Resected Weight Research Articles

Superomedial pedicle reduction mammaplasty: increased resection weight does not increase nipple necrosis

BackgroundThe superomedial pedicle (SMP) reduction mammaplasty offers several advantages over more traditional operative techniques, such as retained sensation to the nipple areola complex (NAC) and improved preservation of long-term breast shape. However, many surgeons believe that using the SMP can cause an increase in NAC necrosis rates up to 13.1%, especially in large volume reductions. The aims of this paper are to determine the rate of nipple necrosis when performing an SMP reduction mammaplasty at our institution and establish if there is a difference in those rates based on the weight of tissue removed. We then compared our overall rate of nipple necrosis to those found using a systematic review of literature involving other pedicles to determine if this technique is equivalent to more commonly used methods. MethodsWe performed a retrospective chart review of patients who underwent breast reduction surgery using SMP at a single institution between May 1, 2013, and May 1, 2015. Each breast was counted separately, and the weight of the tissue removed was recorded. Six-mo follow-up data were analyzed using the chi-square analysis to compare rates of NAC necrosis among our patients and historical cohorts. ResultsOne hundred thirty-five breasts (70 patients) met inclusion criteria. Patients had a mean resection weight per breast of 1016.7 g (±478.3). There was an NAC necrosis rate of 0% in the groups where 1200 g or less of tissue were removed and 2.3% (n = 1) in the group where greater than 1200 g of tissue were removed. We found no statistically significant difference in the rate of NAC necrosis with increased resection weights, (P = 0.32). The overall rate of NAC necrosis for this study was 0.7% per breast, which is equivalent to the rates found during the systematic review of literature. ConclusionsIn this study, the SMP breast reduction technique shows a low rate of NAC. We found no statistically significant increase in NAC necrosis rates as the volume of tissue removed increases, and the SMP appears to have an overall rate of NAC necrosis similar to more commonly used pedicles. Although the results of this study may be related to patient selection or surgical technique, we believe that this pedicle preserves the breast's main blood supply so that less tissue ischemia occurs.

Long-term effect of oncoplastic breast-conserving surgery using latissimus dorsi miniflaps on mammographic surveillance and the detection of local recurrence

Latissimus dorsi miniflap is a breast-conserving volume replacement technique for the reconstruction of large breast defects. While mammographic features of miniflap reconstruction have been described, little is known about the incidence, mode of presentation and size of local recurrence after this procedure. This study aimed to investigate the impact of latissimus dorsi miniflap reconstruction on the frequency, presentation and detection of local recurrence. Clinical, radiological and pathological data were reviewed in 261 patients. Complete records were available for 11 patients developing local recurrence, including mode, time of presentation and size of the recurrent tumours. All mammograms before and after local recurrence were assessed in relation to a range of specific characteristics including parenchymal density, flap visibility, architectural distortion, mass, calcifications, fat necrosis, skin thickening and breast oedema. Twenty-one patients developed local recurrence at 10.4 years following reconstruction (mean age 49 years, resection weight 182g and tumour size 33mm). Following radiotherapy, 0.5% of patients developed local recurrence each year, which increased five-fold when radiotherapy was omitted (HR 4.99). Local recurrences were diagnosed in five patients by mammography alone, in three by mammography and palpable lump, and in three by palpable lump alone. They were detected when small (15mm) and were associated with new mammographic abnormalities in 10 patients. Long follow-up demonstrates that latissimus dorsi miniflap reconstruction allows oncologically safe breast conservation when combined with postoperative radiotherapy. Local recurrences are detected early, either by mammography, clinical examination or both, and detection is not compromised by the presence of a flap.

The Sternum-Nipple Distance is Double the Nipple-Inframammary Fold Distance in Macromastia.

Reduction mammaplasty is one of the most commonly performed plastic surgery operations. For a majority of techniques, the most common long-term complication is pseudoptosis. It has previously been proposed that upper breast suspensory ligaments (SL) are weaker than lower breast SL. We tested this hypothesis through anthropometry of the proxies for upper and lower SL strength: the sternal notch-nipple (SN-N) distance and the nipple-inframammary fold (N-IMF) distance, respectively. An institutional review board-approved retrospective review of patients undergoing reduction mammoplasty in an academic faculty practice between 2008 and 2015 was conducted. Patient demographics included age, race, and body mass index (BMI); patient comorbidities included smoking status, diabetes, and hypertension. Breast anthropometric measurements included SN-N and N-IMF. Sternal notch-nipple was used as the primary metric of the upper SL strength, whereas N-IMF was used as the primary metric of the lower SL strength. Intraoperative details included reduction technique and resection mass. Postoperative complications were recorded, including nipple areola complex necrosis and hematoma. Linear regression analysis was performed with the primary endpoint of the relationship between SN-N and N-IMF distance in macromastia. Data from 208 patients, totaling 400 individual breast measurements, were collected. The mean SN-N length was 35.1 cm, mean N-IMF length was 16.0 cm, and mean resection weight was 1094 g. Linear regression found that N-IMF distance could be predicted as 45% of the SN-N distance (N-IMF = 0.454 * SN-N). This was a strong relationship, demonstrated by univariate analysis of SN-N and N-IMF (R, 0.624; P < 0.001). A Wise pattern was used in 89.9% of cases; an inferior pedicle was used in 83.7% of cases. Nipple areola complex necrosis occurred in 15 breasts (3.75%). Sternal notch-nipple (R, 0.127; P = 0.011) and N-IMF (R, 0.119; P = 0.017) were both predictive of nipple areola complex necrosis (Table 4). In our series, the N-IMF distance increased 0.45 cm for every 1 cm increase in the SN-N distance. This relationship strengthens our primary hypothesis that the lower pole ligaments stretch at a significantly slower rate than the upper pole ligaments. Taking this into consideration, we suggest that surgeons seeking to minimize pseudoptosis rates should favor techniques that minimally disrupt the lower SL.

Morcellation Efficiency in Holmium Laser Enucleation of the Prostate: Oscillating Morcellator Outperforms Reciprocating Morcellator With no Apparent Learning Curve

To compare the morcellation efficiency of the Wolf Piranha oscillating morcellator with the Lumenis VersaCut reciprocating morcellator. After institutional review board approval, we conducted a retrospective analysis of patients undergoing holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia. The first 41 cases of HoLEP with morcellation performed with the oscillating morcellator were matched by weight of resected tissue to 41 control patients from our historic data set who underwent morcellation with the reciprocating system. The primary outcome of interest was morcellation efficiency. We also evaluated surgeon experience level to assess for a learning curve with the oscillating morcellator. The 41 patients from each group were comparable in terms of age, prostate size, continuation of aspirin, and catheter status. The oscillating morcellation efficiency was nearly double that of the reciprocating morcellator (8.6 g/min [range: 3.0-18.3] vs 3.8 g/min [range: 0.9-10.1], P <.0001). Mean resected weights for cases with the oscillating and reciprocating instruments were 69 g (range: 17-224 g) and 69 g (range: 17-213 g), respectively (P = .9). The total operative time and complication rates did not significantly differ. For the oscillating system, morcellation efficiency for cases performed by staff alone was 9.8 g/min compared with 8.1 g/min when trainees were involved (P = .2), and there was no correlation between morcellation efficiency and number of cases performed (R = 0.01). The oscillating morcellation system resulted in a morcellation efficiency double that of the reciprocating system for tissue retrieval after HoLEP. Achieving efficiency with the oscillating system was not associated with a significant learning curve and was not impacted by trainee involvement.

MP27-01 CHARACTERISTICS OF PATIENTS WITH PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER HOLEP IN BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2017MP27-01 CHARACTERISTICS OF PATIENTS WITH PERSISTENT LOWER URINARY TRACT SYMPTOMS AFTER HOLEP IN BPH Kang Sup Kim, Yong Sun Choi, Hong Jin Suh, Hyun Woo Kim, Joon Chul Kim, and Donh Hwan Lee Kang Sup KimKang Sup Kim More articles by this author , Yong Sun ChoiYong Sun Choi More articles by this author , Hong Jin SuhHong Jin Suh More articles by this author , Hyun Woo KimHyun Woo Kim More articles by this author , Joon Chul KimJoon Chul Kim More articles by this author , and Donh Hwan LeeDonh Hwan Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Holmium laser enucleation of the prostate (HoLEP) in BPH is widely used and the effects are known to be equivalent or better than traditional TUR-P with low incidence of complications. However, some patients who underwent HoLEP still have the lower urinary tract symptoms(LUTS) after surgery. We evaluated the characteristics of patients who visited our clinics due to persistent LUTS and required additional medications after HoLEP in BPH patients. METHODS The medical records of the patients who underwent HoLEP from March of 2011 to June of 2015 were reviewed retrospectively. The analysis was performed in patients who have been followed for more than 6 months after surgery. The patients were divided into 2 groups. Group A is the patients with persistent obstructive symptoms and group B is with irritation symptoms. Age, prostate specific antigen, International prostate symptom score (IPSS), prostate volume, transition zone volume of prostate, peak flow rate, maximum cystometric capacity, post voided residual volume, resected weights, operation time were analyzed. RESULTS Among the 482 patients who underwent the HoLEP, the numbers of patients who required the medicine for lower urinary tract symptoms were 138 (28.6%). Among the patients, 53 patients (40.2%) were enrolled in Group A and 85 patients (59.8%) were enrolled in Group B. The mean age, total IPSS, PSA, total prostate volume, peak flow rate, maximum cystometric capacity, post voided residual volume, and operation time between two groups were statistically insignificant. However, transition zone volume and resected weights were significantly different between group A and B. (p=0.017, p=0.010 respectively) CONCLUSIONS More than 25% of the patients were still taking the medicines for lower urinary tract symptoms after HoLEP. Among the patients who required the medicine, 60% of patients have complained of irritation symptoms. Bigger transition zone with resection weights were correlated with remaining of postoperative irritation symptoms. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e328 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kang Sup Kim More articles by this author Yong Sun Choi More articles by this author Hong Jin Suh More articles by this author Hyun Woo Kim More articles by this author Joon Chul Kim More articles by this author Donh Hwan Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP59-09 FUNCTIONAL CHANGE OF CONTRALATERAL KIDNEY AFTER PARTIAL NEPHRECTOMY USING DIETHYLENE TRIAMINE PENTA-ACETIC ACID (DTPA) RENAL SCINTIGRAPHY: LONG TERM ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-09 FUNCTIONAL CHANGE OF CONTRALATERAL KIDNEY AFTER PARTIAL NEPHRECTOMY USING DIETHYLENE TRIAMINE PENTA-ACETIC ACID (DTPA) RENAL SCINTIGRAPHY: LONG TERM ANALYSIS Se Young Choi, Jeman Ryu, Jae Hyeon Han, Wonchul Lee, Han Kyu Chae, Sangjun Yoo, Dalsan You, In Gab Jeong, Cheryn Song, Bumsik Hong, Hanjong Ahn, and Choung-Soo Kim Se Young ChoiSe Young Choi More articles by this author , Jeman RyuJeman Ryu More articles by this author , Jae Hyeon HanJae Hyeon Han More articles by this author , Wonchul LeeWonchul Lee More articles by this author , Han Kyu ChaeHan Kyu Chae More articles by this author , Sangjun YooSangjun Yoo More articles by this author , Dalsan YouDalsan You More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Cheryn SongCheryn Song More articles by this author , Bumsik HongBumsik Hong More articles by this author , Hanjong AhnHanjong Ahn More articles by this author , and Choung-Soo KimChoung-Soo Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1825AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy aims to maintain renal function by nephron sparing. However, the functional change of contralateral kidney remains to be known. We evaluated the functional change in contralateral kidney using DTPA renal scan and determined the predicting factors of contralateral kidney function after partial nephrectomy. METHODS From 2001 to 2012, 699 patients underwent partial nephrectomy and we performed DTPA renal scan before and after surgery in all patients to assess the exact renal function of each kidney. Patients were divided into 3 groups according to initial contralateral glomerular filtration rate (GFR) (group 1: <30ml/min/1.73m2, group 2: 30~45ml/min/1.73m2, and group 3: ≥45ml/min/1.73m2). We evaluated separate renal functions using DTPA up to 5 year after surgery. Logistic regression analysis was used to identify the factors associated with increased GFR of contralateral kidney. Kaplan-Meier method was used for overall survival. Median follow-up period was 45.1 month. RESULTS Patients of group 1 were older age (64.2±9.8 vs 55.0±11.0 vs 48.0±9.5, p<0.001), more hypertension history (59.5% vs 39.3% vs 20.9%, p<0.001), worse American society of anesthesiologists (ASA) score (≥2; 94.0% vs 89.5% vs 80.2%, p<0.001), and shorter ischemic time (19.9±8.0 vs 22.3±8.7 vs 22.8±8.9, p=0.025) among three groups (respectively). Tumor size, resected weight, RENAL nephrometry score and ischemic type were not different among three groups (p=0.293, p=0.255, p=0.582 and p=0.967, respectively). The mean ipsilateral GFR changes were -7.5%, -1.6%, and -21.2% in group 1, 2, and 3, respectively and contralateral GFR changes were 33.9%, 19.9%, and 7.3% in group 1, 2, and 3, respectively at 5 year after partial nephrectomy. On multivariable analysis, ASA score (OR 0.54, 95% confidence interval [CI] 0.31-0.92 p=0.0277) and preoperative contralateral GFR (OR 0.97, 95% CI 0.95-0.99 p=0.0011) were the significant predictive factors for increased GFR of contralateral kidney within 5 years. 5 year overall survival rates were 86.1%, 93.1% and 97.4% in group 1, 2, 3, respectively. CONCLUSIONS Contralateral kidney compensated for the functional loss of ipsilateral kidney. The increase of GFR in contralateral kidney is more prominent in healthy patients with decreased contralateral renal function. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e784 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Se Young Choi More articles by this author Jeman Ryu More articles by this author Jae Hyeon Han More articles by this author Wonchul Lee More articles by this author Han Kyu Chae More articles by this author Sangjun Yoo More articles by this author Dalsan You More articles by this author In Gab Jeong More articles by this author Cheryn Song More articles by this author Bumsik Hong More articles by this author Hanjong Ahn More articles by this author Choung-Soo Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract 38. Atypical Proliferative Lesions after Reduction Mammaplasty: Incidence and Implications in 993 Reductions

Purpose: Reduction mammoplasty occasionally reveals unsuspected proliferative lesions or carcinoma. Few studies examine incidence, risk factors, and outcomes in this population. Methods: Retrospective review was performed between 2000 and 2012. Pathology was categorized as benign, proliferative, or cancer (DCIS or invasive). Results: Five hundred seventy-three patients had 993 reduction mammaplasties (85% bilateral, 15% unilateral). Cancer was detected in 23 (2.3%) specimens and proliferative lesions in 148 (14.9%). Compared to patients with benign pathology, patients with proliferative lesions or cancer were older (p<0.001), with larger BMI (p=0.001), increased unilateral procedures (p<0.001) and more had a history of cancer (p<0.001). On multivariate regression analysis, age and prior breast cancer were independent risk factors for proliferative lesions (OR 1.057, CI 1.039–1.075, p<0.001 and OR 2.201, CI 1.291–3.752, p=0.004) and age significantly predicted cancer (OR 1.050, CI 1.009–1.093, p=0.015). There was no association with resection weight (p>0.5). Fifty-four percent of patients with proliferative lesions and no history of cancer had a change in management with increased surveillance, hormones, radiation, chemotherapy, or surgery. If there was a history of cancer, 31% had a change in management. Of patients with DCIS or cancer, all required treatment. Conclusion: Proliferative lesions of the breast may be more common that previously reported. Age and a history of breast cancer increase risk for proliferative lesions. All should be referred to oncology.

Does asymptomatic prostatic inflammation alter the outcome of transurethral resection of prostate?

IntroductionThere is contradictory evidence in literature with respect to the association of asymptomatic prostatic inflammation on biopsy with complications of Transurethral Resection of Prostate. The aim of the present study was to evaluate the association of prostatitis in biopsy specimens of patients undergoing transurethral resection of prostate with bladder neck contracture (the primary end point) and other complications.Material and methodsPatients who had undergone transurethral resection at a single centre between 2005 and 2010, with a minimum of 3 months follow-up were included. The study population was divided into two cohorts: those with inflammation on prostatic biopsy (Group A) and those without (Group B). These two groups were compared with respect to demographic data and pre-operative and intraoperative confounding factors. Immediate complications were documented using the modified Clavien-Dindo system and compared. Long term complications like bladder neck contracture, meatal stenosis, urethral stricture, and recurrent adenoma were also compared.ResultsBoth groups were comparable except for Group A patients having a higher median resected weight (20 vs. 14 gms, p = 0.009). There was no significant difference between the groups with respect to the rate of bladder neck contracture and other long-term and short term complications on univariate and multivariate analysis. Larger resected weight of gland was associated with lower rate of bladder neck contracture on multivariate analysis (p = 0.019, Odds ratio: 0.937).ConclusionsPresence of histologically confirmed prostatic inflammation is not associated with bladder neck contracture or other complications following transurethral resection. Smaller resected prostatic weight was associated with higher incidence of bladder neck contracture.

The Effects of Moufarrege Total Posterior Pedicle Reduction Mammaplasty on Breast Cancer Incidence

Introduction: The Moufarrege total posterior pedicle breast reduction involves complete denudation of the breast offering free access to all breast quadrants. This allows a total resection of the upper outer quadrant which is most implicated in breast cancer. The objective was to assess the postoperative incidence of breast cancer in the cohort of women who underwent the Moufarrege technique. Methods: Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was sent to all patients in 2008. Patients were asked about the date of their last mammogram and any diagnosis of breast cancer. Expected numbers of cancers were calculated from rates in the general population. Age standardization at the time of surgery was done and the incidence of breast cancer was calculated in relation to age at time of surgery and age at last follow-up. Results were presented as standardized incidence ratios (SIR) with their corresponding 95% confidence interval (CI). Results: We included 924 patients. The response rate was 60.38% (n = 558). Mean patient age at the time of the surgery was 32.8 years (14 to 82). Mean resection weight was 620 grs per breast (250 - 1600). Breast cancer was significantly reduced by nearly 64 percent in patients who responded to our questionnaire and were aged 35 years or more at the time of surgery ([SIR] = 0.36; 95 % [CI] 0.09 - 0.93). No difference in breast cancer incidence was observed in patients aged less than 25 years at the time of the surgery. Conclusion: The Moufarrege Total Posterior Pedicle breast reduction is a reliable and safe procedure that may offer a superior breast cancer risk reduction based on the results of our retrospective chart review and patient questionnaire.

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis.

BackgroundReduction mammoplasty (RM) is a proven method of treating macromastia, but the risk factors for postoperative complications have not been clearly identified. Through this meta-analysis, the authors aimed to identify the risk factors of RM complications.MethodsAn extensive search of the literature describing complications after RM was performed using the PubMed Central, Embase, and Cochrane databases. The following risk factors were extracted: age, body mass index (BMI), tissue resection weight per breast (TRW), smoking and radiation therapy. Odds ratios (OR) were pooled with 95% confidence intervals (CI) to evaluate the relationship between these risk factors and complications after RM.ResultsA total of 16 unique studies including 10 593 patients were included in the final analysis. It showed that there was a significant difference in complications in BMI ≥30 kg/m2 (OR 0.73; 95% CI: 0.61–0.89, p = 0.001) and smoking (OR 1.56; 95% CI: 0.98–2.49, p = 0.06). Infection in those with BMI ≥30 kg/m2 showed a significant difference (OR 0.68; 95% CI: 0.52–0.89, p = 0.004), as well as wound dehiscence in smokers (OR 2.73; 95% CI: 1.60–4.67, p = 0.0002) and infection in irradiated breasts (OR 20.38; 95% CI: 3.42–121.35, p = 0.0009). However, there was no significant difference in age ≥50 years (OR 0.96; 95% CI: 0.71–1.29, p = 0.78), combined TRW ≥1000 g (OR 1.04; 95% CI: 0.43–2.50, p = 0.93).ConclusionsBMI ≥30 kg/m2 and smoking increase the risk of complications. Persons who are obese or irradiated are more likely to develop infections, and smokers experienced a higher incidence of wound dehiscence than did nonsmokers. However, patients aged ≥50 years and TRW ≥1000 g are not associated with complications from RM.

Vertical Scar Breast Reduction: Does Gathering the Incision Matter?

The vertical scar bilateral breast reduction is a highly effective technique to reduce breast volume and create long-lasting aesthetic improvements. A cited disadvantage is the inability to adequately shorten the vertical scar, leading to chest wall scars or inframammary puckers. Gathering or cinching sutures have been described as a strategy to confront this issue. This article aims to determine if suture gathering is an effective methods to (1) reduce the incision length, (2) shorten the areola-to-inframammary fold (IMF) distance, and (3) reduce the pucker revision rate. All patients undergoing vertical breast reduction performed by the senior author (E.H.F.) from 2001 to 2007 were included. The patient population was divided into "gather" and "no gather" groups depending on how the vertical incision was closed. There were 203 patients in the "no gather" group and 193 in the "gather" group. Age, body mass index, and resection weight were statistically but not clinically different. The percent reduction in vertical incision length was significantly greater in the "gather" group (34.2 ± 9.9% vs. 12.2 ± 5.9%). Both groups showed a gradual lengthening of areola-to-IMF distance postoperatively. Suture gathering had no impact on the pucker revision rate but increased healing complications. Gathering sutures significantly reduce the incision length in the operating room but do not change the areola-to-IMF distance or pucker revision rate. Gathering negatively influences skin vascularity and wound healing. It is acceptable and necessary to have a longer areola-to-IMF distance in a vertical reduction to accommodate increased projection.

Influence of anesthesia on blood loss during prostatic resection

Objective: The volume of blood loss during prostatic resection (TURP) is determined by a number of factors. The aim of the present study was to ascertain the independent effect of a general or a spinal anaesthetic on the amount of intraoperative blood loss. Patients and methods: A total of 110 patients treated by TURP, were entered in to a prospective study. The mean age of the patients was 71 years (range 45-91). Sixty-six patients (60%) received a spinal and 44 (40%) had a general anaesthetic ; 80 % of resections were benign and 20 % for malignant disease. The mean resected weight was 29.7grams (range 3-100) and the mean resection time was 28.9 minutes (range 5 - 60). The volume of blood loss was calculated by a well described method and the mean loss was 319mls (range 6 - 1587). Results: The mean weight of the resected prostate tissue and the volume of blood loss was significantly high in patients who had received a spinal anaesthetic (p=0.001 and p=0.005 respectively). However, when the independent i nfluence of the type of anaesthesia and the resected weight on blood loss was analysed, it was found that the former had no significant effect (p=0.28) whereas the later influenced very significantly (p&lt;0.001). Blood transfusion requirement was similar in both groups and no hypotensive episodes were recorded. Conclusion: Although previous studies have suggested that spinal anaesthesia reduces blood loss during prostatic resection, however, the present study fails to confirm this association

The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n=12) or near-total thyroidectomy with a remnant of <1g (n=26). Surgical indications were recurrence after antithyroid drugs (ATDs) and unwillingness to undergo radioiodine therapy (n=27), local compressive symptoms (n=2), adverse drug reactions to ATDs (n=5), and patient's preference (n=4). Mean resection weight was 71.7±16.2g (range 44-109g), mean operative duration 87.7±17.3min (range 66-136min), intraoperative blood loss 70.6±11.3mL (range 43-92mL), and drainage was 42.0±8.5mL (range 20-62mL). Temporary postoperative recurrent laryngeal nerve palsy and temporary hypoparathyroidism occurred in 3 cases (7.89%) each. Mean hospital stay was 2.5±0.3days (range 2-4days). There was no recurrence of hyperthyroidism over the follow-up period of for 68.1±5.6months (range 6-89months). All patients were satisfied with their cosmetic results. Gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.

970 For patients with smaller resection weight of transurethral resection of prostate, could combined incision of bladder neck lead to less acute urinary retention after surgery? A nationwide database study

970 For patients with smaller resection weight of transurethral resection of prostate, could combined incision of bladder neck lead to less acute urinary retention after surgery? A nationwide database study

The Effect of Abdominoplasty and Outcome of Rectus Fascia Plication on Health-Related Quality of Life in Post-Bariatric Surgery Patients.

The authors prospectively evaluated the effect of isolated abdominoplasty with or without rectus fascia plication on the physical, functional, and psychosocial dimensions of health-related quality of life in post-bariatric surgery patients. They also evaluated whether the objectively measured amount of abdominal excess skin affects the discomfort of excess abdominal skin and changes in health-related quality of life after abdominoplasty. Ninety-four post-bariatric surgery patients answered questionnaires regarding their experience of excess skin and health-related quality of life before and 1 year after isolated abdominoplasty. An objective assessment of the amount of abdominal excess skin was also performed. All study participants were assigned randomly to either undergo or not undergo rectus fascia plication. Significant improvements were reported at the follow-up concerning physical, functional, and psychosocial dimensions of health-related quality of life. A significant decrease was observed for the general health subscale of the 36-Item Short-Form Health Survey for the nonplicated group (p = 0.039). No significant differences were observed between the plicated and nonplicated groups. A significant low correlation was identified between the change in the Short-Form physical function subscale after abdominoplasty and measured amount of excess abdominal skin (rs = 0.26, p = 0.033) or resection weight (rs = 0.20, p = 0.10). Isolated abdominoplasty in post-bariatric surgery patients seems to improve both physical and psychosocial dimensions of health-related quality of life. However, rectus fascia plication does not appear to influence health-related quality of life. In addition, the correlation between the objectively measured amount of abdominal excess skin and improvements in health-related quality of life after abdominoplasty in post-bariatric surgery patients appears to be low.

Impact of increasing age on breast reduction surgery: A single centre analysis

Women with hypertrophic breasts suffer for physical and psychological reasons. Breast reduction surgery is a safe procedure that can effectively improve symptoms and quality of life. As most studies have been performed in younger women, little is known about complications and long-term patient satisfaction in elderly women. We analysed complication rates and patient satisfaction in women aged 60 years and older who underwent a bilateral reduction mammaplasty. Patient satisfaction was measured with a validated questionnaire (client satisfaction questionnaire (CSQ)-8). The results obtained were compared to those of a control group including women aged 35 years and younger. Twenty-five women met the inclusion criteria in each group. The mean age in the elderly and young was 65.4 and 23.4 years, respectively. Older women had more comorbidities (35 vs. 9, p < 0.05). The average overall resection weight was 1684.4 g with slightly lower resection weights in younger women (1541 vs. 1828 g; p = 0.34). Eight women in the young group and 11 in the elderly developed minor complications (p = 0.56). Two women in the young group had major complications. Patient satisfaction was significantly higher in older women, with a mean score of 27.3 in the young and 30.3 in the elderly (maximum score of CSQ-8: 32, p < 0.05). Age is not a contraindication for reduction mammaplasty. Breast reduction surgery is a safe procedure in elderly women and leads to even higher patient satisfaction. Level of evidence: IV.

Patient age and breast resection weight affect immediate postmastectomy breast reconstruction in ductal carcinoma in situ

Mastectomy is necessary for 40% of the ductal carcinoma in situ. If immediate breast reconstruction (IBR) is systematically proposed, 81% of the patients would choose immediate versus delayed breast reconstruction, but the actual IBR rate is only approximately 50% of them. Therefore, the aim of this study was to identify objective characteristics that distinguish the patients who actually underwent IBR from those who did not. Several criteria of 248 patients who have undergone mastectomy for ductal carcinoma were analyzed. Factors studied were age, body mass index, diabetes, tobacco use, and weight of the specimen of resection. The rate of IBR was 43%. An increase in age and weight of the resection specimen, irrespective of the body mass index, was associated with a lower rate of IBR. Thus, an increase of 100 g in the weight of the breast induces a significant reduction of the IBR (33%). In our series, older patients or patients with larger breasts (irrespective of the body mass index) were less likely to undergo IBR. In order to be in line with the patient's desire, the surgeons of our unit should broaden their indications of IBR. The lack of reconstruction of large breasts should certainly be compensated in part with the recent development of free tissue transfers in our unit. 3.

Oncoplastic Resection of Breast Cancers Located in the Lower-Inner or Lower-Outer Quadrant with the Modified McKissock Mammaplasty Technique.

Oncoplastic surgery for breast cancer (BC) may result in postoperative morbidity that can delay adjuvant treatment(s). The McKissock procedure is a reliable mammaplasty technique used in plastic surgery. The authors present their experiences in using a derived technique for the oncoplastic resection of extended malignancies located in the lower-inner (LIQ) or lower-outer (LOQ) breast quadrants. Between 2011 and 2014, operative data of 25 patients receiving an oncoplastic resection for invasive BC or ductal carcinoma in situ (DCIS), using the modified McKissock procedure, were recorded. This technique conserved a bipedicle dermoglandular flap to improve the nipple-areola complex blood supply. Oncological and cosmetic results, as well as aesthetic outcomes and patients' satisfaction, were analyzed. Invasive BCs (n = 21) and DCIS (n = 4) were located in the LIQ (n = 18) or LOQ (n = 7). The median age of patients was 62 years (range 34-85), the mean resection weight was 134 g (range 43-314), and the global morbidity rate was 12 %. No nipple necrosis occurred in these patients. Free margins were obtained in 22 cases (88 %) and the secondary mastectomy rate was 8 %. Contralateral symmetrization was performed, or was required, in the majority of cases (17/23). Cosmetic results were classified as excellent or good in 93 % of patients, and the median satisfaction rate on a visual analog scale was 9.6. The modified McKissock procedure allows wide resection of cancers located in the LOQ or LIQ, and produced favorable postoperative outcomes and cosmetic results despite important resection weights.

Pubic symphysitis after transurethral resection of the prostate.

Pubic symphysitis (PS) after urological operations is uncommon. This is a systematic single-institution review of patients with transurethral resection of the prostate (TUR-P) with the aim to determine the incidence of PS after TUR-P and to identify a risk profile. In the past 15 years, 12,118 transurethral operations were performed in our department, 33.4% (n = 4045) were TUR-P, and 84.6% (n = 3421) had routine suprapubic trocar placement. A systematic retrospective analysis identified 12 patients, who developed PS (0.297%). Median age was 69.5 years (64-83). All patients had voiding difficulties. Urine culture had been positive in three cases. All 12 TUR-Ps were monopolar resections, and n = 11 patients had a suprapubic trocar. Median resection weight was 47.5 g (10-100). Two patients had a perforation of the capsule. Histopathological examination revealed chronic prostatitis in nine cases. After 1.0 ± 1.2 months, all patients developed pain in the pubic region. All patients underwent MRI, which suggested PS. Symptomatic and antibiotic medications were administered. Final outcome was resolution of symptoms in all patients after 3.8 ± 5.6 months. No patient retained voiding difficulties. PS remains a rare complication after TUR-P. We could not identify a single cause for developing PS. In our study, suprapubic trocar placement (11/12), chronic prostatic inflammation (9/12), previous UTI (3/12) and extended resection (2/12) were overrepresented. Inflammatory, thermic and/or surgical damage of the capsule may be causative. Patients require antibiotic and symptomatic medication. However, prognosis for remission is excellent.

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate