Significant Operative Complications Research Articles

Effectiveness of NOTES versus traditional techniques on surgical outcomes in adults with diverticulitis: a systematic review protocol.

This review will evaluate the effectiveness of natural orifice transluminal endoscopic surgery (NOTES)/hybrid NOTES versus traditional surgical techniques in the management of diverticular disease. Diverticular disease can have a significant impact on a patient's quality of life, especially the changes affecting bowel function. Recurrent/severe symptoms may require surgery. Resections are invasive and can have significant operative complications. There has been a shift from an open resection to a more minimally invasive technique such as laparoscopy. Furthermore, the use of natural orifice transluminal endoscopic resection, using a transanal/transvaginal approach, has begun to be used in colorectal resections. Eligible studies will include patients who underwent surgical resection for diverticular disease or diverticulitis. The review will consider studies that evaluate NOTES in the management of diverticular disease or diverticulitis. This will include hybrid procedures involving both NOTES and natural orifice specimen extraction (NOSE), with the aid of laparoscopy/endoscopy/robotic equipment. Studies on participants under 18 years of age and presenting with non-diverticular pathologies will be excluded. This review will follow the JBI methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Databases to be searched will include PubMed, MEDLINE (Ovid), CINAHL (EBSCOhost), Cochrane Library, Web of Science, Scopus, ProQuest, ClinicalTrials.gov, and ANZCTR, with no language limitations. The reference lists of included studies will be screened for additional studies. This review will preferentially consider experimental and quasi-experimental study designs. Two reviewers will conduct critical appraisal and data extraction. Studies will, where possible, be pooled in statistical meta-analyses. PROSPERO CRD42023420771.

Surgical Technique: Wide Arthroscopic Dorsal Capsuloligamentous Repair for Advanced Scapholunate Instability

In the most advanced cases of scapholunate instability with dynamic or static signs, classical arthroscopic repair seems impossible. Ligamentoplasties or open surgery procedures are technically demanding, hampered by significant operative complications and often stiffening. Therapeutic simplification is therefore necessary for the management of these complex cases of advanced scapholunate instability. We propose a minimally invasive, reliable, and easily reproducible solution that requires little equipment other than arthroscopic material.

Deep anterior lamellar keratoplasty in keratoconus

Aims: To analyse the outcome of DALK in patients with keratoconus in terms of best corrected and uncorrected visual acuity, average K and topographic astigmatism. Settings and design: Prospective interventional case series study Material and methods: 28 eyes of 28 patients diagnosed with keratoconus were evaluated from August 2009 – July 2011 in a tertiary eye care hospital. All patients underwent DALK and outcomes were assessed on 4 parameters: Average Keratometric reading, topographic astigmatism, UCVA and BCVA alongwith epidemiological analysis. Statistical analysis used: ANOVA testing and Dunnett multiple comparison test. Results: We had evaluated 28 eyes of 28patients (10 males and 18 females) in the age group of 15 to 35 years. Cases were classified as moderate (4) and severe (24) category. There was a statistical significant decrease Average K and Topographic Astigmatism in post op period which was evaluated at 1, 3 and 6 months. (p value <0.05). From the sample size, allof the patients showed improvement in visual acuity by more than one Snellens. No significant post operative complications occurred. Conclusion: DALK is a safe and effective treatment for severe keratoconus, corneal scarring and contact lens intolerance.

Post-operative Complications of Complicated Paediatric Appendicitis in a Tertiary Teaching Hospital

Background: Acute appendicitis is a common surgical problem, with complicated appendicitis having significant post operative complications, which contribute significantly to cost of medical care. Methodology: A hospital based retrospective study was conducted in department of paediatric surgery, Thiruvananthapuram. Study population consisted of children treated with complicated appendicitis from January 2016 to June 2021. Results: The study had 30.4% surgical site soft tissue infection (SSI). There was 13.48% incidence of major complication, with laparoscopic and open appendicectomies having similar incidence even though not statistically significant. SSI was more common with appendicular abscess and post ileal appendix. Post operative intra-abdominal abscess is more common with open appendicectomy, generalised peritonitis, post ileal appendix and base/proximal perforation of appendix. Post operative adhesive intestinal obstruction was more common with laparoscopic appendicectomy, appendicular abscess and base/proximal perforation of appendix. Total hospital stay correlates significantly with duration of symptoms on presentation with mean hospital stay of 7.72 days. Conclusion: Complicated appendicitis have high incidence of post operative complications, 30.4% SSI and 13.48% serious complications like intra-abdominal collection and adhesive intestinal obstruction. Keywords: Appendicitis, Complication, Surgical site infection, Children.

Pyloric stricture after corrosive ingestion in children: an attempt to address the optimum management of this rarity

Corrosive ingestion in pediatric population can have devastating consequences. Pyloric stricture which is a rarer complication has not been discussed in details in existing literature. Whereas the presentation is more or less similar, a “case specific” approach may be required for the best outcome. We analyzed our series of eight patients to formulate a suitable approach to its management. This was a prospective observational study in the department of Pediatric Surgery in a tertiary health care centre in central India. Eight (n=8) patients with corrosive injuries exclusive to the pyloric antrum were analyzed with respect to the corrosive ingested, symptomatology, nutritional status, investigation findings, surgery undertaken and follow up. Total number of patients in our study were eight. Male -7 and female-1, mean age of 6.8 years, ranging from 4 and 10 years, most common agent was acid, ingested accidentally. Period of development of gastric outlet obstruction was 23 days, range between 11 days and 33 days. Initially presented with odynophagia but later developed features of gastric outlet obstruction. Procedure performed were Heineke Mickulicz pyloroplasty and Billroth I gastroduodenostomy with FJ depending on the intra operative findings. No significant post operative complications were encountered on follow up, all the patients had improved general condition and gained adequate weight. No re do surgeries were performed. Corrosive injury of the UGI tract is not uncommon in children. Pyloric stricture as a complication is relatively rare. Parents may seek consultation late only after the child has lost reasonable amount of weight. UGI Endoscopy and UGI contrast study are indispensable to evaluate the severity of damage and formulate the optimum plan of surgery. Early surgical intervention gives excellent result. Both Pyloroplasty and Billroth I anastomosis are safe with low morbidity and excellent long term outcome.

Vascular disorders of the gallbladder and bile ducts: Imaging findings.

Vascular disorders of the gallbladder and biliary tree are many and varied. In the acute setting, the clinical presentation of vascular conditions such as hemorrhagic cholecystitis and gangrenous cholecystitis are non-specific and rely on imaging for diagnosis and triaging for emergent surgery. These hemorrhagic and ischemic complications of acute cholecystitis are uncommon but potentially fatal. Hemorrhage into the gallbladder and biliary tree, from other causes, may itself result in acute cholecystitis. Knowledge of vascular anatomy of the gallbladder and biliary tree is essential for surgeons to prevent significant operative bleeding complications, particularly in laparoscopic cholecystectomy. The unique venous drainage of the gallbladder and biliary tree, with their connections to the portal venous system, lends itself to less well-recognised vascular phenomena such as gallbladder varices, portal biliopathy, and gallbladder bed perfusion abnormalities.

Efficacy of Total Thyroidectomy for Treatment of Benign Thyroid Lesions

Background: Total thyroidectomy is currently the preferred treatment for thyroid cancer, multinodular goitre (MNG) and Graves' disease. However, many surgeons choose not to perform total thyroidectomy to treat benign thyroid diseases owing to the associated risk of postoperative hypoparathyroidism, recurrent laryngeal nerve damage and bleeding. We reviewed 100 total thyroidectomies performed for benign thyroid diseases, when surgery was indicated. Objective: Assessment whether total thyroidectomy is safe and can be considered as the optimal surgical approach for treating benign thyroid diseases. Patients and methods: This study was conducted on 100 patients presented by thyroid swellings and admitted to Mansoura University Hospitals, Endocrine Surgery Unit over one year during the period between November, 2017 and October, 2018. All patients were submitted to careful history taking, clinical examination and radiological and laboratory investigations. Total thyroidectomy was done to all patients. Patients were evaluated early postoperative at 1, 6 and 12 months by sr. TSH, total & ionized calcium, PTH and vocal cord assessment. Results: Preoperative diagnoses in our patients revealed that there were 74 cases MNG (74%), 2ry toxic 19 cases (19%) and 1ry toxic 7cases (7%). The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy was 1%. Whereas the incidence of temporary unilateral recurrent laryngeal nerve palsy was 5%. Permanent hypocalcaemia occurred in 2% and overall temporary hypocalcaemia occurred in 8% of patients. Hemorrhage requiring repeat surgery occurred in 1% of patients. Conclusion: In our study, total thyroidectomy showed no significant operative and/or postoperative complications. Also, it was noticed that total thyroidectomy operation gave very good results in patients with benign thyroid diseases provided that they were done in qualified center and by experienced endocrine surgeons.

Combined phacoemulsification and viscocanalostomy with Ologen implant versus combined phacoemulsification and viscocanalostomy

BackgroundTo study the efficacy of the biodegradable collagen implant Ologen® as an adjuvant in phaco-viscocanalostomy in patients with coexisting cataract and primary open angle glaucoma.MethodsThis prospective, interventional, randomized clinical study was done at Alpha Vision Center, Zagazig, Egypt. Patients with coexisting cataract and glaucoma were randomized to receive either phaco-viscocanalostomy (Phacovisco group) (39 eyes) or phaco-viscocanalostomy with Ologen® implant (OloPhacovisco group) (40 eyes). Follow-up period was 2 years. Nd:YAG laser goniopuncture was done in cases where the intraocular pressure (IOP) was elevated above 21 mmHg after discontinuation of corticosteroid eye drops at any follow-up visit.ResultsNo significant operative or postoperative complications (other than failure) were encountered in either group. At 2 years follow-up, the mean IOP level was statistically significantly decreased in the OloPhacovisco group (p = 0.02) and complete success occurred in 23 eyes (59.0%) in the Phacovisco group and in 32 eyes (80.0%) in the OloPhacovisco group. There was a statistically significant higher success rate regarding complete success in patients that received Ologen® implant (p = 0.04).ConclusionsOlogen® implant improved the success rate of phaco-viscocanalostomy. Larger studies with longer follow-up periods may be required to confirm these findings.Trial registrationThis trial was retrospectively registered on 20/12/2018 under the number (NCT03782051).

Laparoscopy and the Era of ART in Unexplained Primary Infertility: Randomized Clinical Trial

OBJECTIVES: To compare the outcomes (effectiveness and safety) of laparoscopic surgery as a treatment option of unexplained primary infertil-ity with ART. DESIGN: Randomized prospective clinical trial. PATIENTS AND METHODS: 536 patients with primary unexplained infertility diag-nosed by normal hormonal profile and ovulatory at ovulation testing, nor-mal HSG, and normal semen analysis were randomized according to com-puter based system into: group I, 267 patients were managed with laparos-copy with aim of diagnosis and treatment. While in group II, 269 patients were treated by controlled ovarian stimulation and IUI up to 3 trials, if failed ICSI was performed. We calculated cumulative pregnancy outcome after two years for each group. RESULTS: In group I, Laparoscopic find-ings were as follow: minimal to mild endometriosis was found in 83 cases (31.1%), moderate to severe endometriosis 44 cases (16.5%) managed by adhesiolysis and ablation-excision of endometriotic implants. The preg-nancy rate after two years was 55.4% (46 cases), 38.6% (17 cases) in both respectively, significant periadnexal and pelvic adhesions 41 cases (15.3%) managed by adhesiolysis with pregnancy occurred in 22 cases (53.7%), while laparoscopy revealed hypo plastic tubes 33 cases (12.4%), and 66 cases (24.6%) remained unexplained. With the expectant manage-ment, pregnancy rate was 21.2% (7 cases), and 15.2% (10 cases) respec-tively. The overall pregnancy rate in group I is 102 cases (38.2%). In group II, 114 cases (42.3) got pregnant as 27 cases (8.78%) by IUI, and 87 cases (33.52%) by ICSI. OHSS occurred in 3 cases, multiple pregnancy occurred in 13 cases, abortion and miscarriage 6 cases in group II, while 2 cases of ectopic pregnancy in group I, and the patients of both groups did not suffer any significant operative complications. CONCLUSION: Laparoscopy is safe and effective as a treatment option in unexplained infertility and its performance provides diagnostic findings which are valuable in manage-ment of the unidentified causes, enabling good number of patients to have pregnancy spontaneously which is comparable to ART while avoiding economic, psychological and physical burdens of ART, like OHSS, multi-ple pregnancy and abortion which are higher in cases treated with ART. In the future if ART is needed, the success rate is increased by closure of (undiagnosed) hydrosalpinx and reposition of the ovary to facilitate oocyte retrieval.

Management of Dumbbell and Paraspinal Tumors of the Thoracic Spine Using a Single-stage Posterolateral Approach: Case Series.

This study investigated the surgical results of a single-stage posterolateral approach with arc incision, unilateral laminectomy, and costotransversectomy for the management of dumbbell tumors and paraspinal tumors of the thoracic spine. From January 2010 to March 2017, 14 patients with dumbbell tumors or paraspinal tumors of the thoracic spine who underwent resection with single-stage posterolateral approach were followed up and analyzed retrospectively. The operations were performed using a single-stage posterolateral approach with arc incision, unilateral laminectomy, and costotransversectomy without any instrumentation. We reviewed the scores of clinical symptoms and imaging results, including postoperative MRI and reconstructed 3D-CT images. Gross total removal was achieved in 13 patients, and subtotal removal was achieved in 1 case. Histopathology revealed schwannoma in 9 patients, angiolipoma in 1 patient, and paraganglioma and mixed hemangioma in 2 patients each. No significant operative or postoperative complications occurred in any patient. The 14 patients were followed up for 14-68 months (mean 39.4 months). At the final follow-up, no obvious spinal deformity or tumor recurrence was found in any patient except one with paraganglioma. Single-stage posterolateral approach is a good alternative surgical method for removing dumbbell tumors and paraspinal tumors of the thoracic spine without necessitating a subsequent anterior operation.

Small bowel obstruction due to dried fruit and vegetable bezoars in paediatric patients of northern India.

Introduction: Many foods have been implicated in bezoar obstruction especially sun dried apricots, peaches, and prunes. Dried fruits and vegetable being hygroscopic imbibe water, swell in size and cause mechanical small bowel obstruction. We hereby submit our experience of dealing with patients who presented with acute small bowel obstruction (ASBO) due to dried phytobezoars.
 Materials and methods: This was a retrospective study which was conducted from March 2017 to March 2012. Operative records of the patients with ASBO due to phytobezoars were retrieved from Hospital Records Section. The clinical details, investigative work up, operative findings and intervention and type of bezoars were noted.
 Results: Over the period of 5 years, 12 patients of phytobezoars were admitted in the department. The mean age of the patients was 1.85 years with 7(58.3%) males and 5 females (41.6.5%). Vomiting was most common and was present in all the patients, bilious in 11 (91.7%). The other features included abdominal pain in 10 (83.3%), abdominal distension in 8 (66.7%), failure to pass stools in 9 (75%), failure to pass flatus in 9 (75%), diarrhoea 16 (25%), bleeding per rectum 2 (16.6% patients). All the patients were operated in emergency settings within the period of 8 ± 3 hours of admission. There were no significant operative complications and average hospital stay was 5.2±1 days.
 Conclusion: Dry fruits and vegetables like apricot, turnip and peach can lead to bezoar formation which subsequently leads to acute small bowel obstruction in these infants and young children. We also want to impress upon the treating physicians to keep in mind the probability of phytobezoars obstruction in patients presenting with mechanical ASBO especially in patients from Himalayan regions.

Arthroscopy assisted MPFL reconstruction by anatomic inverted ‘V’ tunnels placement technique

Background: The medial patellofemoral complex, consisting of the medial patellofemoral ligament (MPFL) and the medial patellotibial ligament, is the main passive stabilizer of the patellofemoral joint. Since it has been shown that rupture of the MPFL is the main pathological consequence of patellar dislocation and biomechanical studies have demonstrated that the MPFL is the main passive restraint against patellofemoral instability (PFI) and lateral patellar displacement. Materials and methods: In 13 patients of post traumatic recurrent dislocation of patella, arthroscopy assisted minimally invasive MPFL reconstruction was done between March 2011 and July 2014, reconstruction was done with the hamstring tendon graft. Results: All the patients were treated successfully, on 1 and 2 year follow up they were able to walk and run well without the apprehension of dislocation of patella, Range of movement improved to complete flexion in 11 patients. 1 patient c/o stiffness of knee, 1 patient had minimal infection. No other significant post operative complications were seen. Conclusion: Since the recurrent dislocation of patella is a bothersome condition and most of the cases are associated with MPFL tear. Reconstruction of the MPFL has become a widely accepted for restoration of patellofemoral stability and it can be treated well with the minimally invasive arthroscopy assisted MPFL reconstruction technique. Results are encouraging and rehabilitation of the patient is early. Satisfaction level of the patient as well as the Surgeon is pretty good.

Early Australian experience in robotic sleeve gastrectomy: a single site series.

The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice.

The experience of submental intubation for severe maxillofacial injuries

Oral and nasal routes for intubation are often not feasible in maxillofacial fractures. The paper presents our experience of midline and paramedial approaches for submental intubation in the airway management of facial trauma patients. The prospective study included 47 patients with maxillofacial trauma in whom submental orotracheal intubation was performed in 2005-2014. When using midline approach the tube does not always accurately fit into the mandibular lingual groove creating an inconvenience for the surgeon. By paramesial approach the working conditions for the surgeon were the most comfortable. The average duration of the procedure was 5-6 minutes. At the end of the surgery the tube was reversed, the submental wound was stitched, patients were extubated (10 of them were extubated through the submental approach). Eight patients required short-term post-operative mechanical ventilation. In all patients the submental intubation allowed simultaneous reduction and fixation of fractures and intraoperative control of the dental occlusion without interference from the tube during the operation. There were no significant operative or postoperative complications. Submental intubation is a simple, secure and effective procedure for operative airway control in maxillofacial traumas. It is an attractive alternative to tracheotomy in the surgical management of selected cases of maxillofacial trauma.

Complications of low compared to standard pneumoperitoneum pressures in laparoscopic surgery for benign gynecologic pathology: a systematic review protocol.

BackgroundNo definite consensus has been established about the optimal pressure for artificial pneumoperitoneum when performing laparoscopic surgery. It has been postulated that lowering intra-peritoneal pressure levels while performing general laparoscopic surgery would lower surgical complications including post-operative pain, but data remain scarce about significant operative complications. Furthermore, such data is not available for gynecologic laparoscopy. The objective of this systematic review is to compare the frequency and nature of significant operative complications of lower and standard pneumoperiteoneal pressure levels in gynecologic laparoscopic surgery for benign indications.Methods/designWe will search PubMed, Embase, the Cochrane Library, randomised control trials registries, and reference lists of included articles. Randomised controlled trials comparing different intra-peritoneal pressure levels in women undergoing gynecologic laparoscopic surgery for a non-malignant indication will be eligible. Two reviewers will independently select and review references, extract data, and assess quality from included studies. We will use RevMan5 to calculate risk ratios and their 95 % confidence intervals to compare the frequency of complications according to intra-peritoneal pressure levels. We will perform sensitivity analyses to explore heterogeneity potentially due to various operative characteristics or characteristics of patients.DiscussionOur results will help identify the optimal intra-peritoneal pressure level in gynecologic laparoscopic surgery and determine if lowering intra-peritoneal pressure levels while trying to achieve lower levels of post-operative pain is an acceptable change of practice according to the frequency and nature of significant complications.Systematic review registrationPROSPERO: CRD42015020231Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0091-6) contains supplementary material, which is available to authorized users.

Reconstruction of Oromandibular Defects after Prior Irradiation Using a Temporalis Muscle and Temporoparietal Fascia Flap

Objectives: Reconstruction of oromandibular defects in the setting of previous treatment, or significant patient comorbidities, presents a significant challenge. Although free tissue transfer has shown success, it is not without considerable risk, especially in patients with poor baseline functional status. In these patients, regional pedicled flaps may provide a more suitable alternative. The combined temporalis muscle and temporoparietal fascia flap is a versatile option for oromandibular reconstruction in a previously treated field, or in patients with severe comorbidities and poor functional status. Our objective was to report our experience using a combined temporalis muscle and temporoparietal fascia flap for reconstruction of oromandibular defects in high-risk situations. Methods: Three patients were identified, medical records were reviewed, and their clinical courses were described. Functional outcomes were reviewed. We include a discussion of the relevant surgical anatomy and operative technique. All patients had previously undergone extensive treatment. They needed additional ablative surgery for different reasons: new malignancy, intractable trismus, and osteoradionecrosis. A combined temporalis muscle and temporoparietal fascia flap was used to reconstruct the oromandibular defects in each patient. Results: All flaps survived. Functional status improved in all patients. There were no significant operative or postoperative complications. Conclusions: The combined temporalis muscle and temporoparietal fascia flap provides a reliable option for reconstruction of complex oromandibular defects in high-risk situations. In previously treated fields, the transfer of a vascularized flap into the wound hastens healing and improves the quality of native oral cavity tissue.

Minimally Invasive, Robot-Assisted, Anterior Lumbar Interbody Fusion: A Technical Note

Minimally invasive techniques in spine surgery have gained significant popularity due to decreased tissue dissection and destruction, postoperative pain, and hospital stay. The laparoscopic anterior lumbar interbody fusion (ALIF), an innovation in minimally invasive spine surgery, is rarely done because it has marginal benefit over the mini-open ALIF technique in rates of retrograde ejaculation and vascular complications. We propose these outcomes can be improved with enhanced robotic-assisted dissection and exposure for ALIF. Two patients with single-level degenerative spine disease at L5-S1, associated with mechanical back pain, underwent anterior spinal exposure using the da Vinci S Surgical Robot during ALIF. In this report, we provide the first description of the use of a surgical robot in the dissection and exposure for ALIF in patients with degenerative spine disease. We demonstrate successful use of the da Vinci Surgical Robot in separating the presacral nervous plexus from retroperitoneal structures without postoperative vascular or urological complications over a 1-year follow-up period. Use of the robotic assistance in the performance of ALIF is possible without significant operative complications. This technique may provide added benefit over conventional laparoscopic approaches to the spine.

Transumbilical single port laparoscopic surgery for the treatment of concomitant disease

Background: We report our experience of transumbilical single port laparoscopic surgery (TUSPLS) for multiple concomitant intraabdominal pathologies, and assess the feasibility of this technique with several technical tips. Methods: Various combined procedures using TUSPLS were performed since April, 2008. All records of concomitant laparoscopic procedures using TUSPLS were searched at three hospitals. Results: Forty-one patients underwent 82 combined procedures using TUSPLS in a single session. The perioperative outcomes of simultaneously performed cholecystectomy and ovarian cystectomy using TUSPLS (n = 14) are compared with those of using CLS (n = 11). The operating time was significantly longer with the TUSPLS method than with the CLS method. However, postoperative convalescent outcomes such as postoperative hospital stay, VAS pain score, and required analgesics showed no differences between the two methods. Also, there were no significant operative complications associated with the two methods. Fewer trocars were used with the TUSPLS method. Conclusions: Combined laparoscopic procedures for various concomitant pathologies in the abdomen can be performed using transumbilical single port laparoscopic surgery without increasing morbidity or hospital stay in patients with acceptable risk.

The role of dermal regeneration template “Integra®” in reconstructive skin cancer surgery

Dermal regeneration templates (DRT) use, like “Integra®”, has spread over the past years since its introduction a few decades ago beyond its initial role in burn reconstruction. There is now evidence that it can be used as a biological template in post-cancer excision surgery as a method of reconstructing challenging defects We identified the patients that have undergone reconstruction following cutaneous cancer surgery within our institute by reviewing our records. The case notes of the patients were retrieved and the information extracted from the case notes. This is a retrospective analysis of the case studies. Over the time period of the study, we performed reconstruction using DRT on five individual cases. All the patients did not have any significant post operative complications and the reconstruction seemed durable and reliable. We discuss its benefits as part of the reconstructive ladder post cancer resection reconstructive surgery. DRT can now play a role in post cancer excision reconstruction in selected patient groups, especially the elderly or in those in which flap reconstruction options have been exhausted or deemed unsuitable. Level of Evidence: Level V, therapeutic study.

Management of post-operative pain after caesarean section

Effective pain control after a Caesarean Section has many benefits, not only to the new mother, but to her family and the hospital. It is vital in aiding mobilisation, thus...