Repair Procedures Research Articles

The Life Cycle of Orofacial Cleft Operations.

Patients with cleft lip and palate must undergo various surgical interventions at appropriate times to achieve optimal outcomes. While guidelines for the timing of these operations are well known, it has not yet been described if national surgical practice reflects these recommendations. This study evaluates whether orofacial operations are performed in time frames that align with advised timing. Time-to-event analyses were performed using the 2012-2020 Pediatric National Surgical Quality Improvement Program database on the ages at time of orofacial operations. Outliers with an absolute Z-score of 3.29 or greater were excluded. Cleft lip (N=9374) and palate (N=13,735) repairs occurred earliest at mean ages of 200.99±251.12 and 655.08±694.43 days, respectively. Both operations clustered along the later end of recommended timing. 69.0% of lip versus 65.1% of palate repairs were completed within the advised age periods. Cleft lip (N=2850) and palate (N=1641) revisions occurred at a mean age of 7.73±5.02 and 7.00±4.63 years, respectively. Velopharyngeal insufficiency operations (N=3026), not including palate revision, were performed at a delayed mean age of 7.58±3.98 years, with only 27.7% of operations occurring within the recommended time frame. Finally, 75.8% of alveolar bone grafting cases (N=5481) were found to happen within the advised time period, with a mean age of 10.23±2.63 years. This study suggests that, with the exception of VPI procedures, orofacial operations reliably cluster near their recommended age periods. Nevertheless, primary lip repair, palatoplasty, and velopharyngeal insufficiency procedures had a mean age that was delayed based on advised timing.

Efficacy of levosimendan vs its combination with magnesium sulphate on spinal cord protection in infants undergoing coarctectomy: A randomized controlled study

ABSTRACT Background and Objective Spinal cord ischemia with subsequent paraplegia secondary to aortic coarctation repair procedures is rare, but it has serious consequences that can affect quality of life. Infrared spectroscopy (NIRS) is used for non invasive spinal cord oxygenation monitoring to estimate cord perfusion and detect early cord ischemic changes. Several pharmacological agents have been used to improve cord perfusion, the main action of these agents is to improve regional/systemic perfusion and decrease ICP. In the current study, we studied magnesium sulphate and levosimendan for their vasodilating effect that might improve spinal cord perfusion as part of spinal cord protection. Methods Forty two infants undergoing aortic coarctectomy under general anaesthesia were registered in double blinded randomized controlled study, three groups were included; group C received i.v. saline, group L received levosimendan in loading dose 6ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min till end of surgery and group M received levosimendan in loading dose 6 ug/kg i.v. for 15 minutes then maintenance dose 0.1 ug/kg/min in combination with magnesium sulphate in loading dose 25 mg/kg i.v. for 15 minutes then maintenance dose 10 mg/kg/hr till the end of surgery. The vital signs and NIRS values assessed before, during and after clamping of aorta. Results All baseline demographic data were comparable among all groups except for height (cm), which was significantly lower in Group L compared to Group C (p = 0.013). NIRS values were comparable among the three groups throughout experimental protocol except after cross clamp at 20 minutes, where Group M was significantly higher compared to group C (P = 0.007).Heart rate, mean arterial blood pressure, total fluid intake, urine output, aortic cross clamp time and surgical time was comparable among all groups, were comparable among 3 studied groups. Conclusion Adding magnesium sulphate to levosimendan has showed improvement in spinal cord perfusion during cross clamping as monitored by NIRS when compared to use of levosimendan alone or placebo in coarctectomy operations without affecting hemodynamics.

Endoscopic Tendon Compression Bridge Technique for Repair of Partial-Thickness Gluteus Medius Tears With Concomitant Arthroscopy for Labral Tears: Minimum 2-Year Outcomes With Benchmark Control Group

Background: The transtendinous technique has been used to treat partial-thickness gluteus medius tears in the setting of concomitant arthroscopy for labral tears. The tendon compression bridge technique for gluteus medius repair has been developed as an alternative method, providing several advantages; however, comparative studies between the 2 techniques are lacking in the literature. Purpose: (1) To evaluate the short-term patient-reported outcomes (PROs) of the tendon compression bridge technique and (2) to compare these findings with short-term PROs of the transtendinous technique. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who were followed for a minimum of 2 years after an endoscopic tendon compression bridge procedure for gluteus medius repair in the setting of concomitant hip arthroscopy for labral tears. The following PROs were collected preoperatively and postoperatively: modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, visual analog scale score for pain, and the International Hip Outcome Tool. Clinical outcomes were assessed using the Patient Acceptable Symptom State, minimal clinically important difference, and maximum outcome improvement satisfaction threshold. Patients were propensity matched 1:1 to a cohort that underwent gluteus medius repair using the endoscopic transtendinous technique with concomitant hip arthroscopy. Results: A total of 48 hips (48 patients) that met inclusion criteria (age, 53.3 ± 9.8 years; 92% female; body mass index, 26.7 ± 4.6), with a mean follow-up of 38.5 ± 15.7 months, were matched to 48 hips (46 patients) that underwent gluteus medius repair using the transtendinous technique. Both groups demonstrated significant improvement from preoperative scores to latest follow-up (P < .05). Mean magnitude of improvement and latest follow-up scores were not significantly different between the tendon compression bridge group and the transtendinous group, and the groups demonstrated similar favorable rates of achieving Minimal Clinically Important Difference (79% vs 79%, respectively), Patient Acceptable Symptom State (73% vs 73%, respectively), and Maximum Outcome Improvement Satisfaction threshold (65% vs 58%, respectively) for modified Harris Hip Score (P > .05). Patient satisfaction between groups was similar (8.1 ± 2.2 vs 7.7 ± 2.7, respectively) (P = .475). Conclusion: At minimum 2-year follow-up, the endoscopic tendon compression bridge technique for partial-thickness gluteus medius tears, when performed with concomitant hip arthroscopy, was associated with significant improvement in functional outcomes. These postoperative results were comparable with those of a matched cohort that underwent the endoscopic transtendinous technique for partial-thickness gluteus medius tears, suggesting that the tendon compression bridge technique for gluteus medius repair is an effective treatment option for partial-thickness gluteus medius tears.

Avulsion fracture is associated with more pain after anatomic repair procedure for ATFL injury at the talar side

AbstractPurposeTo evaluate the clinical outcomes of anatomic repair procedure for chronic anterior talofibular ligament (ATFL) injury at the talar side, and to compare the outcomes between patients with and without concomitant avulsion fractures. It was hypothesized that anatomic repair procedure could produce similarly satisfactory outcomes for those two groups.MethodsThirty‐nine consecutive patients with chronic ATFL injuries at the talar side who underwent anatomic repair procedure at the department of sports medicine at Peking University Third Hospital between 2013 and 2018, were retrospectively evaluated. The pain visual analogue scale (VAS), American Orthopaedic Foot &amp; Ankle Society (AOFAS) score, Tegner score, and Foot &amp; Ankle Outcome Score (FAOS) were recorded as the primary outcomes. Time to return to sports (RTS), surgical satisfaction, deficiency of ankle range of motion (ROM), recurrent sprain, and postoperative complications were recorded as the secondary outcomes. Outcomes were compared between patients with (Group A, 16 cases) and without (Group B, 23 cases) concomitant avulsion fractures.ResultsThe mean follow‐up time was 79.4 ± 17.0 and 76.6 ± 18.5 months for Group A and B, respectively. VAS, AOFAS, Tegner, FAOS, and all subscale scores of FAOS were significantly improved in both groups at the final follow up. Patients in group A had inferior postoperative VAS, AOFAS, FAOS, and pain score of FAOS compared to group B (1.1 ± 1.1 vs. 0.4 ± 0.5, 89.1 ± 10.1 vs. 95.2 ± 5.2, 87.2 ± 7.2 vs. 91.5 ± 4.1, and 88.4 ± 11.3 vs. 96.7 ± 3.5, respectively).The mean time to RTS, rate of satisfaction and recurrent sprain had no significant differences between group A and B (6.1 ± 2.8, 93.8%, and 18.8% vs. 5.2 ± 2.2, 100.0%, and 13.0%, respectively), and the rate of ROM deficiency was significantly higher in group A (37.5 vs. 8.7%). Avulsion fracture was identified as an independent risk factor for inferior pain score of FAOS.ConclusionAnatomic repair procedure for chronic ATFL injuries at the talar side produces favourable results for patients with and without avulsion fractures at 5 to 10 years follow‐up, however, avulsion fracture is associated with more pain.Level of evidenceIII.

Increased risk of reoperation and failure to attain clinically relevant improvement following autologous chondrocyte implantation of the knee in female patients and individuals with previous surgeries: a time-to-event analysis based on the German cartilage registry (KnorpelRegister DGOU)

PurposeThis study aimed to analyze the risk of reoperation following autologous chondrocyte implantation (ACI) of the knee utilizing third-generation ACI products in a time-to-event analysis and report on the associated patient-reported outcome measures (PROM) in case of reoperation.MethodsPatients undergoing ACI were included from a longitudinal database. Patient age, sex, body mass index (BMI), number of previous surgeries, lesion localization, lesion size, symptom duration, as well as time and type of reoperation was extracted. A cox proportional-hazards model was applied to investigate the influence of baseline variables on risk of reoperation. Reoperation was defined as any type of subsequent ipsilateral knee surgery, excluding hardware removal. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was utilized to compare PROM between patients with and without reoperation.ResultsA total of 2039 patients were included with 1359 (66.7%) having a minimum follow-up of 24 months. There were overall 243 reoperations (prevalence 17.9%). Minor arthroscopic procedures (n = 96, 39.5%) and revision cartilage repair procedures (n = 78, 32.1%) were the most common reoperations. Nineteen patients (0.9%) reported conversion arthroplasty at 17.7 (10.4) months after ACI. Female sex (HR 1.5, 95% CI [1.2, 2.0], p = 0.002) and the presence of 1–2 previous surgeries (HR 1.5, 95% CI [1.1, 2.0], p = 0.010), or more than 2 previous surgeries (HR 1.9, 95% CI [1.2, 2.9], p = 0.004) were significantly associated with increased risk of reoperation following ACI. Significantly less patients surpassed the minimal clinically important difference (MCID) in the reoperation group at 24 months regarding the KOOS subscores pain (OR 1.6, 95% CI [1.1, 2.2]), quality of life (OR 2.2, 95% CI [1.6, 3.2]), symptoms (OR 2.0 [1.4, 2.9]), and sports (OR 2.0 [1.4, 2.8]).ConclusionFemale patients and individuals with a history of previous surgeries face an elevated risk of requiring reoperation after undergoing ACI, which is associated with failure to attain clinically relevant improvements. A thorough evaluation of the indications for ACI is paramount, particularly when patients have a history of previous surgeries.Level of evidenceLevel III.

A novel hemodynamic index characterizing mitral regurgitation undergoing transcatheter edge to edge repair: the mitral pulse pressure fraction

Abstract Objectives Our study sought to investigate the role of invasive hemodynamic monitoring during Transcatheter Edge to Edge Repair (TEER) procedure on top of transesophageal echocardiographic (TEE) guidance. Background Direct hemodynamic impact of residual MR after TEER is not always univocally measured by TEE assessment alone. When analyzing TEER procedure result operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring. Methods We analyzed 78 patients with moderate-to-severe or severe mitral regurgitation (MR) who underwent TEER. Mitral pulse Pressure Fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. 23 patients with the same grade of MR not undergoing TEER were included as a control group. Results TEER had a significant impact reducing MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting (p &amp;lt; 0.001) and control group (p = 0.004). MR reduction assessed by TEE guidance was not found to be correlated with improved clinical and functional status at follow-up as assessed by New York Heart Association (NYHA) classification (p = 0.424) and 12-items Kansas City Cardiomyopathy Questionnaire (KCCQ) (p = 0.1). On the contrary, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification (p = 0.003) and 12-items KCCQ (p&amp;lt;0.001) during the follow-up period. Conclusions MPF provides an immediate estimate of the real hemodynamic impact of MR and can offer a prompt prediction of the functional improvement after TEER.

Efficacy and evolution of edge-to-edge transcatheter valve repair procedures

Abstract Background Edge-to-edge transcatheter mitral valve repair (M-TEER) has shown safety and efficacy in reducing secondary mitral regurgitation (MR) (1,2) and led to the development of similar devices for transcatheter valve repair (T-TEER) for tricuspid regurgitation (TR) (Fig. 1A). However, T-TEER implementation is challenging due to complex valve anatomy and periprocedural imaging. We sought to understand to which extent procedural success of M-TEER changed over time and possibly impacted T-TEER results. Methods We retrospectively analyzed intraprocedural reduction of secondary MR and TR after release of a valve specific device, between 2018, when M-TEER was implemented in our center, through 2020, when T-TEER procedures started, and up to the end of 2022. We compared results between the 55 T-TEER procedures performed (age 81.8±4.7, 55% females) and 3 M-TEER cohorts: the very first 55 M-TEER, the last 55 M-TEER before T-TEER, and the very last 55 M-TEER (overall mean-age 78.4±8.2, 49% females) (Fig. 1B). Severe MR III/IV was defined by an effective regurgitation orifice area (EROA) of 20-39mm², and IV/IV by EROA ≥40mm², while TR was evaluated using the I/V to V/V classification. Considering that a 5-grade reduction of TR is either not possible or not desirable, the extension of regurgitation reduction for both valves was set on a scale from 1- to 4-grade. Also, optimal results were defined as residual MR 0+ (none or trace) or TR I+ (mild or mild to moderate), while acceptable results were considered MR I+ and TR II+ (moderate or moderate to severe). Results In all groups, regurgitation was successfully and significantly reduced within-group (Fig. 1C). MR reduction to optimal or acceptable levels increased over time from 60% at the start of the M-TEER program to 78% after 12-18 months (p=0.039), and 84% (p=0.005) after approximately 3 years. Accordingly, the extent of regurgitation reduction significantly improved between the first 2 M-TEER cohorts (p=0.016), as well as the first and the last 55 M-TEER (p=0.045), with no significant change from the second to the third population (p=0.267) (Fig. 2). Two years after the first M-TEER, T-TEER with valve specific devices was implemented and achieved 84% optimal or acceptable residual TR, better than initial M-TEER (p=0.005) and similar to the second (p=0.466) and third M-TEER cohorts (p=1.000). In terms of extent of regurgitation reduction, T-TEER also performed similar to the very first (p=0.645) and the very last M-TEER procedures (p=0.076), despite higher mean-EROA (78.5±32.2mm² vs 44.8±16.1mm² in all MR patients, p&amp;lt;0.001), more complex anatomy, more challenging imaging, and sicker patients (mean-EuroSCORE II 8.8±6.6% vs 6.4±5.3% in all MR patients, p&amp;lt;0.001). Conclusions In our center, gain in knowledge and experience, coupled with technological advances, have significantly impacted procedural M-TEER success over time and allowed similar successful implementation of a T-TEER program.Figure 1Figure 2

Abstract 16946: The Optimal Surgical Procedure of Mitral Valve Repair According to Risk Analysis of Postoperative Functional Mitral Stenosis

Background: Functional mitral stenosis (FMS) after mitral valve repair (MVr) is associated with pulmonary hypertension in the late period, increasing the risk of re-operation and deterioration of long-term outcomes. However, the risk factors for FMS after MVr, especially the impact of surgical procedures, have not been thoroughly investigated. Hypothesis: We hypothesize that procedures of valve repair, including prosthetic ring orifice area (ROA), may be associated with FMS in the late period. Methods: We retrospectively evaluated 205 patients who underwent MVr using full annuloplasty rings between 2011 and 2021 at our institution. FMS was defined as mean trans-mitral pressure gradient (TMPG) ≥8 mmHg measured by annual echocardiography. ROA was determined by calculating the internal area of each valve type and size. Perioperative factors such as repair techniques, ROA, and ROA divided by BSA (ROAi) were used to analyze risk factors for FMS. The mean follow-up period was 4.8±0.4 years. Results: MVr was performed using artificial chordae in 110 cases and intervention in valve leaflet in 83 cases (resection suture: 43, cleft closure: 26, plication: 12, and edge-to-edge repair: 8). We also utilized semi-rigid full ring in all cases (26 or less: 15, 28: 53, 30: 73, 32: 49, 34 or more: 15). We identified postoperative FMS in 23 cases (11.2%, 2.5±0.9 years after MVr) with TMPG of 9.0 ± 0.7 mmHg. In the FMS group, decreasing TR-PG in the late period was not achieved after MVr. TR-PG in the late period was also significantly higher in the FMS group (28.3 ± 5.8 vs. 20.3 ± 2.1 mmHg, p=0.01). The freedom from re-operation for MV and re-hospitalization for heart failure rate was not significantly different in the two groups (93.6% vs. 95.5%, p=0.32, 87.7% vs. 90.6%, p=0.36, respectively). However, the freedom from MACE rate was lower in the FMS group (81.4% vs. 86.3%, p=0.11). Univariate analysis demonstrated that intervention in valve leaflet (OR 2.53, p=0.04) and ROAi (OR 0.98, p=0.005) were significant risk factors for FMS. Conclusion: Although further follow-up is mandatory, these results suggested that the use of sufficiently large prosthetic ring and avoidance of intervention in valve leaflet are efficient for preventing FMS and improving clinical outcomes after MVr.

Long-term cosmetic outcomes of the slit-slide procedure for umbilical hernia repair in children.

To assess the long-term cosmetic outcomes of the "slit-slide procedure", designed to provide a more natural appearance for umbilical hernia repair, as perceived by the patients and their parents. A total of 149 patients with umbilical hernia underwent the slit-slide procedure at our hospital. The slit-slide procedure allows for the creation of an umbilicus with a more natural and integrated appearance. The patient satisfaction survey questionnaire was mailed to the families (n = 139), and there were 74 (53.2%) respondents. A questionnaire survey on postoperative appearance was also distributed to pediatric surgeons. The median age at the time of operation was 2.5years (range, 2months to 14years) and the average median age at the time of answering the questionnaire was 6.25years old (range, 2.5-14.8years). The average median period of observation was 3.2years (range, 4months to 8.97years). Most patients (89.2%) and parents (93.2%) were satisfied with the appearance of the umbilicus. Twenty-seven patients reported improved satisfaction after surgery (36.2%). Surgeons tended to score the elongated-oval shape highly; however, there was no difference in satisfaction among the shapes. The slit-slide procedure is not only effective and safe, but it achieves a satisfactory aesthetic outcome.

Abstract 14516: Combined Platelet Morphology and Clinicoradiological Features to Predict Type II Endoleaks Following Endovascular Abdominal Aortic Aneurysm Surgery

Introduction: Persistent endoleak and associated endotension following endovascular abdominal aortic aneurysm repair (EVAR) can compromise successful repair and lead to continued sac expansion and eventual life-threatening rupture event. Hypothesis: A risk-stratification algorithm of the inherent anatomical and systemic cellular characteristics of patients might predict the incidence of type II endoleaks on abdominal aortic aneurysm (AAA) patients undergoing EVAR or fenestrated endovascular aortic aneurysm repair (FEVAR) procedures. Methods: Single-center retrospective study includes 146 AAA patients undergoing primary elective EVAR and FEVAR procedures between September 2013 and July 2021. A review of institutional medical records was conducted for the analysis. Patients who or who did not developed a type II endoleaks were included in this study. Results: Mean platelet volume (MPV) was significantly increased in patients with type II endoleaks and was associated with lower endoleak-free survival. Receiver operating characteristic (ROC) curve analysis showed that MPV demonstrated satisfactory predictive performance in distinguishing patients who developed type II endoleaks, yielding an area under the curve (AUC) value of 0.64. A risk-stratification panel consisting of postoperative MPV, history of type II diabetes, and number of preoperative patent lumbar arteries achieved an AUC value of 0.72 and predicted endoleak-free survival rate with HR of 4.88. We built an easy-to-use nomogram for predicting the risk of postoperative type II endoleak and revealed that MPV had the highest scoring weight of any variable in our model. Conclusions: We refined the anatomical and systemic traits in the blood that identified MPV as a significant predictor for type II endoleaks, which might facilitate post-surgical monitoring using complete blood count (CBC) as a supplement to imaging practice.

Research Progress and Prospects on Hydrogen Damage in Welds of Hydrogen-Blended Natural Gas Pipelines

Hydrogen energy represents a crucial pathway towards achieving carbon neutrality and is a pivotal facet of future strategic emerging industries. The safe and efficient transportation of hydrogen is a key link in the entire chain development of the hydrogen energy industry’s “production, storage, and transportation”. Mixing hydrogen into natural gas pipelines for transportation is the potential best way to achieve large-scale, long-distance, safe, and efficient hydrogen transportation. Welds are identified as the vulnerable points in natural gas pipelines, and compatibility between hydrogen-doped natural gas and existing pipeline welds is a critical technical challenge that affects the global-scale transportation of hydrogen energy. Therefore, this article systematically discusses the construction and weld characteristics of hydrogen-doped natural gas pipelines, the research status of hydrogen damage mechanism, and mechanical property strengthening methods of hydrogen-doped natural gas pipeline welds, and points out the future development direction of hydrogen damage mechanism research in hydrogen-doped natural gas pipeline welds. The research results show that: ① Currently, there is a need for comprehensive research on the degradation of mechanical properties in welds made from typical pipe materials on a global scale. It is imperative to systematically elucidate the mechanism of mechanical property degradation due to conventional and hydrogen-induced damage in welds of high-pressure hydrogen-doped natural gas pipelines worldwide. ② The deterioration of mechanical properties in welds of hydrogen-doped natural gas pipelines is influenced by various components, including hydrogen, carbon dioxide, and nitrogen. It is necessary to reveal the mechanism of mechanical property deterioration of pipeline welds under the joint participation of multiple damage mechanisms under multi-component gas conditions. ③ Establishing a fundamental database of mechanical properties for typical pipeline steel materials under hydrogen-doped natural gas conditions globally is imperative, to form a method for strengthening the mechanical properties of typical high-pressure hydrogen-doped natural gas pipeline welds. ④ It is essential to promptly develop relevant standards for hydrogen blending transportation, welding technology, as well as weld evaluation, testing, and repair procedures for natural gas pipelines.

Rapid artificial ventricular pacing for thoracic endovascular aortic repair

Aim: Rapid artificial ventricular pacing (RAVP) is a reproducible method for rapid and reversible reduction of transvascular flow during endovascular procedures. This method has the potential to increase patient tolerance, reduce operation duration, infection risk, X-ray dose and facilitate early patient mobilisation. The aim of this study to compare the efficacy, safety and impact of RAVP and pharmacological-induced hypotension in patients who underwent thoracic endovascular aortic repair (TEVAR) procedures for aortic dissection and aneurysm. Material and Methods: This retrospective, observational, case-control study was conducted between January 2014 and December 2022. The adult patients who underwent TEVAR procedures for aortic dissection and aneurysm were enrolled in this study. Mean arterial pressure, heart rate, total operation duration, incidence of endoleak, duration of intensive care unit-hospitalization stay, and hospital mortality ratio were compared between nitroglycerin induced hypotension group and RAVP group. Results: A total of 279 patients who underwent TEVAR procedures were included in this study. The mean age of patients in this cohort was 65.6±5.7 years and 158 (56.6%) of the patients were male. Of these 279 patients, hypotension during stent-graft was achieved with nitroglycerin in 155 patients. There were no statistical differences between these two groups in terms of age, gender, body mass index, comorbidities and drugs. The blood pressure lowering effect and the heart rate during the intervention was significantly higher in RAVP. Endoleak and hospital mortality rates were similar in each group. Conclusion: RAVP is a feasible and safe method because it paves the way for agile maneuvers to maintain optimal hemodynamic conditions. Besides this, more meticulous, accurate deployment of endograft can be established with RAVP.

The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair.

A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.

AKULTURASI KOMPETENSI BIDANG CHASIS KENDARAAN PADA KURIKULUM BERBASIS KERJASAMA INDUSTRI

AbstractThe potential for human resource development in Chassis' area of expertise is still very broad. In addition, the time span of its usefulness is still very long because it is not displaced by the transition of electric vehicles. Therefore, it is important to conduct research that develops the competence of the Chassis area of expertise, which then cultures it into the curriculum and learning of automotive workshops and partner industries. This type of research is qualitative descriptive research. Data were collected through surveys, interviews, FGDs and observations in the automotive industry regarding wheel alignment competencies. The results showed that attitudes that can be observed and experienced developments when carrying out jobs in campus workshops and the chassis industry include accuracy in measuring chassis components, dexterity in carrying out the sequence of work and responsibility in working on vehicle maintenance and repair needs. In the aspect of automotive technology knowledge, components that can be observed for development includebasic knowledge, working principles, procedures, understanding of construction, knowledge of vehicle safety and security equipment requirements. Meanwhile, the ability to diagnose tire/wheel problems/damage skills according to manual repair procedures and skills in carrying out vehicle chassis maintenance procedures..

First-in-Human Treatment of Severe Tricuspid Regurgitation Using a Novel Cross-Caval Heterotopic Device

A 79-year-old woman, previously surgically treated for mitral and aortic valve replacement, experienced recurrent torrential tricuspid regurgitation after 2 transcatheter edge-to-edge repair procedures. Heart team assessment deemed the patient high risk for redo surgery and excluded transcatheter edge-to-edge repair and orthotopic replacement. The patient was then scheduled for a novel cross-caval device implantation.

Single-incision laparoscopic surgery transabdominal preperitoneal approach for recurrent inguinal hernia: A case series of long-term follow-up

Introduction and importanceLaparoscopic surgery is recommended to treat recurrent inguinal hernia (IH). Single-incision laparoscopic surgery transabdominal pre-peritoneal (SILS-TAPP) has been an option for IH repair but few studies on the application of this method for recurrent IH was conducted. We aimed to report our experience of SILS-TAPP for recurrent IH and the long-term outcomes of this technique. Case presentationTen patients of recurrent IH, including three multiple recurrences, were successfully treated with SILS-TAPP. Previous surgeries were Bassini and Lichtenstein's procedures. No perioperative complications were observed; neither additional trocar nor conversion to open surgery was needed. Median operation time was 65 (range: 45–95) minutes. Post-operative pain lasted for two to three days. Neither long-term complications nor recurrence was seen until the median follow-up time of 37 (range: 16–53) months. Clinical discussionAlthough the surgical procedure of hernia repair of SILS-TAPP was the same as conventional TAPP, the manipulation of the instrument was technically challenging. This surgical method should be done by an SILS expert with application of several surgical tips to overcome difficulties adhering to single-port surgery. Also, meticulous and patient dissection of the inguinal site is suggested. ConclusionSILS-TAPP is safe and feasible to repair recurrent inguinal hernia. However, it should be done by experienced surgeons.

Repairable ex vivo model of functional and degenerative mitral regurgitation.

Transcatheter mitral valve repair is an emerging alternative to the surgical repair. This technology requires preclinical studies to assess efficacy in mitigating mitral regurgitation (MR). However, ex vivo MR models are not established. We developed 2 novel repairable models, functional and degenerative, which can quantitatively assess regurgitation and effect of intervention. We used porcine mitral valves and a pulsatile flow circulation system. In the functional MR model, the annulus was immersed in 0.1% collagenase solution and dilated using 3D-printed dilators. To control the regurgitation grade, the sizes of the dilator and silicone sheet in which the valve was sutured to were adjusted. Chordae of P2 were severed in the degenerative model, and the number of severed chordae was adjusted to control the regurgitation grade. Models were repaired using the edge-to-edge or artificial chordae technique. The mean regurgitant fraction of the moderate-severe functional and degenerative models were 47.9% [standard deviation (SD): 2.2%] and 58.5% (SD: 8.0%), which were significantly reduced to 28.7% (SD: 4.4%) (P < 0.001) and 26.0% (SD: 4.4%) (P < 0.001) after the valve repair procedures. Severe functional model had a mean regurgitant fraction of 59.4% (SD: 6.0%). Both functional and degenerative models could produce sufficient MR levels that meet the interventional indication criteria. The repairable models are valuable in evaluating the efficacy of valve repair procedures and devices. The ability to control the amount of regurgitation enhances the versatility and reliability of these models. These reproducible models could expedite the development of novel devices.

Tissue Augmentation Techniques in the Management of Ligamentous Knee Injuries.

Despite early reports of high failure rates in knee ligament repair techniques resulting in favor of reconstruction, newer advances in surgical technology have shifted the attention back to repair with the addition of various tissue augmentation techniques. Ligament repair preserves proprioceptors in the native ligament and avoids autograft tendon harvest, minimizing the complications associated with donor site ruptures in reconstruction techniques. Tissue augmentation has been successfully used in knee ligamentous and tendon repair procedures, as well as in some upper extremity procedures. This study provides a clinical update on the surgical techniques, biomechanics, and outcomes with the application of various tissue augmentation techniques in the ligaments surrounding the knee joint.

Single-Stage Arthroscopic Cartilage Repair With Chondrectomy and Implantation of a Templated Membrane Collagen Scaffold With Bone Marrow Aspirate Concentrate Augmentation (AMIC Plus)

Single-staged cartilage repair techniques have shown great clinical efficacy in the treatment of articular cartilage defects of the knee, particularly when using bilayered acellular scaffolds augmented with bone marrow aspirate concentrate. We describe an all-arthroscopic approach to the single-staged cartilage repair procedure using a porcine-derived collagen I/III bilayered scaffold that is templated arthroscopically and augmented with bone marrow aspirate concentrate, in the treatment of critically sized articular defects of the knee.

Remplissage reduced sense of apprehension and increased the rate of return to sports at preinjury level of elite overhead athletes with on-track anterior shoulder instability.

The purpose of this study was to compare the results of arthroscopic isolated Bankart repair (B) with Bankart repair plus Remplissage (B + R) procedure in contact overhead athletes with on-track anterior shoulder instability. A total of 64 athletes playing basketball, volleyball and handball in elite professional level who underwent arthroscopic isolated Bankart repair (34 patients) or Bankart repair plus Remplissage procedure (30 patients) with the diagnosis of recurrent anterior shoulder instability between 2017 and 2020, were retrospectively reviewed. Radiologically all patients had on-track Hill-Sachs defects and minimal or subcritical glenoid bone loss (< 13.5%). Patients were evaluated using pre- and postoperative pVAS, SANE, ASES, ROWE, WOSI scores and postoperative active ROM assessment. Patients were also asked for the frequency of any subjective apprehension and satisfaction with the surgery in four grades. The mean ages of the groups B and B + R were 26.8 and 26years (SD = 3.22), respectively; the mean follow-up times were 37.8 and 36.2months (SD = 11.19). Compared with the preoperative status, there was a statistically significant improvement of all 5 postoperative outcome scores in both groups (P < 0.001). However, significant difference between the improvement of the groups were only found for the SANE (B: 22.3 ± 4.1, B + R: 26.3 ± 4.3; P = 0.0004), ASES (B: 26.1 ± 2.6, B + R: 30.2 ± 3.6; P < 0.001) and ROWE (B: 42 ± 3.7, B + R: 47.7 ± 2.8; P < 0.001) scores in favor of the group B + R. The loss of internal and external rotation of the adducted arm in group B + R was found to be approximately 5 degrees compared to the group B (P < 0.001). More than 80% of group B + R showed no apprehension in sports activities and almost completely returned to pre-injury athletic level, depicting statistically significant improvement compared to group B athletes (P = 0.002 and 0.036, respectively). 3 patients developed re-dislocation after isolated Bankart repair, whereas no re-dislocation occurred in the B + R group. Adding Remplissage procedure to the Bankart repair provided an advantage in terms of both return to sport at preinjury level and the frequency of apprehension sensation during sports activity. III.