Surgical Success Rate Research Articles

Relationship between Schlemm’s canal incision length and the results of ab interno gonioscopy-assisted transluminal suture trabeculotomy

We retrospectively investigated the relationship between Schlemm’s canal incision length and the results of ab interno gonioscopy-assisted transluminal suture trabeculotomy (GATST) with/without cataract surgery in open-angle glaucoma patients at Tsukazaki Hospital from 2018–2021. The study included 113 eyes from 76 patients (age: 70.0 ± 10.8 years; female/male: 43 [56.6%]/33 [43.4%]). GATST with and without cataract surgery was performed on 87 (phakia) [77.0%] and 26 eyes (pseudophakia) [23.0%], respectively; 102 [90.3%] eyes had primary open-angle glaucoma, and 11 [9.7%] had pseudoexfoliation glaucoma. Intraocular pressure (IOP) significantly decreased at 3/6/12 months, and the antiglaucoma eyedrop number significantly decreased at 6/12 months (all P values < 0.001). Linear mixed-effects models showed that incision length had significant positive associations with IOP spikes, hyphema grade, and IOP changes (amount/percentage) at 6 months; surgical success rate (IOP ≤ 15 mmHg, ≥ 20% reduction, no additional surgeries [criterion B]) at 6/12 months; and surgical success rate (IOP ≤ 21 mmHg, ≥ 20% reduction, no additional surgeries [criterion A]) at 12 months (Ps < 0.05). There were no significant associations with IOP changes at 12 months, surgical success rate (criterion A) at 6 months, or antiglaucoma eyedrop number at either timepoint (Ps > 0.05). Longer incisions were more likely to produce greater IOP reduction, requiring more attention to IOP spikes/hyphema.

Clinical Outcomes of XEN45 Gel Stent Implantation (Ab Externo, Open Conjunctival Approach) versus Trabeculectomy: A Real-World Study

Purpose: To compare the clinical outcomes of XEN45 gel stent implantation surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctiva) with those of trabeculectomy.Methods: We retrospectively reviewed electronic medical record of 57 patients (62 eyes) treated with XEN implantation surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctival approach) between April 1, 2021, and July 31, 2023, by the same surgeon. Preoperative clinical data including intraocular pressure (IOP), the number of glaucoma medications, and visual acuity were collected from 1 day to 12 months postoperatively. These data were compared and analyzed with those of 67 patients (78 eyes) received trabeculectomy between February 1, 2017, and April 30, 2022, by the same surgeon. Statistical analyses were performed with &lt;i&gt;p&lt;/i&gt; &lt; 0.05 as significant.Results: Complete surgical success rate was 33.9% and 57.7% of the XEN and trabeculectomy groups, respectively (&lt;i&gt;p&lt;/i&gt; = 0.005). The qualified success rate was 79.0% and 93.6%, respectively (&lt;i&gt;p&lt;/i&gt; = 0.011). Postoperatively, the XEN group used more glaucoma medications than the trabeculectomy group (1.21 ± 1.05 vs. 0.69 ± 0.90, &lt;i&gt;p&lt;/i&gt; = 0.003 at postoperative month 12). After postoperative month 1, the XEN group had a higher IOP (15.77 ± 5.07 mmHg vs. 13.17 ± 3.81 mmHg; at postoperative month 12, &lt;i&gt;p&lt;/i&gt; = 0.001) and lower corneal astigmatism than the trabeculectomy group (1.32 ± 0.79 diopters vs. 1.88 ± 1.45 diopters, &lt;i&gt;p&lt;/i&gt; = 0.020 at postoperative month 6). There was no significant difference in preoperative and postoperative best-corrected visual acuity (logMAR) between the groups at any of the follow-up period (favorable visual acuity subgroup; logMAR &lt; 0.7). Postoperative complications were 0 cases of XEN group and 13 cases of trabeculectomy group (0% vs. 16.7%, &lt;i&gt;p&lt;/i&gt; = 0.001). Also, XEN surgery (24 minutes 40 seconds ± 6 minutes 26 seconds) had a shorter operation time than the trabeculectomy (40 minutes 18 seconds ± 8 minutes 27 seconds, &lt;i&gt;p&lt;/i&gt; &lt; 0.001).Conclusions: Compared to trabeculectomy, XEN surgery (&lt;i&gt;ab externo&lt;/i&gt;, open conjunctiva) showed relatively lower effectiveness (surgical success rate, IOP reduction). However, it demonstrated advantages as a minimally invasive glaucoma surgery, including a surgical success rate approaching about 80%, stability in inducing corneal astigmatism, fewer postoperative complications, and shorter operation times.

Clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy

BackgroundThis study aimed to evaluate the clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy (PECD) in treating patients with symptomatic cervical spondylotic radiculopathy (CSR).MethodsA total of 105 patients with single-segment symptomatic CSR treated between January 2020 and January 2022 were retrospectively analyzed and divided into PECD and ACDF groups based on the surgical approach. Patient demographics, operation time, estimated intraoperative blood loss, complications, postoperative hospital stay, total hospitalization cost, neck dysfunction index (NDI), arm and neck visual analog scale (VAS) scores were compared and analyzed. The learning curve of the PECD group was assessed using cumulative sum (CUSUM) analysis.ResultsThere was no statistically significant difference in baseline data between the two groups (P > 0.05). The PECD group had shorter operative time, smaller incision length, less estimated intraoperative bleeding, lower total hospitalization costs, and shorter postoperative hospital stays compared to the ACDF group (P < 0.05). Postoperative NDI, arm VAS, and neck VAS scores improved significantly in both groups compared to preoperative values (P < 0.05). However, no significant difference was found between the two groups during the same period (P > 0.05). There were also no significant differences between the PECD and ACDF groups in the number of intraoperative fluoroscopies, complications, or surgical success rates (P > 0.05). As more cases accumulated, a trend toward shorter operative times was observed in the PECD group. When grouped according to the learning curve, with the 23rd case as the cutoff point, there was no significant difference in clinical outcomes between the learning phase and proficient phase groups (P > 0.05).ConclusionsPECD is a safe and effective procedure for treating single-segment CSR, offering clinical outcomes comparable to ACDF. PECD has a notable learning curve, requiring beginners to perform 23 cases to reach proficiency. However, longer operative times do not negatively impact preclinical outcomes.Trial registrationRetrospectively registered.

Systematic Review of Surgical Success, Complications, Revision Rates, Radiation Dosage, and Operative Time of 3D-Navigated versus Non-Navigated Spinal Procedures.

Three-dimensional (3D) navigation offers real-time guidance in surgery. However, there is limited and inconsistent data regarding the usability, safety, and efficacy. To address gaps in knowledge about 3D navigation in spinal surgery, we conducted a comprehensive review of success rates, complications, revisions, radiation exposure, and operative time associated with Federal and Drug Administration-approved 3D surgical navigation tools. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used a protocol registered on International Prospective Registration of Systematic Reviews (CRD42023404554). Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched using relevant keywords for 3D surgical navigation and spinal procedures from 1946 to March 02, 2023. Two independent reviewers assessed the studies using inclusion/exclusion criteria and risk of bias tools. Statistical analyses included one-way analysis of variance, weighted-mean difference, and unpaired t-tests with Welch's correction for associations and comparisons between groups, respectively. Of the total 11,324 studies identified and 7198 screened, 62 studies totaling 3170 adult patients were included in this comprehensive review. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.5% and 94.0%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r= 0.25, P= 0.68). The most commonly reported complication was pedicle screw malposition or breach. A subset of 20 studies, totaling 1554 patients, compared the performance of 3D navigation to two-dimensional fluoroscopy or freehand navigation. There was a significant difference of 6.53% between surgical success rates of the 3D-navigated and control groups (P= 0.03). However, there was no significant difference in radiation exposure or operative time. The 3D navigation in spinal procedures has higher surgical success rates than two-dimensional fluoroscopy and freehand navigation. Included studies exhibited varying limitations, including no patient follow-up (n= 1), less than 10 patients (n= 6), various types of spinal disorders (n= 1), and varying comorbidities among participants (n= 2). Improving 3D navigation tools remains imperative to decrease operative time and radiation exposure.

Coblation Versus Radiofrequency for Tongue Base Reduction in Obstructive Sleep Apnea: A Meta-analysis.

The objective of this study is to determine the effectiveness and safety profile of coblation tongue base reduction (CBTR) compared to radiofrequency base of tongue (RFBOT) reduction on sleep-related outcomes in patients with obstructive sleep apnea (OSA). PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews databases. Literature search by 2 independent authors was conducted using the abovementioned databases. Studies on CBTR and RFBOT as part of OSA treatment in adult patients with pre- and postoperative apnea-hypopnea index (AHI) were included. Direct meta-analysis and single-arm meta-analysis were conducted to compare sleep-related outcomes (AHI, apnea index [AI], surgical success rates, Epworth sleepiness score [ESS], SpO2, body mass index [BMI], and visual analog scale [VAS]) between both groups. A total of 40 studies with a total of 1940 patients were included, of which 1440 individuals who underwent tongue base reduction interventions (RF = 306, RF + UPPP = 656, and coblation + UPPP = 482) met inclusion criteria. Pooled analysis showed significant improvements in AHI (CBTR = -22.84, RFBOT = -11.14), AI (CBTR = 15.64, RFBOT = -5.26), ESS (CBTR = -7.59, RFBOT = -7.18), mean oxygen saturation (CBTR = 7.43, RFBOT = 4.25), mean BMI (CBTR = -0.69, RFBOT = -4.09), and snoring visual analog scale (CBTR = -16.20, RFBOT = -18.21). Surgical success rate (postoperative AHI < 20 and drop >50% from baselines) was 70% for CBTR and 43% for RFBOT. Both interventions decreased sleep-related outcomes in adult patients with OSA. Coblation appears to exhibit superiority over radiofrequency with a similar safety profile. However, further studies with direct comparisons between both interventions must be performed.

Understanding the anatomical basis of anorectal fistulas and their surgical management: exploring different types for enhanced precision and safety.

Anorectal fistulas remain one of the most challenging conditions in colorectal surgery and require precise anatomical knowledge for successful management. This comprehensive review synthesizes the current evidence on the anatomical foundations of fistula development and treatment, particularly focusing on the cryptoglandular hypothesis and its clinical implications. A systematic analysis of the recent literature has examined the relationship between anatomical structures and fistula formation, classification systems, diagnostic modalities, and therapeutic approaches. The review revealed that anatomical considerations fundamentally influence treatment outcomes, with modern imaging techniques achieving up to 98% accuracy in delineating fistula anatomy. Key findings demonstrate that surgical success rates vary significantly based on anatomical complexity: 92-97% for simple fistulas versus 40-95% for complex cases using sphincter-sparing techniques. Emerging minimally invasive approaches and regenerative therapies, including mesenchymal stem cells, show promising results with 50-60% healing rates in complex cases. Special considerations are needed for complex cases such as Crohn's disease-related and rectovaginal fistulas. This review provides surgeons with an evidence-based framework for selecting optimal treatment strategies based on anatomical considerations, emphasizing the importance of preserving the anal sphincter function while achieving complete fistula eradication. Integrating advanced imaging, surgical techniques, and emerging therapies offers new possibilities for improving patient outcomes. This review aimed to bridge the gap between anatomical knowledge and practical surgical application, enhance clinical decision-making, and improve patient outcomes in anorectal fistula management.

Effect of Tympanostomy Tube Removal Technique on Surgical Success and Operative Time.

Tympanostomy tube removal is a common procedure, the most common complication of which is persistent perforation. Multiple surgical techniques exist. This study seeks to determine whether the technique used affects success rate or surgical time. This was a retrospective cohort study in a tertiary-care children's hospital. Tube removal procedure codes were used to extract charts from 2008 to 2023. Data were collected on surgical technique, success, operative time, indications, and patient factors. Primary outcome measure was surgical success, defined as no residual perforation. A total of 1562 patient ears were analyzed. Success rate was 95.5% for trichloroacetic acid (TCA) myringoplasty with patch, 86.5% for cold myringoplasty with patch placement (CMwP), 74.7% for cold myringoplasty without patch placement (CMsP), and 73.8% for tube removal alone (TR). TR as compared with CMsP did not show a difference in closure rates (p = 1.0000). CMwP was more likely to be successful than TR (p = 0.0162) or CMsP (p = 0.0117). TCA was more likely to be successful than CMwP (p = 0.0197). Median operative time was 4 min for TR, CMsP, and CMwP and 5 min for TCA. This difference in operative time between the groups was statistically significant (p < 0.001). TCA myringoplasty with patch shows greater surgical success rate than cold myringoplasty with patch, cold myringoplasty without patch, or tube removal alone, but it has a longer operative time. Cold myringoplasty with patch has greater surgical success than cold myringoplasty without patch or tube removal alone. 3 Laryngoscope, 2025.

An evaluation of surgical excision versus steroid injection for the management of ganglion cysts

Ganglion cysts are benign soft tissue tumors that commonly occur in the joints, especially the wrist. Surgical excision and steroid injection are the two main treatment options; however, their efficacy remains unclear. This prospective interventional control trial included 54 patients with ganglion cysts treated between March 2023 and March 2024 at Saveetha Medical College Hospital, Chennai. Patients were divided into two groups: Group A underwent surgical excision and Group B received aspiration followed by 40 mg of intralesional triamcinolone acetonide injection. The highest incidence was observed in younger patients aged 14–19 years (13 patients), with more females (57.4%) affected. The cysts were equally distributed between the left and right hands. All patients presented with swelling, and 59.3% experienced pain/discomfort. In Group A surgical excision success rate was 92.5%, with a 7.5% recurrence rate. Group B had a lower success rate (64.3%) and higher recurrence rate (35.7%) with aspiration and injection. Surgical excision demonstrated significantly better outcomes, with higher success and lower recurrence rates than aspiration and steroid injection for the management of ganglion cysts. Therefore, this should be considered the preferred treatment option.

Quantifying right ventricular function in tetralogy of fallot: 3D echo into longitudinal, radial, and anteroposterior directions

Abstract Introduction Tetralogy of Fallot (ToF) is a congenital heart disease requiring surgical correction in early childhood. Despite high surgical success rates, patients cope with severe morbidity during adulthood predominantly originating from the right ventricle (RV). Pathophysiological processes underlying these conditions remain largely unknown, but are mostly attributed to RV remodelling. Improved understanding of remodelling patterns is essential for advancements in clinical decision making and treatment planning. Purpose To gain better insight in RV remodelling in patients with ToF, a method for detailed quantification of directional components of RV function was developed using three-dimensional echocardiography (3DE). Methods From RV-focused 3DE studies of 50 ToF patients and 50 healthy controls, three-dimensional dynamic RV meshes were obtained using commercially available software (TomTec 4D RV-Function). Within an in-house developed software application (RV-Dynamics), a technique was realized to decompose RV contraction in longitudinal (LT), radial (RD), and anteroposterior (AP) motion directions (Figure 1). Their relative contributions to RV ejection fraction (RVEF) were calculated as measure for RV function, analysed, and statistically compared within and between ToF patients and healthy controls. Results Decomposed RVEF in the AP motion direction was identified as the largest relative contributor to RVEF in both ToF patients (38% [31 – 42]) and healthy controls (40% [37 – 44]). Moreover, the AP component was significantly reduced in ToF patients compared to healthy controls (p=0.004). Deterioration in AP direction was complemented by a significant increase of the LT RVEF component (p=0.009), with 28% [26 – 33] in ToF patients compared to 26% [23 – 31] in healthy controls. Relative contribution of RD motion remained the same between both groups (p=0.649) (Figure 2). Conclusion RV-Dynamics allowed for effective directional decomposition of RVEF, enabling detailed quantification of RV function in patients with ToF. The AP component proved to be the largest relative contributor to RVEF in both ToF patients and healthy controls, disputing currently applied parameters focussing on LT wall motion for RV function assessment. Deterioration of RV function in ToF patients was mostly assigned to decreased contribution of AP wall motion to RVEF. We hypothesised this relates to the crucial involvement of left ventricular function in RV function, as RV motion in AP direction is largely attributed to left ventricular systolic function. A compensatory increase in LT contraction was observed, suggesting RV remodelling in LT direction in ToF patients.

Anatomical and Functional Outcomes of Heavy Silicone Oil (Oxane® HD and Densiron® 68) in Complex Primary Rhegmatogenous Retinal Detachment.

To evaluate the efficacy of heavy silicone oils (HSO) as endotamponades in the repair of primary complex rhegmatogenous retinal detachment (RRD). This retrospective, single-centre, non-randomised study included 82 eyes of 82 patients with primary macular-off RRD associated with inferior proliferative vitreoretinopathy. Each eye was treated with one of two HSO tamponades: Oxane® HD or Densiron® 68. Study outcomes were primary and final success rates, final logMAR gain and postoperative complications. The final outcome was based on 12-month follow-up. Of the 82 eyes, 45 were treated with Oxane HD and 37 with Densiron 68. There were no significant differences in demographic and clinical characteristics between the groups. The primary and final surgical success rates were 66.6% and 75.7% for Oxane HD and 75.6% and 81% for Densiron 68, respectively; these differences were not statistically significant. In addition, the final logMAR gain was 0.36 ± 0.51 (median 0.2) in the Oxane HD group and 0.57 ± 0.58 (median 0.5) in the Densiron 68 group (p = 0.027). Complication rates were similar between groups (p > 0.05). Our study suggests that HSOs may be an effective alternative for suitable patients in primary complex RRD cases, demonstrating high anatomical success and a low adverse event profile.

The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis.

This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.05). The LTCBDE group had shorter surgical time, earlier time to get out of bed, earlier first flatus time, shorter postoperative hospital stays, and earlier removal of abdominal drainage tube compared to the LCBDE and the ERCP + LC groups (all p < 0.05). The average hospitalization cost was also lower in the LTCBDE group (p < 0.05). LTCBDE for the treatment of gallbladder stones with common bile duct stones leads to faster recovery and improved quality of life. It is safe and effective, making it a method worthy of promotion.

An analysis of heavy silicone oil treatment for inferior proliferative vitreoretinopathy

PurposeProliferative vitreoretinopathy (PVR) is a complication of retinal detachment which requires multiple vitreoretinal surgical interventions and frequent use of oil endotamponade. In this study, we conducted an in-depth analysis of complications associated with the use of heavy silicone oil in the management of inferior PVR.MethodsA retrospective cohort study of 20 eyes that underwent vitrectomy for inferior PVR with use of heavy silicone oil (Densiron 68) between March 2021 and October 2022 at Oxford Eye Hospital. Complications were classified into major categories relating to intraocular pressure, inflammation, lens, and oil emulsification/migration. Visual outcomes and surgical success rate were also evaluated.ResultsFill-induced pressure spikes (> 30 mmHg) within 14 days post-surgery were common after Densiron tamponade, especially in patients previously on glaucoma drops. The number of glaucoma drugs were increased in 45% of patients during Densiron tamponade. In 20% of cases, an increased medication was continued long-term after Densiron removal. Significant cataract progression occurred in all phakic patients. In 25% of pseudophakic cases, posterior capsule opacification was noted. Inflammatory complications, such as anterior uveitis, were rare and any cystoid macular oedema was transient. No unexplained acute loss of vision following Densiron removal was encountered. The anatomical success rate at 30 days after Densiron removal was 70%. The mean (± SD) best-corrected visual acuities were 1.04 (± 0.79), 0.85 (± 0.62) and 0.50 (± 0.51) logMAR prior, during and after Densiron tamponade, respectively.ConclusionThe outcomes in this cohort treated with Densiron 68 were comparable to previously reported anatomical and functional results in cases with inferior PVR. IOP and lens-related complications require additional treatment during or after Densiron tamponade. Inflammatory complications rarely occurred over tamponade durations of around three months.Trial registrationAnalyses were conducted as an internal quality improvement audit and as such did not require external IRB review.

Effect of intracameral air injection during Ahmed glaucoma valve implantation on hypertensive phase

The purpose of this study was to evaluate the difference in the incidence of the hypertensive phase (HP) between Ahmed glaucoma valve (AGV) patients who received intracameral air injection and those who did not. A total of 78 patients who underwent AGV surgery between January 1, 2016 and June 30, 2023 were included in this retrospective study. HP was defined as intraocular pressure (IOP) greater than 21 mmHg within the first 6 postoperative months. Among baseline characteristics, except for neovascular glaucoma and baseline IOP, there were no differences between the air injection and control groups. In the air injection group, the rate of HP was 19%, which was significantly lower than 49.1% in the control group (p = 0.017). In multivariate logistic regression analysis, baseline IOP had a significant positive correlation (OR: 1.120, p = 0.026), while age and intracameral air injection had a significant negative correlation with the incidence of HP (OR: 0.938, p = 0.028, OR: 0.142, p = 0.029). Postoperative IOP at 1 year and surgical success rates were not different between the two groups. Intracameral air injection during AGV surgery can significantly reduce the risk of HP. Intracameral air injection can be a simple procedure in AGV surgery for reducing HP.

Effect of multi-level upper airway surgery on obese patients with obstructive sleep apnea.

Obesity is a major risk factor in Obstructive sleep apnea (OSA), which is a prevalent disease that leads to significant morbidity. Multi-level Sleep Surgery (MLS) is a method of treatment for patients who cannot tolerate continuous positive airway pressure. Obesity has previously been identified as a risk factor that may decrease the success rate of MLS. The purpose of our study is to assess the success rates of MLS in obese patients. A retrospective cohort study in 109 adults that underwent MLS in our institution. All the participants completed pre-operative and post-operative level 1 polysomnography. They were divided into four groups as per their body mass index (BMI): Normal (BMI < 25), overweight (25-30), obese (30-35), morbid obese (> 35) and the variables were compared. We measured the surgical success as defined by Sher Criteria (AHI drop > 50% from preoperative baseline and AHI < 20) and cure rates (AHI < 5). The average BMI was 30.9 pre-op and 30.4 post-op. The mean AHI was 29.8 pre-op and decreased to 10.1 (p < 0.001) and the Epworth Sleepiness Scale from 12.9 to 4.8 (p < 0.001). There were 13, 31, 43, and 22 patients in normal, overweight, obese and morbidly obese groups, respectively. The surgical success rate as defined by Sher's criteria was 84%, 84%, 72%, and 77% in the respective groups, with no statistical difference (p = 0.662). Moreover, the cure rate was 77%, 45%, 44%, and 45%, with no statistical difference (p = 0.192). The AHI reduction was 9.93, 19.73, 21.1 and 22.8 in the respective groups. A linear regression analysis revealed no significant difference in assessing the surgical success and cure rates as BMI increases. Data regarding MLS success rates on obese patients is scarce. The current study demonstrates that MLS can offer positive outcomes for this population. However, further studies are warranted to investigate this relationship.

Impact of mitomycin C on surgical outcomes of PAUL glaucoma implant in neovascular glaucoma: 12-month follow-up results.

To evaluate the effectiveness of the PAUL Glaucoma Implant (PGI) and the adjunctive impact of intraoperative Mitomycin C (MMC) on surgical outcomes in patients with neovascular glaucoma (NVG). This retrospective, comparative study included NVG patients who underwent PGI implantation. The cohort was divided into two groups: Group 1 (PGI without MMC) and Group 2 (PGI with MMC). Inclusion criteria encompassed a minimum 12-month postoperative follow-up and preoperative light perception. Surgical success was defined as maintaining intraocular pressure (IOP) between 6-21 mmHg without additional surgical intervention from the third month to the end of the 12-month follow-up. Failure due to hypotony was defined as an IOP ≤5 mmHg. The study enrolled a total of eighty-one patients, with 40 patients in Group 1 and 41 in Group 2. There were no significant differences in the demographic data and baseline ocular characteristics between the groups. Group 1 required more medications at 1, 3, 6, and 12 months (p < 0.05 for all). Surgical success rates at 12 months were 85% for Group 1 and 87.8% for Group 2, with no statistically significant difference between the groups (p = 0.140). Group 2 demonstrated a lower frequency of additional glaucoma procedures (p = 0.003) and delayed ripcord suture removal (p = 0.0001). Incorporating MMC as an adjunct to PGI implantation may improve IOP control and decrease the requirement for additional medications and surgical interventions in NVG patients. However, there was no statistically significant difference between the two groups in terms of the surgical success criterion.

Polysomnographic endotypes of successful multilevel upper airway surgery for obstructive sleep apnea.

Multilevel upper airway surgery is effective for some patients with obstructive sleep apnea (OSA), but prediction the response to surgery remains a challenge. The underlying endotypes of OSA include upper airway collapsibility, muscle compensation, loop gain, and the arousal threshold. This study aimed to explore the effect of surgery on polysomnography (PSG)-derived OSA endotypes and establish a surgical response prediction model. Our study included 54 Chinese patients with OSA who underwent multilevel upper airway surgery. Participants underwent PSG before and after surgery with a median follow-up time of 6.5 months. Using AHIBaseline/AHIpost-surgery ≥ 2 and AHIpost-surgery < 10 events/h as criteria, participants were classified as surgery responders and non-responders. The surgical success rate was 26%. These endotypic traits were derived from a standard PSG data by validated methods. The surgery altered both anatomical and non-anatomical endotypic traits, including increased Vpassive (baseline VS post-surgery: 51.5[18.7-84.2] VS 86.8 [67.4-93.7] %Veupnea, p<0.001), decreased loop gain (baseline VS post-surgery: 0.7 [0.7-0.8] VS 0.6[0.5-0.6]; p<0.001), and a higher arousal threshold (baseline VS post-surgery: 202.9[183.7-222.0] VS 160.7[143.9-177.4] %Veupnea; p<0.001). However, it did not significantly affect muscle compensation. Fully adjusted logistic regression analyses indicated that a favorable response to surgery was independently associated with a lower LG (OR [CI 95%], 0.1[0.0-0.5], p= 0.032). In patients with improved muscle compensation or a more collapsible airway (lower Vpassive), a lower loop gain was more strongly indicative of success. However, when muscle compensation was lower or collapsibility was less severe (higher Vpassive), a lower loop gain was less predictive of success. This study demonstrated that multilevel upper airway surgery altered both anatomical and non-anatomical endotypes in Chinese patients with OSA. An endotype based regression model may meaningfully predict surgical success.

Effectiveness and safety of full-thickness versus circular muscle myotomy in peroral endoscopic myotomy: a retrospective single-center analysis of 152 patients.

Achalasia is a primary esophageal motility disorder, which shows impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristalsis, leading to dysphagia, weight loss, and chest pain. In recent years, peroral endoscopic myotomy (POEM) has become a popular method for treating achalasia. However, the effectiveness and safety of full-thickness myotomy (FTM) versus circular muscle myotomy (CMM) in POEM require further investigation. This retrospective single-center analysis studied 152 patients who underwent POEM surgery at the General Hospital of the Western Theater Command from May 2014 to May 2023. Patients were divided into two groups based on the depth of myotomy: the FTM group and the CMM group. Parameters such as surgical success rate, procedure time, and myotomy length were evaluated, and treatment efficacy was assessed based on the Eckardt score. Postoperative complications and efficacy were also monitored. Technical success was achieved in both groups, with shorter procedure times in the FTM group (P < 0.05). There were no significant differences in postoperative Eckardt scores and symptom improvement between the FTM and CMM groups. The incidence of adverse events was similar in both groups. The incidence of gastroesophageal reflux disease (GERD) seemed to be higher in the FTM group, although this difference was not statistically significant (P = 0.051). For patients with achalasia, there were no significant differences in short-to-medium-term treatment efficacy and safety between FTM and CMM in POEM. Although FTM significantly reduced procedure time, it may lead to a higher incidence of GERD. More cases are needed in the future to explore the more appropriate myotomy for different achalasia subtypes.

The Impact of Preoperative Risk Factors on Delayed Discharge in Day Surgery: A Meta-Analysis.

This study aims to evaluate and identify the main preoperative risk factors affecting the timely discharge of day surgery patients, offering evidence to enhance preoperative assessments and minimize delayed discharge. With the widespread adoption of day surgery in global healthcare systems, ensuring timely discharge of patients post-surgery has become a critical challenge. Numerous studies have explored various preoperative risk factors influencing delayed discharge. This meta-analysis integrates existing evidence to clarify the primary preoperative risk factors. A systematic search was conducted across the PubMed, CINAHL, Scopus, Web of Science, Embase, Cochrane Library, and CNKI databases, including all clinical studies on preoperative risk factors for day surgery published until 15 October 2024. A systematic review and random effects model were employed to aggregate data and estimate the main preoperative risk factors for day surgery. A total of nine studies involving 41,458 patients were included. The analysis revealed statistically significant differences in the following preoperative risk factors: age (MD = 1.33, 95% CI: 0.73-1.93, p < 0.0001), body mass index (BMI) (MD = 0.69, 95% CI: 0.18-1.20, p = 0.008), the presence of chronic comorbidities (OR = 3.62, 95% CI: 2.93-4.46, p < 0.00001), the type of anesthesia (OR = 15.89, 95% CI: 7.07-35.69, p < 0.00001), a history of cardiac disease (OR = 2.46, 95% CI: 1.71-3.53, p < 0.00001), gender (OR = 3.18, 95% CI: 2.03-4.99, p < 0.00001), the expected duration of surgery (MD = 0.18, 95% CI: 0.15-0.20, p < 0.00001), complex procedures (OR = 1.78, 95% CI: 1.47-2.16, p < 0.00001), a lack of social family support (OR = 2.42, 95% CI: 1.60-3.67, p < 0.0001), and inadequate preoperative assessment (OR = 3.64, 95% CI: 2.06-6.41, p < 0.00001). There were no statistically significant differences between the delayed discharge group and the non-delayed discharge group in terms of the American Society of Anesthesiologists (ASA) classification (p = 1.00) and preoperative anxiety (p = 0.08). This study identifies the primary preoperative risk factors for delayed discharge in day surgery, including age, high BMI, the presence of chronic comorbidities, the type of anesthesia, a history of cardiac disease, gender, the duration of surgery, the complexity of the procedure, a lack of social family support, and inadequate preoperative assessment. These findings provide a reference for preoperative assessment, highlighting the need for clinical attention to these high-risk groups during preoperative screening and management to reduce the likelihood of delayed discharge and enhance surgical safety and success rates.

Pediatric Robotic-assisted Laparoscopic Pyeloplasty: Defining Mastery Over a 15Year Experience.

Robotic-assisted laparoscopic pyeloplasty (RALP) has been widely utilized within pediatric urology as RALP provides additional advantages to laparoscopic pyeloplasty including a more manageable learning curve. We aim to describe the maturation and mastery of pediatric RALP through our proposed trifecta of operative time, complication rates, and surgical success rates. We retrospectively reviewed 148 patients who underwent RALP between 2007 and 2022. Primary outcomes included operative time, Clavien-Dindo Grade (CDG) III complications, and surgical success rate. Patients were retrospectively divided into three cohorts (learning phase, competency phase, and mastery phase) based upon a cumulative sum (CUSUM) analysis of operative time. Three learning phases were differentiated at case 13 and case 41 per CUSUM analysis. Operative time significantly decreased from a mean of 261.33±42.52min in the learning phase to 140.61±25.87min in the mastery phase (p<0.001). CDG III complications were significantly different between phases as well, decreasing from 27.3% to 5.75% (p=0.045). Success rates were significantly different and increased from 83% in the learning phase to 98% in the mastery phase (p=0.015). Successful RALP implementation, and the achievement of surgical mastery, is multifaceted and multi-phasic. Our data suggests that learning is established within the first 12 cases and mastery and maximal outcomes are achieved after 41 cases. More specifically, operative time, complication rates, and success rates become increasingly optimized at each phase of learning. Our work can be used to establish clinical goals, design training curriculums, and inform patient counseling. Level III.

Comparison of Graft Uptake in Perforated Eardrums with and without Myringosclerosis: A Prospective Case-control Study in a Tertiary Centre.

Introduction Various factors have been reported to affect the rates of success after tympanoplasty, among them, myringosclerosis. However, there are few studies focusing only on the effect of myringosclerotic plaque removal on tympanoplasty outcomes. Objective To compare the outcome of tympanoplasty in perforated eardrums with and without myringosclerosis. Methods The study included patients aged between 21 and 53 years diagnosed at the outpatient department with inactive mucosal chronic otitis media. The sample was divided into the case group, which included subjects with tympanic membrane perforation and myringosclerosis, and the control group, which included subjects with tympanic membrane perforation only, without myringosclerosis. We assessed the audiological findings of the patients before and after surgery, as well as hearing gain, graft uptake, and residual perforation/reperforation. Results No significant relationships were observed involving the age or sex of the patient and the closure rate or hearing gain, neither between the location of the perforation and graft uptake. Graft uptake was higher in patients with perforation size < 50%. The graft uptake and hearing gain were higher in the case group. Conclusion The removal of sclerotic plaques increases the surface of the raw area created by subepithelial excision of the myringosclerotic plaques, leading to a high rate of surgical success for the closure of tympanic membrane defects with coexisting myringosclerosis.