Requiring Surgical Intervention Research Articles

Successful Preoperative Transjugular Intrahepatic Portosystemic Shunt for Portal Decompression in Patients With Inflammatory Bowel Disease and Cirrhosis Requiring Surgical Intervention.

Colorectal surgery in patients with inflammatory bowel disease (IBD) and cirrhosis has increased morbidity, which may preclude surgery. Preoperative transjugular intrahepatic portosystemic shunt (TIPS) is postulated to reduce surgical risk. In this retrospective single-center study, we characterized perioperative outcomes in patients with IBD and cirrhosis who underwent preoperative TIPS. We identified patients with IBD and cirrhosis who had undergone preoperative TIPS for portal decompression between 2010 and 2023. All other indications for TIPS led to patient exclusion. Demographic and medical data were collected, including portal pressure measurements. Primary outcome of interest was perioperative outcomes. Ten patients met the inclusion criteria. The most common surgical indications were dysplasia (50%) and refractory IBD (50%). TIPS was performed at a median of 47 days (IQR 34-80) before surgery, with reduction in portal pressures (22.5 vs. 18.5 mmHg, P < .01) and portosystemic gradient (12.5 vs. 5.5 mmHg, P < .01). Perioperative complications occurred in 80% of patients, including surgical site bleeding (30%), wound dehiscence (10%), systemic infection (30%), liver function elevation (50%), and coagulopathy (50%). No patients required re-operation, with median length of stay being 7 days (IQR 5.5-9.3). The 30-day readmission rate was 40%, most commonly for infection (75%), with 2 patients having intra-abdominal abscesses and 1 patient with concern for bowel ischemia. Ninety-day and one-year survival was 100% and 90%, respectively. Patients with primary sclerosing cholangitis (PSC)-cirrhosis were noted to have higher perioperative morbidity and a 30-day readmission rate. In patients with IBD and cirrhosis, preoperative TIPS facilitated successful surgical intervention despite heightened risk. Nevertheless, significant complications were noted, in particular for patients with PSC-cirrhosis.

Umbilical Complications That Require Surgical Intervention after Gynecologic Laparoscopic Surgery.

In laparoscopic surgery, the trocar is often inserted through the umbilicus because of the ease of insertion and inconspicuous postoperative scar formation. However, postoperative complications that require plastic surgical intervention may occur to the umbilicus. We reviewed 14 patients who received plastic surgery for umbilical issues following gynecologic laparoscopic surgery in our department from January 2015 to September 2021. Most complications requiring umbilical surgery post gynecologic laparoscopic surgery include local infections, scar contractures, ectopic endometriosis, and umbilical necrosis. Mass resection and umbilical formation procedures were performed under general or local anesthesia. After a follow-up period of 6 months following surgery, no incidences of tumor development or recurrence of infection were seen, and the hypertrophic scar at the wound site gradually healed after the complete removal of the tumor and adequate suturing. Pathologically, 90% of the cases with keloid-like collagen disorder had concomitant inflammatory diseases such as epidermal cysts and abscesses. The majority of umbilical complications associated with laparoscopic surgery were predicted to be due to implantation of epithelial and tumor components during laparoscopic surgery and delayed postoperative inflammation. Therefore, it is necessary to educate surgeons about general measures of local infection control and careful surgical manipulation to prevent umbilical problems associated with laparoscopic surgery.

Histopathological Changes in Liver of Patients With Chronic Pancreatitis Requiring Surgical Intervention and Their Clinical Significance.

The histopathological changes in the liver and their clinical implication in chronic pancreatitis (CP) have not been studied well. We analyzed the incidence, risk factors, and long-term outcomes of these changes in CP. Chronic pancreatitis patients who underwent surgery with intraoperative liver biopsy from 2012 to 2018 formed the study group. Based on liver histopathology, 3 groups were formed: normal liver, group NL; fatty liver, group FL; and inflammation/fibrosis, group FS. The risk factors and long-term outcomes, including mortality, were evaluated. Among 73 patients, 39 (53.4%) had idiopathic, and 34 (46.6%) had alcoholic CP. The median age was 32 years, 52 (71.2%) were males and comprised NL, n = 40 (55%); FL, n = 22 (30%); and FS, n = 11 (15%). The preoperative risk factors were comparable among NL and FL groups. Overall 14 of 73 patients (19.2%) (NL, 5 of 40; FL, 5 of 22; FS, 4 of 11 [P = 0.82]) had died at median follow-up of 36 months (range, 25-85 months). The main causes of mortality were tuberculosis and severe malnutrition secondary to pancreatic insufficiency. The mortality is higher in patients with inflammation/fibrosis or steatosis in liver biopsy, and such patients need monitoring for progression of liver disease and pancreatic insufficiency.

894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?

Abstract Introduction All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission. Method We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded. Results Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation). Conclusions Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.

Clinical Features of Patients with Exfoliation Glaucoma Requiring Surgical Intervention.

Purpose To clarify the clinical features of patients with exfoliation glaucoma (XFG) requiring surgical intervention. Study Design. Retrospective study. Methods The study included 46 eyes from 36 XFG patients, 85 eyes from 53 primary open-angle glaucoma (POAG) patients, and 54 eyes from 35 normal-tension glaucoma (NTG) patients. Age, duration of previous glaucoma treatment, intraocular pressure, medication scores, visual function, and surgical procedure were compared among the three patient groups. Results The XFG group had the highest mean age (XFG: 75.7 ± 8.3 years, POAG: 65.8 ± 12.8 years, and NTG: 53.3 ± 12.8 years; p < 0.001) and the shortest mean duration of previous treatment with glaucoma medication (XFG: 5.1 ± 3.5 years, POAG: 8.9 ± 6.9 years, and NTG: 8.9 ± 5.9 years; p < 0.001). Intraocular pressure and medication scores were slightly higher in the XFG group than in the POAG group, although the differences were not significant. Among XFG patients, trabeculectomy was performed in 20 eyes from 16 patients (55.6%) and trabeculotomy was performed in 16 eyes from 14 patients (44.4%). Both trabeculectomy (3 eyes) and trabeculotomy (14 eyes) were performed in combination with cataract surgery. Conclusions The XFG patients referred to our department for initial examination were older than the POAG and NTG patients, and their duration of treatment before referral was shorter. Moreover, intraocular pressure and the eye drop medication score were higher in the XFG patients. A significantly higher percentage of XFG patients required surgical intervention compared to patients with other disease types.

The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review.

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.

Patient-related Risk Factors for Postoperative Stiffness Requiring Surgical Intervention After Arthroscopic Rotator Cuff Repair.

Risk factors for stiffness after arthroscopic rotator cuff repair (RCR) have been limited to studies with small patient numbers. The objective is to determine patient-related risk factors for stiffness after RCR. The PearlDiver database was queried from 2007 to 2015 for patients undergoing isolated arthroscopic RCR. A multivariate binomial logistic regression analysis assessed for risk factors requiring a postoperative manipulation under anesthesia (MUA) or lysis of adhesions (LOA) within 9 months after RCR. Two hundred thirty-two of 19,229 patients (1.2%) underwent a LOA and/or MUA within 9 months after arthroscopic RCR. Significant risk factors identified were age less than 50 years (odds ratio [OR], 1.9; P < 0.0001), female gender (OR, 2.0; P < 0.0001), diabetes mellitus (DM) type I (OR, 2.7; P < 0.0001), hypothyroidism (OR, 1.3; P = 0.020), and systemic lupus erythematosus (OR, 2.1; P = 0.004). However, tobacco use was associated with a 0.5 risk of developing stiffness (P < 0.0001). Systemic lupus erythematosus, hypothyroidism, and DMI (but not DMII) in addition to young age and female gender were risk factors for LOA/MUA after arthroscopic RCR.

Ovoid-shaped Left Main Coronary Calcified Aneurysm Leading to Unstable Angina Requiring Surgical Intervention

Ovoid-shaped Left Main Coronary Calcified Aneurysm Leading to Unstable Angina Requiring Surgical Intervention

Delayed Presentation of Hemothorax and Mediastinal Hematoma Requiring Surgical Intervention After Linear Endobronchial Ultrasound

Delayed Presentation of Hemothorax and Mediastinal Hematoma Requiring Surgical Intervention After Linear Endobronchial Ultrasound

Risk Factors and Adequate Management for Complications of Bevacizumab Treatment Requiring Surgical Intervention in Patients With Metastatic Colorectal Cancer

BackgroundBevacizumab (BV) has been approved for treating colorectal cancer since 2004. Although BV use may lead to adverse effects, few studies have reported incidences requiring surgical intervention. We aimed to identify the risk factors and adequate interventions for complications requiring surgical intervention after BV treatment. Patients and MethodsWe retrospectively reviewed the records of patients with metastatic colorectal cancer treated with BV in our institute from January 2009 to December 2016. The baseline patient characteristics were used to evaluate the potential risk factors for complications requiring surgery. ResultsOf the 1008 patients recruited for this study, 60 (5.9%) experienced complications necessitating surgery after BV therapy. Gastrointestinal perforation was the most frequently observed complication, occurring in 36 patients (3.5%), and diverting colostomy was the most commonly performed intervention (22 patients, 36.6%). Multivariate analysis helped identify poor differentiation, signet ring cell carcinoma, stent insertion status, rectal location of the primary tumor, and intact primary tumor status as the risk factors. Survival time remained unchanged regardless of a complication that required surgery. ConclusionCareful monitoring during BV treatment for metastatic colorectal cancer is essential for patients who have a predisposition to complications that may require surgery. After detection, adequate and timely surgical management is imperative for ensuring patient survival.

Severe GERD with Non Resolving Pneumonia Requiring Surgical Intervention for Survival

Infant reflux becomes evident in the first few months of life, peaks at 4 months and resolves in up to 88% by 12 months and in nearly all by 24 months. Infantile reflux manifests more often with regurgitation, signs of esophagitis and resulting failure to thrive. We report the case of two months old male child with GERD with non-resolving pneumonia only relieved after surgical intervention.

An Obstructed Anomalous Left Anterior Descending Coronary Artery Arising from the Right Coronary Artery Requiring Surgical Intervention.

A 47-year-old female presented to our hospital with symptoms of stable angina. Cardiac catheterization revealed a rare coronary artery anomaly of the left anterior descending (LAD) artery branching off the right coronary artery ostium. Furthermore, the anomalous LAD artery exhibited significant atherosclerotic obstruction. Our review of the literature found only nine such previously described cases. Due to the unique nature of coronary artery anomalies and their complications, we would like to contribute our case to the medical literature.

Ingested intraabdominal foreign bodies that require surgical intervention.

The aim of the present study was to review cases that required surgical intervention to remove ingested foreign bodies. Medical records of 7 patients who underwent surgical intervention at the Yüzüncü Yıl University Department of General Surgery between 2009 and 2014 after ingesting foreign bodies were reviewed. Female:male ratio was 5:2; mean age was 25 (16-35). Four patients had swallowed pins, 1 patient had swallowed a sewing pin, 1 patient had swallowed a safety pin, and 1 patient had swallowed a wristwatch. The patient who had swallowed the wristwatch had psychiatric disorders. All other patients stated that they had swallowed the objects by accident. Most ingested foreign bodies pass smoothly through the gastrointestinal (GI) tract within a week, but those that migrate out of the lumen require surgical intervention due to complications including perforation, abscess, fistula, and peritonitis. Early diagnosis and intervention is crucial to reduce morbidity and mortality. It is believed that sharp and pointed objects that migrate outside of the lumen ought to be removed, lest they cause complications.

ПРОБЛЕМЫ ЭКОНОМИЧЕСКОГО РАЗВИТИЯ: ФАКТОРЫ И ДЕТЕРМИНАНТЫ

The subject / topic: TThe theme of this article is very relevant in the light of changes in the global geo-economic structure and changing the role and place ofRussiain world economic and geopolitical relations. The article deals with the basic aspects of national economic growth, which slowed down in the last three years. The main reason for slowing national economic growth is associated with the depletion of the reserves of the traditional export-oriented development of the Russian economy, as well as problems with sluggish innovative transformation. In this paper, based on a systematic analysis of economic processes and the interpretation of analytical data, addresses the general theoretical and methodological aspects of the quality of economic development, as well as practical guidelines and recommendations related to sustainable national socio-economic development in the context of external constraints. The purpose / objectives: The aim of the article is to analyze the theoretical and methodological aspects of the quality of economic development of the Russian economy, which happened in the face of economic sanctions. Objectives of the article: justify practical directions and recommendations related to sustainable national socio-economic development in the context of external constraints, determine the prospects for the economy of theRussian Federationin the conditions of the introduction of sectoral sanctions by Western countries. Methodology: Methodological basis of this article are the comparative and economic-statistical methods of analysis. The Results: The study revealed that the harsh environment (sanctions, depreciation of the ruble, and others.) Require surgical intervention and adjustments not only the current socio-economic plans, but also to take urgent measures to ensure the development prospects. The most important decision is the degree of support advanced scientific and technical programs and the creation of new domestic technologies. Conclusions / significance: Measures to ensure the recovery mechanism of reproduction of the development potential of the economy on the basis of innovation should be complemented by a faster action to increase the absorptive capacity for innovation and new technologies. The practical application of the results of this work will improve procedures for forecasting and planning the strategic development of an economic complex in view of the current economic and social trends.

Paliperidone Palmitate Associated with Necrotizing Deep Tissue Infection and Sepsis Requiring Surgical Intervention.

Long-acting injectable antipsychotics provide the delivery of medication over an extended period of time requiring administration typically only every 2 to 4 weeks. The side effect profile of a long-acting injectable antipsychotic is predictable and similar to the oral formulation. However, injection site reactions may occur with this novel delivery system. The risk of an injection site reaction may be greater with the repeated administration of a lipophilic decanoate formulation and include pain, development of indurations, and fibrosis. Severe complications from injection site reactions have rarely been described in the literature with newer agents. We report the first case of a patient prescribed paliperidone palmitate every 3 weeks that developed severe sepsis requiring vasopressors and intubation due to delayed relayed recognition of a necrotizing infection at an injection site. Clinicians should be alerted to screen for injection site reactions when there is an unknown source infection in a patient receiving a long-acting injectable antipsychotic.

A case of pseudohyperkalaemia secondary to thrombocytosis in a patient with grumbling abdominal sepsis

A case of pseudohyperkalaemia secondary to thrombocytosis in a patient with grumbling abdominal sepsis

Complications of Neonatal Circumcision Requiring Surgical Intervention in a Developing Country

The recent scale-up in neonatal circumcision (NC) may require strategies to reduce complications. This study evaluated complications of NC requiring surgery. A prospective analysis of 64 patients with complications of NC managed by surgery between June 2006 and May 2012 at the University of Nigeria Teaching hospital Enugu was conducted. Circumcision was performed by nurse in 54 (84.4%) patients, traditional practitioner in 5 (7.8%) and doctor in 5 (7.8%), at a median age of 9 days (range: 2-21 days). Complications noticed 1 day to 7 years (mean: 7.8 months) after circumcision were glanular adhesion in 27 (42.2%) children, meatal stenosis in 14 (21.9%), urethrocutaneous fistula in 11 (17.2%), trapped penis in 5 (7.8%), implantation dermoid in 4 (6.2%) and glans amputation in 3 (4.7%). After treatment, outcome was good in 59 (92.2%) patients, whereas 5 (7.8%) had residual defect. NC may be associated with serious complications in our setting. Adequate training of providers on safe procedure may minimize complications.

Severe Clostridial Pyomyoma following an Abortion Does Not Always Require Surgical Intervention

Background. Clostridial infection following pregnancy may be fatal, and surgery is considered as the treatment of choice. We suggest a conservative management in selected cases when preservation of fertility is of major importance. Case. A 41-year-old primigravida presented with abdominal pain and fever, one day following dilatation and curettage at 20 weeks of gestation. Her abdomen was diffusely tender, with a uterus enlarged to 20 weeks' gestation. Laboratory studies were consistent with sepsis and hemolysis. CT demonstrated a gas-containing mass compressing the uterine cavity, and presence of air in pelvic veins. Blood cultures were positive for Clostridium perfringens. The patient was treated conservatively, with IV antibiotics and fluid resuscitation, and recovered. Conclusion. In selected cases of infected myoma complicated by clostridial sepsis, refraining from surgical intervention is a possible therapeutic approach.

Chylous Ascites Requiring Surgical Intervention after Donor Nephrectomy: Case Series and Single Center Experience

Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN.

Osteonecrosis in Patients Infected With HIV

There is a paucity of data on clinical epidemiology of osteonecrosis in HIV-infected patients. We aimed to describe patients' characteristics and natural history of this poorly known condition. All cases of symptomatic HIV-related osteonecrosis diagnosed from 1990 through 2003 in 19 Spanish clinics were reviewed. Functional status at the last visit was assessed with the validated Western Ontario and McMaster Universities Index questionnaire. Of 54 patients analyzed, 29 (53.7%) had a single bone necrosis, and 25 (46.3%) had 2 or more sites involved. Progression of symptoms happened more often in patients with hip involvement (17/39 vs 0/8 patients; P = 0.019). Twenty patients (37%) required surgical intervention. Male sex and higher CD4 cell count were associated with surgery on multivariable analysis. Overall, at the end of the follow-up period, half of the patients had moderate to severe disability (Western Ontario and McMaster Universities Index score > or =60). During a follow-up period of 137 person-years, only 2 new episodes of osteonecrosis were observed (rate of recurrences, 1.5/100 person-years; 95% confidence interval, 0.4-5.1). HIV-related osteonecrosis is associated with significant disability over time. Location of bone necrosis, sex, and CD4 cell count may influence the outcome. The risk for recurrences for patients who have experienced 1 episode is low.