Prolonged Drainage Research Articles

Allogenic Cancellous Bone versus Injectable Bone Substitute for Endoscopic Treatment of Simple Bone Cyst and Intraosseous Lipoma of the Calcaneus and Is Intraosseous Lipoma a Developmental Stage of a Simple Bone Cyst?

Simple bone cysts (SBCs) and intraosseous lipoma (IOL) of the calcaneus are rare tumor entities that are primarily diagnosed due to unspecific heel pain, incidental findings, or rarely due to pathological fractures. Compared to traditional open tumor resections, endoscopic resection of these benign tumors aims to minimize surgical morbidity and maximize surgical efficiency without compromising safety. Grafting is regularly performed to reduce the risk of recurrence and stimulate osseous consolidation of the lytic lesion. As the incidence is low and treatment strategies are heterogeneous, there is no clear consensus for the treatment of simple cysts or intraosseous lipomas of the calcaneus. The objectives of this study are (a) to present medium to long-term results after endoscopic resection and grafting with allogenic cancellous bone or bioresorbable hydroxyapatite and calcium sulfate cement, and (b) to add further evidence to the discussion of whether calcaneal SBC and IOL are the same entity at different developmental stages. Between 2012 and 2019, a total of 25 benign bone tumors consisting of 17 SBCs and 8 IOLs were treated by A.T. with endoscopic resection and grafting, comprising the largest cohort to date. For grafting, 12 patients received allogenic cancellous bone (group A) and 13 patients received injectable bone substitute (group B). Pre- and postoperative imaging using plain X-rays and MRI was retrospectively analyzed with a mean follow-up time of 24.5 months to assess tumor size, osseous consolidation (modified Neer classification), and tumor recurrence. A retrospective chart analysis focusing on adverse intra- and perioperative events and other complications associated with the surgical procedure was performed using the modified Clavien-Dindo classification (CD1-3). A total of 12/13 cases with allogenic bone grafting showed a Neer Type 1 osseous healing of the tumorous lesion after endoscopic resection, whereas only 5/11 cases with injectable bone substitute showed sufficient healing (types 1 and 2). There were three recurrent cysts (Neer 4) and two persistent cysts (Neer 3) after using injectable bone substitute. Two CD1 complications were observed in group A (prolonged wound drainage, sural neuritis) and eight complications were observed in group B (6× CD1, 2× CD3). At least two IOLs diagnosed preoperatively using MRI were ultimately identified as SBCs upon histopathologic examination. Allogenic cancellous bone grafting after endoscopic resection of calcaneal SBC or IOL showed a very low rate of complications and no tumor recurrence in our series. On the other hand, depending on the material used, injectable bone substitute showed a high rate of "white-out" (excessive drainage), resulting in multiple complications such as prolonged wound healing, insufficient permanent defect filling, recurrence, and revision surgery. Over time, calcaneal SBC may transform into IOL, exhibiting distinct features of both entities simultaneously during ossoscopy and histopathological analysis.

Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on the risk of SSCs following THA and TKA. A systematic literature review identified studies published between January 2005 and July 2021 comparing ciNPT (Prevena Incision Management System) to traditional standard-of-care dressings for patients undergoing THA and TKA. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national database. Twelve studies met the inclusion criteria. Eight studies evaluated SSCs, where a significant difference was seen in favor of ciNPT (relative risk [RR]: 0.332, P < .001). Significant benefits in favor of ciNPT were also observed for surgical site infection (RR: 0.401, P= .016), seroma (RR: 0.473, P= .008), dehiscence (RR: 0.380, P= .014), prolonged incisional drainage (RR: 0.399, P= .003), and rate of return to the operating room (RR: 0.418, P= .001). The estimated cost savings attributed to ciNPT use was $932 per patient. The use of ciNPT after TKA and THA was associated with a significant reduction in the risk of SSCs, including surgical site infections, seroma, dehiscence, and prolonged incisional drainage. The risk of reoperation was reduced as were the costs of care in the modeled cost analysis, suggesting a potential for both economic and clinical advantages for ciNPT over standard-of-care dressings, particularly in high-risk patients.

Risk factors and care of early surgical site infection after primary posterior lumbar interbody fusion

Abstract Objectives To explore the risk factors and nursing measures of early surgical site infection (SSI) after posterior lumbar interbody fusion (PLIF). Methods A total of 468 patients who received PLIF in our hospital from January 2017 to June 2020 were enrolled into this study. According to the occurrence of early SSI, the patients were divided into two groups, and the general data were analyzed by univariate analysis. Multivariate logistic regression analysis was conducted with the dichotomous variable of whether early SSI occurred and other factors as independent variables to identify the risk factors of early SSI and put forward targeted prevention and nursing measures. Results Among 468 patients with PLIF, 18 patients developed early SSI (3.85%). The proportion of female, age, diabetes mellitus and urinary tract infection (UTI), operation segment, operation time, post-operative drainage volume, and drainage time were significantly higher than those in the uninfected group, with statistical significance (P &lt; 0.05), whereas the preoperative albumin and hemoglobin in the infected group were significantly lower than those in the uninfected group, with statistical significance (P &lt; 0.05). There was no significant difference between the two groups in the American Society of Anesthesiologists (ASA) grading, body mass index (BMI), complications including cardiovascular and cerebrovascular diseases or hypertension (P &gt; 0.05). Logistic regression analysis showed that preoperative diabetes mellitus (OR = 2.109, P = 0.012)/UTI (OR = 1.526, P = 0.035), prolonged drainage time (OR = 1.639, P = 0.029) were risk factors for early SSI. Men (OR = 0.736, P = 0.027) and albumin level (OR = 0.526, P = 0.004) were protective factors in reducing early SSI. Conclusions Women, preoperative diabetes/UTI, hypoproteinemia, and prolonged drainage time are risk factors for early SSI after PLIF. Clinical effective preventive measures should be taken in combination with targeted nursing intervention to reduce the risk of early SSI.

Comparison of long-term results according to the primary mode of management of injury for posterior urethral injuries.

The management of post-traumatic rupture of the posterior urethra remains controversial, leaving the choice between early endoscopic realignment (EER) or suprapubic catheterization with deferred urethroplasty. The objective is to compare the results of endoscopic realignment and those of urethroplasty in terms of voiding. We underwent a retrospective study collating all patients managed for post-traumatic complete urethral rupture between 2010 and 2020. These patients were subdivided into two groups: a first one including those who had an endoscopic realignment and a second one including those who had a deferred urethroplasty. We studied the quality of voiding and the complications that occurred in each group. The success of the technique was defined by the resumption of a satisfactory voiding, and the absence of recourse to the urethroplasty in case of endoscopic realignment. Satisfactory voiding was defined by a Qmax ≥ 15mL/s and a post-void residual (PVR) < 150ml by ultrasound. Fifty-eight patients were identified. The mean age was 32 ± 12years. Endoscopic realignment was performed in 26 patients. Satisfactory voiding was reported in 16 patients (61.53%). Recourse to internal urethrotomy after realignment was reported in 7 patients (26.92%). Three failures of endoscopic realignment were reported, necessitating an urethroplasty. Two patients reported urinary incontinence. Urethroplasty was performed in 32 patients. Satisfactory voiding was noted in 22 patients (68.75%). The use of internal urethrotomy after surgery was reported in 5 patients (15.62%). Three patients had treated urinary incontinence. Comparing the two groups, there was no significant difference in postoperative IPSS, flow rate (Qmax), post-void residual urine volume (PVR), satisfactory voiding, and stress urinary incontinence. The voiding outcomes were comparable for both techniques. We conclude that endoscopic realignment can be indicated in first intention, provided certain conditions are met, in order to minimize the morbidity of prolonged suprapubic drainage.

Postoperative drainage management and wound complications following resection of lower limb soft tissue tumors: a retrospective cohort study

PurposePostoperative wound complications are common in patients undergoing resection of lower extremity soft tissue tumors. Postoperative drainage therapy ensures adequate wound healing but may delay or complicate it. The aim of this study is to evaluate the incidence of postoperative wound complications and delayed or prolonged drainage treatment and to propose a standardized definition and severity grading of complex postoperative courses.MethodsA monocentric retrospective analysis of 80 patients who had undergone primary resection of lower extremity soft tissue tumors was performed. A new classification was developed, which takes into account postoperative drainage characteristics and wound complications. Based on this classification, risk factors and the prognostic value of daily drainage volumes were evaluated.ResultsAccording to this new definition, regular postoperative course grade 0 (no wound complication and timely drainage removal) occurred in 26 patients (32.5%), grade A (minor wound complications or delayed drainage removal) in 12 (15.0%), grade B (major wound complication or prolonged drainage therapy) in 31 (38.8%), and grade C (reoperation) in 11 (13.7%) patients. Tumor-specific characteristics, such as tumor size (p = 0.0004), proximal tumor location (p = 0.0484), and tumor depth (p = 0.0138) were identified as risk factors for complex postoperative courses (grades B and C). Drainage volume on postoperative day 4 was a suitable predictor for complex courses (cutoff of 70 ml/d).ConclusionThe proposed definition incorporates wound complications and drainage management while also being clinically relevant and easy to apply. It may serve as a standardized endpoint for assessing the postoperative course after resection of lower extremity soft tissue tumors.

Effects of drought stress on the oxidation of the reaction center chlorophyll of photosystem I and grain yield in paddy-field grown rice plants

ABSTRACT Drought is a serious abiotic stress that leads to decreased yield. In pot experiments, the reaction center chlorophyll of photosystem I (PSI) (P700) has been reported to be oxidized in response to drought stress. In the present study, we examined whether drought stress that decreases grain yield was detected by P700 oxidation in paddy-field-grown rice (Oryza sativa L.) plants. The P700 reduction and SPAD values were also evaluated. Drought stress was imposed by the prolonged mid-season drainage in 2019 and 2020. P700 oxidation was measured at saturated CO2 levels before heading. P700 oxidation was not stimulated in the 2019-drought plots. In contrast, P700 oxidation was stimulated in the 2020-drought plot. However, this phenomenon in 2020 was primarily accounted for by decreases in total leaf-N levels, as previously observed in the rice plants grown under low N availability. Rough rice yields and ratios of filled spikelets tended to decrease in the drought plots. Therefore, drought stress responsible for a decrease in grain yields could not be directly detected by P700 oxidation in paddy-field-grown rice plants, whereas the P700 oxidation responded to changes in total leaf-N levels due to the drought stress treatment. The same conclusion was drawn for the P700 reduction and SPAD value.

Seroma After Breast Reconstruction With Tissue Expanders: Outcomes and Management.

Seroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation. An IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded. Two hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery ( P = 0.043), delayed reconstruction ( P = 0.049), and prepectoral reconstruction ( P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index ( P = 0.044) and larger breast size ( P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients ( P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation ( P = 0.041 and P < 0.005). We recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.

Value of prolonged scrotal drainage after penile prosthesis implantation: a multicenter prospective nonrandomized pilot study.

We aimed to understand the risks and benefits of post-inflatable penile prosthesis (IPP) implantation drainage and optimal duration. Our patients were divided into 3 groups: Group 1 (n = 114) had no drain placed, Group 2 had a drain placed for 24 h (n = 114) and Group 3 had a drain placed for 72 h (n = 117). Postoperative scrotal hematoma and prosthesis infection rates were compared between the groups. The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th postoperative day: (n = 1, 0.9%) compared to Group 2: (n = 11, 9.6%) and Group 1: (n = 8, 7%), (p = 0.013). However, on the 3rd postoperative day, there was a statistically significant lower incidence of hematoma in both Groups 3 and 2: (0.9% and 6.1%, respectively) vs. Group 1: (11.4%), (p = 0.004). Hematoma rates followed the same group order after the first day of surgery: 1.7% (n = 2), 5.3% (n = 6), and 8.8% (n = 10), respectively, (p = 0.05). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3, (p = 0.210). We concluded that prolonged scrotal drainage for 72 h after virgin IPP implantation significantly reduces hematoma and infection rates.

Factors Contributing to Prolonged Drain Duration in Prepectoral Staged Implant-based Breast Reconstruction

Thawanyarat, Kometh BA; Shah, Jennifer K BS; Rowley, Mallory BA; Eggert, Gina; Kim, Trudy BS; Nazerali, Rahim MD, FACS Author Information

Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series.

Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilities of retaining an acutely infected TJA. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads in a setting of acute (<4 weeks from symptoms onset) PJI with pathogen identification. The combination of three different surgical techniques (tumor-like synovectomy, argon beam/acetic acid application and chlorhexidine gluconate brushing) aims to remove the bacterial biofilm from the implant without explanting the original hardware. In total, 62 patients met the acute infection criteria (<4 weeks of symptoms); there were 57 males and five females. The patients' average age at the time of treatment was 71 years (62-77) and the average BMI was 37 kg/m2. The micro-organism, always identified through synovial fluid analysis (culture, multiplex PCR or Next Generation Sequencing), was an aerobic Gram + in 76% (S. Coag-Neg 41%; S. aureus 16%), Gram-in 10% (E. coli 4%) and anaerobic Gram + in 4%. The DAPRI treatment was performed at an average of 3 days from symptoms onset (1-7 days). All patients underwent a 12-week course of post-operative antibiotic therapy (6 weeks I.V. and 6 weeks oral). All patients were available at the 2-year minimum FU (24-84 months). A total of 48 (77.5%) patients were infection-free at the final FU, while 14 patients underwent 2-stage revision for PJI recurrence. In total, four patients (6.4%) had a prolonged drainage from the wound after placement of the calcium sulphate beads. This study suggests that the DAPRI technique could represent a valid alternative to the classic DAIR procedure. The current authors do not recommend this procedure outside of the main inclusive criteria (acute scenario micro-organism identification).

Stability mechanism of controlled acid-resistant hydrophobic polymer nanospheres on CO2 foam

CO2 foam was an effective way to regulate CO2 mobility and control the gas breakthrough during the process of CO2 flooding. The poor stability of foam-phase restricted the enhanced oil recovery (EOR) ability of CO2 foam flooding, especially under the harsh reservoir conditions and the challenges are yet to be solved. As such, current work hypotheses that by applying the polymer nanosphere as the additive can extend the foam rupture to increase the foam-phase stability. The acid-resistant hydrophobic polymer nanosphere P(AM-AA-ARM-C16DMAAC) was prepared by the inverse microemulsion polymerization method, which used ARM and C16DMAAC as acid-resistant monomer and hydrophobic monomer, respectively. Then, the CO2 foam reinforced by anionic surfactant AOS and P(AM-AA-ARM-C16DMAAC) was developed, and the stability was compared with conventional foam system using Warning Blender method and high temperature and high pressure electromagnetic coupling agitator. Furthermore, the foam aging rules were investigated via the multiple light scattering method and double-layer glass model to further understand the CO2 foam stability mechanism of synthesized acid-resistant hydrophobic polymer nanospheres. The results demonstrated that P(AM-AA-ARM-C16DMAAC) had good swelling performance under acid environment. With the consistency of 0.2% AOS and 0.15% P(AM-AA-ARM-C16DMAAC), the CO2 foam showed the highest foam stability. The dynamic variations in the film thickness of the foam were characterized quantitatively. The prolonged liquid drainage was attributed to the foam liquid film maintained by released water and the liquid film ‘skeleton’ formed by polymer nanospheres. In addition, the formula of acid-resistant hydrophobic polymer nanospheres P(AM-AA-ARM-C16DMAAC) is adjustable under different environmental conditions. After deformation of the foam system, the polymer nanospheres could also act as plugging agent in the formation.

PD42-01 DRAINED VERSUS NON-DRAINED INFLATABLE PENILE PROSTHESIS IMPLANTATION: A MULTICENTER PROSPECTIVE PILOT STUDY ON A LARGE COHORT

You have accessJournal of UrologyCME1 Apr 2023PD42-01 DRAINED VERSUS NON-DRAINED INFLATABLE PENILE PROSTHESIS IMPLANTATION: A MULTICENTER PROSPECTIVE PILOT STUDY ON A LARGE COHORT Daniar Osmonov, Ahmed Ragheb, Petry Tim, Ahmed Eraky, Carlo Bettocchi, Glenn Lamers, Koenraad Van Renterghem, Marina Tropmann-Frick, Klaus-Peter Jünemann, Giulio Garaffa, Hartmut Porst, Ahmed Mohamed, and Steven Wilson Daniar OsmonovDaniar Osmonov More articles by this author , Ahmed RaghebAhmed Ragheb More articles by this author , Petry TimPetry Tim More articles by this author , Ahmed ErakyAhmed Eraky More articles by this author , Carlo BettocchiCarlo Bettocchi More articles by this author , Glenn LamersGlenn Lamers More articles by this author , Koenraad Van RenterghemKoenraad Van Renterghem More articles by this author , Marina Tropmann-FrickMarina Tropmann-Frick More articles by this author , Klaus-Peter JünemannKlaus-Peter Jünemann More articles by this author , Giulio GaraffaGiulio Garaffa More articles by this author , Hartmut PorstHartmut Porst More articles by this author , Ahmed MohamedAhmed Mohamed More articles by this author , and Steven WilsonSteven Wilson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite the wide utilization of post-inflatable penile prosthesis (IPP) implantation drainage, many surgeons still regard it as a potential source of infection. Our aim was to understand the risks and benefits of post-IPP drainage and optimal duration. METHODS: Patients underwent IPP implantation for the first time by four European high volume surgeons through penoscrotal access receiving similar perioperative antibiotics. They were divided into 3 groups based on the presence and duration of drainage. Group 1 (n=114) had no drain placed, Group 2 had a drain placed for 24 hours (n=114) and Group 3 had a drain placed for 72 hours (n=117). The presence or absence of postoperative (PO) scrotal hematoma and prosthesis infection were evaluated and compared between the groups via scrotal ultrasound (US) examination carried out 24 hours then 3 and 10 days PO. All patients were followed up postoperatively for a minimum of 80 days. RESULTS: The patients from Group 3 demonstrated a statistically significant lower incidence of hematoma on the 10th PO day: (n=1, 0.9%) compared to Group 2: (n=11, 9.6%) and Group 1: (n=8, 7%, p=0.013). However, on the 3rd PO day, which showed the highest hematoma prevalence, there was a statistically significant lower incidence of hematoma in Groups 3 and 2: (0.9% and 7%, respectively) versus Group 1: (11.4%, p=0.004). Hematoma rates followed the same order after the first day of surgery for Groups 1-3: 8.8% (n=10), 5.3% (n=6), and 1.7% (n=2), respectively. (p=0.054). Five patients (4.4%) in Group 1 and four patients (3.5%) in Group 2 developed an IPP associated infection, opposed to only a single patient (0.85%) in Group 3. CONCLUSIONS: Prolonged scrotal drainage for 72 hours after virgin IPP implantation significantly reduces hematoma and infection rates. It is likely that hematoma formation per se, is a predisposing factor for IPP infection. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1111 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniar Osmonov More articles by this author Ahmed Ragheb More articles by this author Petry Tim More articles by this author Ahmed Eraky More articles by this author Carlo Bettocchi More articles by this author Glenn Lamers More articles by this author Koenraad Van Renterghem More articles by this author Marina Tropmann-Frick More articles by this author Klaus-Peter Jünemann More articles by this author Giulio Garaffa More articles by this author Hartmut Porst More articles by this author Ahmed Mohamed More articles by this author Steven Wilson More articles by this author Expand All Advertisement PDF downloadLoading ...

Cierre de herida en cirugía protésica de rodilla y cadera (PTR y PTC): Resultados de una encuesta sobre la práctica clínica en España

Background and objectiveIn orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Methodan ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. ResultsA total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). ConclusionsThere is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT to standard-of-care dressings between January 2005 and August 2021. Study participant characteristics, surgical procedure, dressings used, treatment duration, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Risk ratios summarized dichotomous outcomes. Difference in means or standardized difference in means was used to assess continuous variables reported on the same scale or outcomes reported on different scales/measurement instruments. The literature search identified 84 studies for analysis. Significant reductions in surgical site complication (SSC), surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage were associated with ciNPT use (P < 0.05). Reduced readmissions and reoperations were significant in favor of ciNPT (P < 0.05). Patients receiving ciNPT had a 0.9-day shorter hospital stay (P < 0.0001). Differences in postoperative pain scores and reported amounts of opioid usage were significant in favor of ciNPT use (P < 0.05). Scar evaluations demonstrated improved scarring in favor of ciNPT (P < 0.05). For these meta-analyses, ciNPT use was associated with statistically significant reduction in SSCs, SSIs, seroma, dehiscence, and skin necrosis incidence. Reduced readmissions, reoperation, length of hospital stay, decreased pain scores and opioid use, and improved scarring were also observed in ciNPT patients.

Prevalence of anatomical variations in children with congenital lung malformations investigated by video recordings of thoracoscopic lobectomy

Background: Sufficient knowledge of anatomy including normal patterns and aberrant variations is crucial in thoracoscopic lobectomy for congenital lung malformations (CLMs). This study aimed to investigate the prevalence of anatomical variations and their correlations with surgical outcome. Methods: Video-recordings of thoracoscopic lobectomy performed for CLMs between 2009 and 2021 were reviewed. The incidences of surgically relevant variations, including abnormal branches of pulmonary arteries and veins, aberrant systemic arteries, and incomplete fissures (as classified by Craig) were assessed in comparison with the previously published reports. Moreover, multiple univariate analyses were performed to seek correlations between surgical finding and prolonged operative times and postoperative drainage. Results: Fifty-six lobectomies were reviewed. Variations of pulmonary arteries were more commonly seen in the left lung (29.6%) compared to right (10.7%). The prevalence of atypical pulmonary venous branches was similar between the right (13.8%) and left (18.5%). The right upper oblique fissure was frequently associated with Grade 2 incomplete fissure (44.8%). Grade 3 incomplete fissure was rare (3.4%) in the right lower oblique fissure but relatively common (14.3 – 18.5%) in other locations. Grade 4 incomplete fissure was limited to the right horizontal fissure (1.7%). Multiple univariate analyses demonstrated a significant correlation between any degree of incomplete fissure and prolonged operative time (p < 0.05), whereas no factor was identified to affect need for postoperative drainage. Conclusions: The incidence of anatomical variations in CLM patients was similar to that reported in adults. Review of intra-operative video footage was useful to closely evaluate and understand anatomical variations.

Optimal management of long-term air leakage after lung resections for cancer

Lung resection is the main diagnostic and therapeutic surgical intervention in terms of lung cancer management. Air leak through pleural drains often occurs after lung resections due to damage to the pulmonary parenchyma. Therefore, proper drainage of the pleural cavity is very important for the successful outcome of the operation. The installation of a single pleural drainage after anatomical resection, the refusal to use vacuum aspiration and the earliest possible removal of drains contribute to the rapid activation of patients in the postoperative period. Prolonged air leakage (PAL) after lung resection, on average, develops in 15 % of lung cancer patients, remaining one of the most common complications adversely affecting the rehabilitation of patients and leading to delayed discharge from the hospital. The incidence of empyema with prolonged air leakage is 10.4 % with air discharge for more than 7 days compared to 1 % with air leaks less than or equal to 7 days. PAL requires prolonged drainage of the pleural cavity, which increases postoperative pain, causing shallow breathing, difficulty coughing leads to an increased risk of pneumonia, decreased mobility is accompanied by a high risk of thromboembolic complications. In addition, the treatment of complications is associated with the need to perform additional invasive interventions such as chemical or mechanical pleurodesis. Prolonged air leakage is associated with an increase in hospital mortality. Patients with an air leak have a 3.4 times greater risk of death than patients without it. Active tactics in relation to PAL include preoperative prediction of a high risk of complications, intraoperative measures to prevent air leak from the lung parenchyma and postoperative treatment to reduce the duration of PAL. The urgency of the problem is due to the fact that prolonged air leakage in patients with lung cancer after organ-preserving operations is associated with an increased risk of infectious complications due to the need for prolonged drainage of the pleural cavity. In this review, the main attention is paid to two components of postoperative management of PAL: diagnosis with an accurate assessment of the intensity of air leak and treatment of alveolar-pleural fistulas.

Optimal discharge planning for esophagectomy patients with enhanced recovery after surgery: Recommendations.

Studies have suggested that the postoperative length of stay (PLOS) of esophagectomy patients under the enhanced recovery after surgery (ERAS) pathway should be >10 days as against the previously recommended 7 days. We investigated the distribution and influencing factors of PLOS in the ERAS pathway in order to recommend an optimal planned discharge time. This was a single-center retrospective study of 449 patients with thoracic esophageal carcinoma who underwent esophagectomy and perioperative ERAS between January 2013 and April 2021. We established a database to prospectively document the causes of delayed discharge. The mean and median PLOS were 10.2 days and 8.0 days (range: 5-97), respectively. Patients were divided into four groups: group A (PLOS ≤ 7 days), 179 patients (39.9%); group B (8 ≤ PLOS ≤ 10 days), 152 (33.9%); group C (11 ≤ PLOS ≤ 14 days), 68 (15.1%); group D (PLOS > 14 days), 50 patients (11.1%). The main cause of prolonged PLOS in group B was minor complications (prolonged chest drainage, pulmonary infection, recurrent laryngeal nerve injury). Severely prolonged PLOS in groups C and D were due to major complications and comorbidities. On multivariable logistic regression analysis, open surgery, surgical duration >240 min, age >64 years, surgical complication grade >2, and critical comorbidities were identified as risk factors for delayed discharge. The optimal planned discharge time for patients undergoing esophagectomy with ERAS should be 7-10 days with a 4-day discharge observation window. Patients at risk of delayed discharge should be managed adopting PLOS prediction.

The Fontan procedures – early outcomes and predictive factors

Objectives: the aim of this study was to describe the early outcomes after the extracardiac conduit Fontan procedure and evaluate predictive factors related to these results.&#x0D; Methods: a cross – sectional study. We retrospectively reviewed the perioperative medical records of 71 patients with Fontan surgery at Hanoi Heart Hospital between January 2017 and December 2020. Data processing using SPSS 22 software&#x0D; Results: the early mortality and early failure rates with Fontan circulation were 4.2%. High postoperative pulmonary artery pressure was a risk factor for early mortality and early Fontan failure. The mean duration of mechanical ventilation was 62.86±108.17 hours; female, short height, and common atrioventricular valve or double­inlet atrioventricular connection increased the risk of prolonged mechanical ventilation. The mean intensive care unit (ICU) length of stay was 6.46±6.32 days, female, short height, and moderate to severe postoperative atrioventricular valve regurgitation increased the risk of prolonged duration in ICU. The mean time of pleural drainage was 16.96±10.23 days, low weight was a risk factor for prolonged pleural drainage. The mean postoperative hospital stay was 23.89±11.83 days, age at the Fontan surgery, preoperative oxygen saturation, concomitant atrioventricular valve repair, and postoperative atrioventricular valve regurgitation were factors associated with prolonged postoperative hospital stay.&#x0D; Conclusion: the early outcomes after Fontan surgery have been consistent with our condition. There have been many risk factors that influenced early results after surgery, and identifying those factors may help with our treatment.

Predicting Prolonged Wound Drainage after Hemiarthroplasty for Hip Fractures: A Stacked Machine Learning Study.

Prolonged wound drainage (PWD) is one of the most important reasons that increase the risk of early periprosthetic joint infection after arthroplasty. It is very important to evaluate the risk factors for PWD in the surgical field after arthroplasty surgery. This can be accomplished using machine learning or artificial intelligence methods. Our aim in this study was to compare machine learning methods in predicting possible PWD. The study was carried out on clinical, laboratory, and radiological data of 313 patients who underwent hemiarthroplasty (HA) for proximal femur fractures. We preprocessed the dataset and trained and tested machine learning methods using cross validation. We compared various machine learning algorithms (linear discriminant analysis, decision tree, k-nearest neighbors, gradient boosting machine, and logistic regression [LR]) based on performance measures. We also combined the most successful algorithms with a metaclassifier. To help understand the relationship between risk factors, we provided a risk factor severity ranking. To estimate the risk of PWD, classification was performed with first-level classifiers and then integrated as a LR-based meta-learner stacking method. More performance improvements were achieved with the stacking method. We found that the stacking method was superior to other methods in PWD classification. We determined that the volume of fluid collected from the drain, morbid obesity class, blood transfusion, and body mass index score were the four most important risk factors according to stacking.

Solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation

Solid pseudopapillary neoplasm of the pancreas has been classified by the World Health Organization as a low-grade malignant tumor with potential to metastasize. The standard treatment for this neoplasm is complete surgical resection. However, it is not always feasible to perform a complex procedure such as pancreaticoduodenectomy or distal pancreatectomy, especially for patients with a history of hepato-biliary-pancreatic surgery. In such cases, the treatment strategy must consider the patient's postoperative quality of life. We herein report a case of solid pseudopapillary neoplasm of the pancreas following living-donor liver transplantation. The patient was a 13-year-old girl who had undergone the Kasai procedure for biliary atresia at 140 days of age. She thereafter underwent living-donor liver transplantation because of recurrent cholangitis and progressive jaundice. Her repeated history of cholangitis had caused narrowing of the portal vein. Therefore, the portal vein was reconstructed using the donor's ovarian vein as an interposition graft. At 13 years of age, a mass was identified at the head of the pancreas. Biopsy was performed and the patient was diagnosed with solid pseudopapillary neoplasm of the pancreas. Surgical resection was planned, and three options were considered: pancreaticoduodenectomy, duodenum-preserving pancreatic head resection, and enucleation. Considering the complications associated with radical surgery, tumor enucleation was performed. The patient developed a postoperative pancreatic fistula that required prolonged fasting and drainage. She began a low-fat diet on postoperative day 15. Because the pancreatic fistula was well controlled with a low-fat diet, the patient was discharged on postoperative day 51 after she and her parents had received dietary guidance. At the time of this writing, 1 year had passed since the enucleation with no evidence of recurrence. We have herein reported a case of solid pseudopapillary neoplasm of the pancreas after living-donor liver transplantation. Although a radical operation such as pancreaticoduodenectomy or distal pancreatectomy is preferable from an oncological perspective, enucleation should be considered for patients with high surgical risk.