthroscopy prior to RSA is increasingly relevant. Therefore, the purpose of this study was to understand the impact of previous ipsilateral shoulder arthroscopy on outcomes and shoulder function following RSA for rotator cuff tear arthropathy. Methods Patients who underwent RSA for rotator cuff tear arthropathy from June 2016 to September 2020 by a single surgeon were retrospectively reviewed from a prospectively collected clinical database. Patients were separated into two groups: 1) patients who underwent RSA following prior ipsilateral shoulder arthroscopy (RSAPA) and 2) patients who underwent RSA without previous shoulder surgery (RSA). Patient-reported outcomes (PROs), including SST, ASES, UCLA score, SAS score, and active shoulder range of motion were measured preoperatively and at a minimum 2 years postoperative. Results A total of 103 patients (n=38 RSAPA and n=65 control RSA) were analyzed. The mean duration of follow-up for patients with prior ipsilateral shoulder arthroscopy was significantly shorter compared to the control patients (RSAPA=33 months and RSA=50 months, p &lt; 0.0001). All PROs improved postoperatively (p &lt; 0.001). Improvements in PROs for RSAPA were diminished relative to RSA control group patients, including SST (RSAPA=5.4 vs RSA=7.6, p = 0.005), ASES (RSAPA=40.8 vs RSA=54.7, p = 0.021), and UCLA (RSAPA=16 vs RSA=20.7, p = 0.009) scores. Improvements in forward flexion (RSAPA=69° vs RSA=95°, p = 0.0003) and abduction (RSAPA= 67° vs RSA=83°, p = 0.003) were decreased in the RSAPA group compared to the control group (RSA). One patient (1.5%) with prior shoulder arthroscopy required revision due to recurrent instability, whereas no patients in the control group required revision surgery (p=0.25). Conclusion Patients with rotator cuff tear arthropathy who underwent RSA following prior shoulder arthroscopy demonstrated significant improvements in function and patient-reported outcomes, but these outcomes are diminished compared to those patients with no history of surgery.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.