Secondary Surgery Research Articles

Clinical outcomes of reconstruction on tissue defects with thin anterolateral thigh flap versus commonly used free soft flaps: A meta-analysis.

Clinical outcomes of reconstruction on tissue defects with thin anterolateral thigh flap versus commonly used free soft flaps: A meta-analysis.

Degradable poly-lactic-co-glycolic acid and non-degradable polymer implants result in similar fracture healing at early timepoints.

Degradable poly-lactic-co-glycolic acid and non-degradable polymer implants result in similar fracture healing at early timepoints.

Discussion: Radical Overlapping Intravelar Veloplasty during Primary Cleft Palate Repair Results in Decreased Secondary Speech Surgery.

Discussion: Radical Overlapping Intravelar Veloplasty during Primary Cleft Palate Repair Results in Decreased Secondary Speech Surgery.

Nomogram for predicting secondary surgery in patients with concomitant exotropia

Concomitant exotropia (CX), a common form of strabismus, often requires surgical correction, yet up to 60% of patients undergo secondary surgery (SS) due to recurrence or residual deviation. Current risk prediction tools remain limited by inconsistent variables and short-term follow-up. This study aimed to develop and validate a nomogram integrating long-term follow-up data to predict individualized SS risk in CX patients. This is a retrospective cohort study of patients with CX who underwent surgery at the Peking University First Hospital between January 1, 2008, and December 31, 2010. Of the 355 CX cases included, 70% were randomly assigned to the training set (n = 248) and 30% to the validation set (n = 107). Demographic and clinical variables were ascertained at hospital admission and discharge and screened using multivariate Cox proportional hazards regression analysis to construct predictive models and generate a one-, three-, and six-year alignment rate nomogram. This nomogram provided an estimate of the risk of SS in patients with surgically treated CX. Internal validation was conducted using the concordance index (C-index) and calibration curve for the training and validation sets, respectively. Four independent prognostic factors were identified: age of onset, refraction, types, and deviation angles one week after surgery entered into the nomogram. The proposed nomogram showed favorable discrimination and accuracy in the training and validation sets. The C-indexes of the training and validation sets were 0.83(95%CI:0.71 ~ 0.95) and 0.80(95%CI: 0.70 ~ 0.89), respectively. The proposed nomogram may serve as a predictive tool for prognostic evaluation of CX surgery.

Long-Term Management of Velopharyngeal Insufficiency and Misarticulation in Unilateral Cleft Lip and Palate: Speech Therapy Outcomes.

This report highlights the long-term management of velopharyngeal insufficiency (VPI) and misarticulation in an 18-year-old male with unilateral cleft lip and palate. Despite primary and secondary surgeries, persistent VPI required a speech appliance and intensive therapy to address glottal stops and pharyngeal fricatives. While therapy eliminated these errors, residual VPI continued to impact speech intelligibility. Reassessment revealed that while some misarticulations persisted, the patient retained speech improvements from prior therapy, allowing for partial substitutions of target sounds. This case emphasizes the role of speech therapy in managing misarticulation despite unresolved VPI and highlights the need for ongoing multidisciplinary care.

Analysis of the incidence and prognostic factors of port-site metastasis following laparoscopic surgery in patients with ovarian epithelial carcinoma

Objective: To investigate the incidence of port-site metastasis (PSM) after laparoscopic surgery in patients with epithelial ovarian cancer and prognostic factors influencing outcomes in those with abdominal wall PSM. Methods: Clinicopathological and follow-up data of 22 ovarian epithelial cancer patients diagnosed with abdominal wall PSM after laparoscopic surgery, who were treated in the Sichuan Cancer Hospital between May 2014 and July 2023, were retrospectively collected. A retrospective analysis of PSM characteristics and prognostic factors influencing outcomes, was conducted in these patients. Results: (1) Between May 2014 and July 2023, a total of 369 ovarian cancer patients with a history of laparoscopic surgery performed at other hospitals were admitted. Among them, 24 cases (6.5%, 24/369) were diagnosed with tumor lesions at the abdominal wall port sites via postoperative pathological examination, with a median interval time of 25.5 days (interquartile range: 19.5, 32.0 days) after laparoscopic surgery. Of these, 22 cases with complete clinicopathological and follow-up data were included in this study. (2) The age of the 22 PSM patients was (53.0±8.6) years, and the median follow-up time was 37.6 months (24.7, 63.4 months). Surgical-pathological staging revealed stage Ⅰ-Ⅱ disease in 4 cases and stage Ⅲ-Ⅳ disease in 18 cases. Histopathological differentiation included 5 cases of well-to-moderately differentiated tumors and 17 cases of poorly differentiated tumors. Pathological subtypes comprised 11 cases of high-grade serous adenocarcinoma, 5 cases of low-grade serous adenocarcinoma, and 6 cases of clear cell carcinoma or cystadenocarcinoma. Lymph node status was as follows: negative for lymph node metastasis (n=16), positive (n=5), and no lymphadenectomy performed (n=1). Postoperative residual disease was categorized as no macroscopic residual disease (n=13), residual disease ≤1 cm (n=7), and residual disease >1 cm (n=2). (3) Following secondary cytoreductive surgery combined with postoperative adjuvant therapy, the median progression-free survival and overall survival (OS) time of the patients were 8.8 months (4.6, 14.3 months) and 27.7 months (15.5, 38.4 months), respectively. Univariate Cox regression analysis demonstrated that surgical-pathological stage, histopathological differentiation grade, and lymph node metastasis status were significantly associated with OS time in patients with abdominal wall PSM (all P<0.05). In contrast, age, Eastern Cooperative Oncology Group performance status score, histopathological subtype, preoperative serum cancer antigen 125 level, presence of residual lesions after surgery and poly adenosine diphosphate ribose polymerase inhibitor usage showed no significant correlation with OS time (all P>0.05). Multivariate Cox regression analysis identified surgical-pathological stage (HR=4.579，95%CI：1.111-18.866；P=0.035) and histopathological differentiation grade (HR=5.307，95%CI：1.042-27.031；P=0.045) as independent risk factors for OS time in PSM patients. Conclusion: Abdominal wall PSM following laparoscopic surgery for epithelial ovarian cancer maybe adversely affect patient prognosis, particularly in cases with advanced stage and poorly differentiated tumors, which warrants significant clinical attention.

Reversal of Roux-en-Y Gastric Bypass: A Multi-Centric Analysis of Indications, Techniques and Surgical Outcomes

Abstract Background Roux-en-Y gastric bypass may present long-term complications that require revisional surgery or even reversal to normal anatomy. Data on the indications, surgical technique and outcomes of RYGB-reversal remain scarce. Aims To analyze indications, techniques and surgical outcomes after reversal of Roux-en-Y gastric bypass. Methods We identified 48 cases of RYGB-reversals with complete 90-day follow-up within a multi-centric international retrospective database of elective secondary bariatric surgery. The operations were performed between 2010–2024 in high volume referral centers in Europe and USA. Data were collected on body weight, associated diseases and on surgical outcomes up to 1-year postoperatively. Results Patients were mainly female (81.3%) with a median age of 50 years (IQR 39-56). RYGB-reversal was performed 7 years (median) after primary RYGB in patients with a BMI 23.9 kg/m2 (IQR 20-27). Half of the patients underwent at least 1 bariatric revision before the reversal. Main indications for reversal were dumping syndrome (33.3%), excessive weight loss (29.2%), marginal ulcer (14.6%), malabsorption (12.5%) and abdominal pain (10.4%). Rate of conversion to open surgery was 8.3% and the postoperative complications during the first year reached 50%, including 31.3% Clavien-Dindo grade I-II, 16.7% grade III-IV complications and one death. At 1-year, the mean BMI of the cohort increased by 18% to 28.25kg/m2; only 1 patient reached pre-RYGB BMI. Conclusion Although RYGB is a theoretically reversible procedure, normal anatomy is re-established only in selected cases which are refractory to medical therapy and often also to revisional bariatric surgery. RYGB-reversals entail high morbidity, while the extent of recurrent weight gain at 1-year post-reversal seems to allow patients to remain below the threshold of severe obesity.

12-month Intraocular Pressure and Hypotensive Medications Outcomes after Phaco-ELIOS Procedure - A Real World Study.

Combined phaco-ELIOS in ocular hypertension and glaucoma showed a statistically significant reduction in the number of hypotensive medications of 1.5 compared to baseline, with 78.4% of eyes being medication-free at 12 months. To describe change in medication and intraocular pressure 12 months after combined phacoemulsification-ELIOS procedure. Retrospective, multicenter interventional case series of adults with ocular hypertension or glaucoma undergoing phaco-ELIOS. Clinical data was collected and analyzed from pre-operative baseline up to 12 months postoperatively. Primary outcome was mean change in medication compared to baseline. Secondary outcomes were intraocular pressure change from baseline, incidence of acute postoperative intraocular pressure elevation, and surgical success at 1 year, defined as intraocular pressure reduction of ≥20% compared to baseline with no increase in medications, or reduction of ≥1 medications compared to baseline with intraocular pressure equal or below baseline, with no secondary glaucoma surgeries and no loss of light perception. 112 eyes were included. Forty-two patients (51.2%) were female. Mean (±SD) age was 70.6 (±9.6) years. Most frequent diagnosis was primary open angle glaucoma (71.4%). Mean number of medications at baseline and 12 months was 1.8 (±0.8) and 0.4 (±0.7), respectively, representing a reduction of 1.5 (±1.0) (P<0.0001). At the end of follow-up, 78.4% of eyes were medication-free. Mean intraocular pressure at baseline and 12 months was 19.9 (±4.0) mmHg and 16.7 (±2.6) mmHg, respectively, a significant decrease of 3.2mmHg (±4.0) or 13.7% (P<0.0001). Surgical success was achieved in 75.9% of eyes at 12 months. Combined phaco-ELIOS in glaucoma significantly reduced medication use and IOP, with over 75% of eyes being medication-free at 12 months.

ENHANCING OUTCOMES WITH SINGLE-STAGE ROBOTIC HYSTERECTOMY AND METOIDIOPLASTY: A NEW PARADIGM IN GENDER AFFIRMATION SURGERY

Abstract Objectives The conventional pathway for female-to-male (FtM) gender-affirming surgery often involves multiple stages, thought necessary for patient safety. However, this staged approach may extend gender dysphoria and reduce cost-effectiveness. In response, our center has developed a single-stage surgical approach combining robotic hysterectomy and vaginectomy with metoidioplasty with hook-up to streamline the transition process and improve patient outcomes. While considered feasible, detailed data on the clinical outcomes of this combined approach remain limited. Methods A prospective evaluation was conducted at Chelsea and Westminster Hospital on FtM patients meeting WPATH criteria for genital surgery and requesting metoidioplasty as their primary option. Exclusions included patients requiring revision, phalloplasty, or secondary surgeries. Patients were referred following a multidisciplinary evaluation from accredited Gender Dysphoria Clinics. A combined procedure involving total robotic hysterectomy, bilateral salpingo-oophorectomy, vaginectomy, and metoidioplasty with urethral hook-up and scrotoplasty (per the Belgrade technique) was performed on all patients. Complications were graded by the Clavien-Dindo scale, and outcomes included operative time and inpatient stay. Statistical analysis was conducted using SPSS. Results Of 21 patients undergoing the combined procedure, the mean age was 34 years (±10.7), and mean BMI was 24.41 (±2.65). The average operative time was 233 (range: 153– 290) minutes, and the mean inpatient stay was 1.85 (range: 1– 7) days. We had 17 complications, 11 being minor (Clavien Dindo I-II) while four patients required reoperation for implant migration, classified as Grade IIIb and two fistulas that required surgical treatment. The mean follow-up time was 8.47 (range 1– 16) months, with PROMs indicating significant reductions in gender dysphoria and high patient satisfaction with physical and aesthetic outcomes. Conclusions Our findings demonstrate that a single-stage approach combining robotic hysterectomy and metoidioplasty is feasible and beneficial, with low complication rates and high patient satisfaction. This approach can potentially reduce the overall cost and psychological impact of transitioning by providing a comprehensive solution within a single operative session. These results support the broader adoption of integrated surgical techniques to enhance the quality of life and well-being of FtM transgender individuals. Conflicts of Interest None.

Use of Radiofrequency-assisted Liposuction (BodyTite) for "Chest Lift" in Patients Undergoing Gynecomastia Correction.

Use of Radiofrequency-assisted Liposuction (BodyTite) for "Chest Lift" in Patients Undergoing Gynecomastia Correction.

Safety and efficacy of MicroPulse transscleral laser therapy with the revised P3 delivery device: A randomized controlled trial.

ObjectiveTo evaluate the safety and efficacy of MicroPulse Transscleral Laser Therapy (MicroPulse TLT) with the Revised P3® Delivery Device.DesignProspective, single-surgeon, interventional study in a tertiary hospital setting.ParticipantsSixty-two eyes of 40 patients with refractory glaucoma.MethodsAll subjects received 360-degree MicroPulse TLT treatment (2500 mW, 31.33% duty cycle) over a total of 240 s (8 sweeps; n = 20), 300 s (10 sweeps; n = 22), or 200 s (10 sweeps; n = 20). Participants were followed up for 6 months to assess changes in intraocular pressure (IOP), glaucoma medication burden, and best-corrected visual acuity (BCVA). Surgical success was defined as a reduction of IOP ≥ 30% from baseline and between 6-18 mmHg at last follow-up with no additional anti-glaucoma medications or secondary reinterventions.ResultsSurgical success was achieved in 72.7% (300 s group), 75.0% (240 s group), and 80.0% (200 s group) of eyes. Mean IOP was significantly reduced (p < 0.001) by 49.0% (300 s group), 45.66% (240 s group), and 39.8% (200 s group) at 6 months. With all groups combined, the mean number of glaucoma medications was significantly reduced by 17.8% (p = 0.005), and no significant changes in BCVA were observed at 6 months. Complications were minimal, including four eyes with IOP spikes, one eye with hyphema, and one eye with cystoid macular edema (CME), all of which resolved. Two eyes of the total sample (3.2%) required secondary glaucoma surgery before 6 months.ConclusionsSecond-generation MicroPulse TLT at fluence values of 154-229 J/cm2 appears to be a safe and effective option for IOP reduction in refractory glaucoma.

Comparing the Outcomes of Cast Immobilization with and Without K-Wire Fixation for Displaced Distal Radius Fractures in the Pediatric Population: A Systematic Review and Meta-Analysis.

Background and Objectives: Distal radius fractures are among the most common pediatric injuries, accounting for approximately 25% of all fractures in children. Displaced fractures are prone to re-displacement, necessitating additional interventions. K-wire fixation is effective in reducing re-displacement risks, but no one has systematically assessed its use. This study aims to compare the outcomes of cast immobilization alone versus cast immobilization with K-wire fixation in pediatric patients with displaced distal radius fractures. Methods: A comprehensive search of PubMed, Web of Science, Cochrane CENTRAL, Scopus, and Embase databases for studies comparing these treatments. The quality assessment was conducted using the Cochrane Collaboration Risk of Bias for randomized studies and the Methodological Index for non-randomized studies. The meta-analysis was carried out using RevMan software V5.4. Results: Out of 267 initial records, 12 studies met the inclusion criteria, encompassing 1455 patients (853 treated with cast alone and 602 with K-wire fixation). Meta-analysis of 10 studies showed significantly higher re-displacement rates with cast immobilization compared to K-wire fixation (OR: 11.42, 95% CI: 2.43-53.77, p = 0.002, I2 = 82%). The risk of secondary surgery was also higher in the cast group (OR: 6.91, 95% CI: 1.5-31.72, p = 0.01, I2 = 75%). However, complications were lower with cast immobilization (OR: 0.68, 95% CI: 0.45-1.03, p = 0.07, I2 = 74%), though not statistically significant. Conclusions: K-wire fixation appears to offer superior fracture stability and reduces the need for secondary surgeries compared to cast immobilization for displaced distal radius fractures in pediatric patients. However, both treatment modalities are associated with comparable complication rates, emphasizing the importance of individualized treatment planning.

Comparative Cost Analysis of Secondary Intraocular Lens Surgeries Using Time-Driven Activity-Based Costing.

Comparative Cost Analysis of Secondary Intraocular Lens Surgeries Using Time-Driven Activity-Based Costing.

Malignant germ cells tumor of the ovary.

Malignant ovarian germ cell tumors are rare and diverse malignancies, accounting for approximately 5% of all ovarian cancers. Primarily affecting young women, these tumors present unique challenges, particularly in balancing effective treatment with fertility preservation. Early diagnosis is common due to the rapid tumor growth and symptoms such as abdominal pain and distension, leading to favorable prognoses when combined with the high chemosensitivity of platinum-based regimens. Fertility-sparing surgery is the cornerstone of treatment for stage I disease, often followed by close surveillance to minimize the long-term toxicities of chemotherapy. Pathology is pivotal for diagnosis, incorporating immunohistochemical markers to differentiate malignant ovarian germ cell tumors subtypes, including dysgerminomas, yolk sac tumors, and immature teratomas. Advanced imaging modalities like ultrasound, magnetic resonance imaging, and computed tomography are essential for staging, monitoring treatment response, and detecting recurrences. Despite high cure rates, long-term follow-up is crucial to manage late toxicities, such as gonadal dysfunction and secondary malignancies. Recurrent malignant ovarian germ cell tumors present significant therapeutic challenges. High-dose chemotherapy with stem-cell transplantation offers promise in select cases, while the role of secondary cytoreductive surgery and radiotherapy is limited to specific indications. Emerging targeted therapies and novel approaches, such as KIT inhibitors for dysgerminomas with KIT mutations, remain experimental, with limited success reported so far. The rarity and heterogeneity of malignant ovarian germ cell tumors impede large-scale research efforts, underscoring the need for greater understanding of their molecular and genetic landscape to develop more effective and personalized therapies.

Trans-flap nasal airway preservation in-house device.

Trans-flap nasal airway preservation in-house device.

Five-Year Experience With Routine Use of Intraoperative Cone-Beam Computed Tomography in Zygomaticomaxillary Complex Fractures.

Five-Year Experience With Routine Use of Intraoperative Cone-Beam Computed Tomography in Zygomaticomaxillary Complex Fractures.

Patients Report Improved Functional Outcomes After Puncture Capsulotomy Technique for Hip Arthroscopy at 5 Years.

Patients Report Improved Functional Outcomes After Puncture Capsulotomy Technique for Hip Arthroscopy at 5 Years.

Silk screws prepared by bidirectional dialysis for bone fracture fixation.

Silk screws prepared by bidirectional dialysis for bone fracture fixation.

Coronectomy in Lower Third Molar Surgery: A Systematic Review and Meta-Analysis.

Coronectomy in Lower Third Molar Surgery: A Systematic Review and Meta-Analysis.

Stereotactic laser ablation for pediatric central nervous system tumors: a systematic review and meta-analysis of the literature.

Stereotactic laser ablation (SLA) or laser interstitial thermal therapy (LITT) is an emerging alternative to conventional surgery for CNS tumors. Further characterization of its effectiveness and safety in the pediatric population is needed. A review was conducted according to PRISMA guidelines using the PubMed/MEDLINE, Scopus, Embase, Google Scholar, and Science Direct databases to investigate the effectiveness and safety in the use of LITT to treat pediatric CNS tumors in children. A total of 24 articles met the inclusion criteria. From the 4 retrospective studies comprising 97 patients (mean age 11.4 years, 55.0% males in the pooled prevalence), the most common tumor types were pilocytic astrocytoma (31.5%) and subependymal giant cell astrocytoma (SEGA; 68.5%). Tumors were primarily located in the frontal lobe (29.7%) and thalamus (24.4%). Postoperative complications included transient neurological deficits in 12.1% and permanent deficits in 6.0% of patients. At a mean follow-up of 43.9 months, mass reduction was observed in 68.8% of patients and overall disease improvement in 91.9% of patients, and the mortality rate was 2.6%. From the 20 case reports/series involving 67 patients (mean age 10.8 ± 4.7 years, 52.2% males), the mean tumor size was 15.7 ± 8.7 cm3. Predominant tumor subtypes were pilocytic astrocytoma (29.9%) and SEGA (16.4%). Tumors were located in eloquent areas in 61.3% of cases, notably the thalamus (24.2%) and ventricular system (24.2%). Prior treatments included surgery (78.8%), chemotherapy (51.5%), and immunotherapy (27.3%). Key LITT parameters were duration (7.2 ± 8.8 minutes), dose (10.2 ± 2.4 W), and extent of tumor volume decrease (68.3% ± 30.4%). The most commonly used LITT system was Visualase (95.7%). Postoperative complications were reported in 26.9% of patients, including transient neurological deficits (55.6%), perilesional edema (22.2%), and hydrocephalus (22.2%). Hospital stays were ≤ 3 days in 92.7% of patients. Tumor size reduction was achieved in 86.7% of patients, and 78.9% experienced disease improvement. Comparative analysis showed that a greater extent of ablation was associated with a reduced need for secondary surgery (p = 0.038, OR 0.94) and improved disease outcomes (p = 0.023, OR 1.05). Longer LITT duration was significantly associated with postoperative complications (p = 0.050). LITT appears effective in reducing tumor size and improving disease outcomes in pediatric CNS tumors. The long-term effectiveness of LITT in pediatric brain tumors requires further randomized prospective investigation.