Simultaneous Repair Research Articles

Simultaneous versus staged approach in transcatheter aortic valve implantation for severe stenosis and endovascular aortic repair for thoracic and abdominal aortic aneurysm.

Thoracic/abdominal aortic aneurysms(T/AAAs) and aortic stenosis(AS) may be concomitant diseases requiring both transcatheter aortic valve implantation(TAVI) and endovascular aneurysm repair(T/EVAR) in high risk patients for surgical approaches, but temporal management is not clearly defined, yet. Aim of the study was to analyze outcomes of simultaneous vs staged TAVI and T/EVAR. Retrospective observational multicentre study on patients requiring TAVI and T/EVAR from 2016 to 2022. Patients were divided into 2 groups: "Simultaneous group" if T/EVAR+TAVI were performed in the same procedure and "Staged group" if T/EVAR and TAVI were performed in two steps, but within 3 months. Primary outcomes were: technical success, 30-day mortality/major adverse events and follow-up survival. Secondary outcomes were procedural metrics and length of stay (LOS). Forty-four cases were collected; 8(18%) had TEVAR and 36(82%) EVAR, respectively. Upon temporal determination 25(57%) and 19(43%) were clustered in simultaneous and staged groups, respectively. In staged group, median time between procedures was 72(interquartile-range-IQR : 57-87) days. Preoperative and intraoperative figures were similar. There was no difference in 30-day mortality(Simultanoeus : 0/25 vs Staged : 1/19; p = 0.43). Pulmonary events(Simultaneous : 0/25 vs Staged : 5/19; p = 0.01) and need of postoperative cardiac pacemaker(Simultaneous : 2/25 vs Staged : 7/19; p = 0.02) were more frequent in Staged patients. The overall LOS was lower in Simultaneous group[Simultaneous : 7(IQR : 6-8) vs Staged : 19(IQR : 15-23)days; p = 0.001]. The median follow-up was 25(IQR : 8-42) months and estimated 3-year survival was 73% with no difference between groups(Simultanoeus : 82% vs Staged : 74%; p = 0.90). Both simultaneous or staged T/EVAR and TAVI procedures are effective with satisfactory outcomes. Despite the small numbers, simultaneous repair seems to reduce length-of-stay and pulmonary complications, maintaining similar follow-up survival.

Innovative Single-Port Approach for Simultaneous Ventral Hernia Repair and Bariatric Surgery: A Retrospective Case Series Study (March 2020 - July 2023)

Background: This retrospective case series study explores the outcomes of single-port bariatric surgery (BS) with ventral hernia repair (VHR) in a simultaneous setting. Through a novel single-port laparoscopic approach, this research emphasizes on operative details, patient selection criteria, and the innovative nature of the technique when repairing ventral hernia in bariatric surgeries. Methods: The research was conducted from February 2021-February 2023 at Al-Noor Specialists Hospital, Makkah, Saudi Arabia. Six patients (5 females and 1 male) underwent simultaneous repair of ventral hernia alongside bariatric surgery through a single-port laparoscopic approach. Results: The study evaluates demographic data, pre-operative parameters, surgical approach, post-operative complications, and post-operative follow-up durations to provide comprehensive insights. Results show the average age of the respondents: 40.5 ± 9.44 years, with a mean BMI of 47 ± 8.25 kg/m2. At post-operative stage, the hospital stay was 48 hours for 50% patients with a mean follow-up duration; 13 ± 3.29 months. At post-surgery, the observed mean weight loss; 33.67 ± 6.66 kg, and the mean excess weight loss was 29.60 ± 5.30%. None of the post-operative complications were reported at the follow-up stage, except minimal seroma. Conclusion: The simultaneous single-port BS and VHR approach provides surgical benefits with lowered complication rates, surgical weight loss, and lesser recurrence of ventral hernia. Single-port bariatric laparoscopy is efficient in treating obese patients. However, further research must advocate for and establish long-term outcomes and broader application of this procedure.

NHEJ and HDR can occur simultaneously during gene integration into the genome of Aspergillus niger

Non-homologous end joining (NHEJ) and homology-directed repair (HDR) are two mechanisms in filamentous fungi to repair DNA damages. NHEJ is the dominant response pathway to rapidly join DNA double-strand breaks, but often leads to insertions or deletions. On the other hand, HDR is more precise and utilizes a homologous DNA template to restore the damaged sequence. Both types are exploited in genetic engineering approaches ranging from knock-out mutations to precise sequence modifications.In this study, we evaluated the efficiency of an HDR based gene integration system designed for the pyrG locus of Aspergillus niger. While gene integration was achieved at a rate of 91.4%, we also discovered a mixed-type repair (MTR) mechanism with simultaneous repair of a Cas9-mediated double-strand break by both NHEJ and HDR. In 20.3% of the analyzed transformants the donor DNA was integrated by NHEJ at the 3’ end and by HDR at the 5’ end of the double-strand break. Furthermore, sequencing of the locus revealed different DNA repair mechanisms at the site of the NHEJ event.Together, the results support the applicability of the genome integration system and a novel DNA repair type with implication on the diversity of genetic modifications in filamentous fungi.

Management of Constricted Upper Arch and Protruded Premaxilla in a 2-Year-Old Patient With Unrepaired BCLP

The paper presented the treatment procedure of a 2-year-old patient with unrepaired bilateral cleft lip and palate (BCLP). Complicated situation included severely protruded premaxilla and constricted upper dental arch, possibly related to delayed treatment of cleft lip and palate. Orthodontic expansion lasted for 8 months, including using fan-type expander for 3 months. After that, premaxillary osteotomy was performed to reset the premaxilla, and 4 months later, simultaneous repair of cleft lip and palate was taken. Follow-up evaluation in 5.5 years revealed acceptable language development and craniofacial profile, and maxillary growth was satisfactory. The treatment procedure of this patient provided an exploratory protocol for those patients with unrepaired BCLP who suffered from deteriorated preaxillary protrusion and constricted upper arch.

Laparoscopic modified e-tep repair of concomitant inguinal and ventral hernias.

Laparoscopic hernia repair in recent times has gained the most acceptance among both the surgical community and the patient groups, as it has proven benefits of lesser postoperative hospital stay and less pain scores. The incidence of both inguinal and ventral hernias has increased significantly in the present days. Various methods have been postulated by different surgical groups for repairing the same but no there is no standard consensus on managing concomitant inguinal and ventral hernias. The conventional e-TEP requires an extensive dissection with increased operative time. We present our experience in managing cases with both inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti using a modified up to down approach for inguinal hernia followed by down to up approach for the ventral hernia, from a tertiary care center in South India. We managed 16 cases with simultaneous incidence of inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti between January 2022 and November 2023. Institute ethical committee clearance and informed consent was obtained from all the 16 patients. They were all subjected to an extra peritoneal repair of both the hernias. All the demographic data, intraoperative data, postoperative complications and follow up were digitally stored. All patients were followed up for six months after surgery. Out of 16 patients, 15 were males and 1 was female. The mean age was 48years and the mean BMI of all the patients was 29.2kg/m2. The postoperative recovery was smooth in all patients and being discharged within 24h after surgery. The pain scores of all patients were significantly lower than patients who underwent intraperitoneal repair. e-TEP hernia repair is gaining popularity and has amused the hernia surgical community. Our method of e-TEP RS repair in cases with concomitant inguinal and primary M2/M3 W1 ventral hernias with or without divarication helps in addressing both the hernias in the extra-peritoneal space. Our technique reduces the area of dissection needed for mesh placement and preserves the integrity of abdominal musculature in the upper abdomen when compared with the conventional technique. It further allows extension of the e-TEP inguinal space into the Rectro rectus space without much alteration in the port arrangement allowing simultaneous repair of groin and umbilical hernias. Good knowledge of anatomy and laparoscopic skills are pertinent for safe and effective hernia repair by this technique.

Hip Labral and Capsular Repair Are Unable to Restore Distractive Stability in a Biomechanical Model

PurposeTo evaluate the change in hip distractive stability after capsulotomy, labral tear, and simultaneous repair of both structures in a biomechanical model. MethodsTen fresh-frozen human cadaveric hips were analyzed using a materials testing system to measure distractive force and distance required to disrupt hip suction seal after (1) native intact capsule and labrum, (2) 2 or 4 cm interportal capsulotomy (IPC), (3) labral tear, (4) T extension, (5) labral repair, (6) T extension repair, and (7) IPC repair. Each specimen was retested at 0° flexion, 45° flexion, and 45° flexion with 15° internal rotation. ResultsA significantly higher distractive force was required to rupture the suction seal in the intact condition compared to an IPC (P = .012, confidence interval (CI): 4.9, 42.4), IPC, labral tear (P = .002, CI: 11.3, 49.4), IPC, labral tear, T extension (P = .001, CI: 13.9, 51.5), IPC, labral repair, T extension (P < .001, CI: 20.8, 49.7), IPC, labral repair, T extension repair (P = .002, CI: 12.5, 52.4), and IPC repair, labral repair, T extension repair (P = .01, CI: 5.8, 46.1). The IPC condition required higher distractive force in isolation compared to when combined with a labral tear (P = 0.14, CI: 1.2, 12.0), T extension (P = .005, CI: 2.8, 15.3), or labral repair (P = .002, CI: 4.4, 18.8). ConclusionsThe distractive resistance of an intact hip capsule and labrum was not restored once the soft tissues were violated, despite labral repair with a loop technique and capsular repair with interrupted figure-of-eight sutures. Clinical RelevanceTime zero complete capsular repair with concomitant labral repair may not be adequate to restore distractive hip stability following hip arthroscopy, reinforcing the use of post-operative precautions in the early post-operative period.

Microbial Mineralization-Based Rapid and High-Strength Simultaneous Repair of Surrounding Rock Fracture Zones and Lining Cracks

Grouting technology based on microbial mineralization represents a novel approach to enhancing the properties of rock and soil. Widely studied for its combination of high efficiency and environmental friendliness, this method improves the strength and permeability of rock and soil. In this study, a novel approach involving bioslurry + filling particles was proposed to reinforce sand columns. It was observed that the addition of filling particles provided new nucleation sites for crystallization, significantly enhancing the cementation effect of sand particles. After 3 days of grouting treatment, sand columns containing 10% filling particles exhibited an order of magnitude reduction in permeability with the unconfined compressive strength (UCS) reaching 2.5 MPa, more than twice that of sand columns reinforced with bioslurry alone. Additionally, this study presented a method for the simultaneous repair of sand particles and concrete cracks. Results indicated that after 3 days of the grouting treatment, the interfacial shear strength between sand columns and concrete reached 100 kPa. Moreover, for concrete with crack apertures less than 1 mm, the permeability coefficient was reduced by over 80%, while the recovery ratio of the splitting tensile strength reached 64.2%. These findings highlight the potential of microbial mineralized grouting technology in addressing practical challenges, providing a foundation for the rapid and high-strength simultaneous repair of tunnel-surrounding rock fracture zones and lining cracks.

Outcomes of Concomitant Glenohumeral Stabilization After Arthroscopic Rotator Cuff Repair in Military Patients Younger Than 40 Years.

While concomitant rotator cuff and inferior labral tears are relatively uncommon in young civilians, military populations represent a unique opportunity to study this injury pattern. To (1) evaluate the long-term outcomes after combined arthroscopic rotator cuff and inferior labral repair in military patients <40 years and (2) compare functional outcomes with those after isolated arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. Military patients who underwent arthroscopic rotator cuff repair between January 2011 and December 2016 and had a minimum of 5-year follow-up data were included in this study. The patients were categorized into those who had undergone combined arthroscopic rotator cuff and inferior labral repair (RCIL cohort) and those who had isolated arthroscopic rotator cuff repair (ARCR cohort). Pre- and postoperative outcome measures-visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons shoulder score, Rowe Instability Score, and range of motion-were compared between the groups. A total of 50 shoulders (27 in the RCIL cohort and 23 in the ARCR cohort) were assessed. The RCIL and ARCR groups were similar in terms of age (mean, 33.19 years [range, 21-39 years] vs 35.39 years [range, 26-39 years], respectively) and sex (% male, 88.46% vs 82.61%, respectively). All patients were active-duty military at the time of surgery. The mean final follow-up was at 106.93 ± 16.66 months for the RCIL group and 105.70 ± 7.52 months for the ARCR group (P = .75). There were no differences in preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores (P < .0001 for all), and there were no significant group differences in any final postoperative outcome measures. At the final follow-up, 26 (96.30%) patients in the RCIL cohort and 20 (86.96%) in the ARCR cohort had returned to unrestricted active-duty military service (P = .3223). The study findings indicate that concomitant glenohumeral stabilization does not prevent worse outcomes after arthroscopic rotator cuff repair in this military cohort. Combined repair produced statistically and clinically significant improvements in outcome scores at the long-term follow-up, indicating that simultaneous repair of combined lesions was an appropriate treatment option in this patient population.

IBC-Oxford University2023_BJSPoster_15Safety and Efficacy of Simultaneous Repair of Ventral Hernias at the time of the Bariatric surgery

Abstract Introduction Obesity is one of the main contributors for the development of Ventral hernias. Controversies exist about the timing of the repair; those with simultaneous repair of Ventral hernia at time of obesity surgery studied regarding it is safety and efficacy. Materials and Methods Retrospective analysis of the patients undertaken hernial repair at the same time with bariatric surgery using V loc suture without the use of the meshes including - age, sex, BMI, size of the hernia, type of bariatric surgery, postoperative complications, and recurrence of the hernia, Results During the period 2018-2023 of 1500 patients undergoing bariatric surgery; 60 patients (48 females and 12 males) with Ventral hernias (40 umbilical or paraumbilical and 20 incisional hernias (18 midline and 2 Right para median). Regarding the type of the procedure (Sleeve Gastrectomy= 52, Roux-en-Y Gastric Bypass=2, SASI=2, MGB-OAGB=1, TB=1 and Revisional surgery 2 patients. Average BMI was 41, hospital stay 2 nights, no major postoperative complications and hernia recurrence occurred in one patient. Conclusions Ventral hernias can be repaired at the time of Bariatric Surgery safely and effectively using V Loc suture, however further studies must be done to support the study.

Primary Free Flaps for Coverage and Reconstruction in Acute Facial Trauma.

Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal, neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in these defects mandates the use of flap cover; paucity of local tissues necessitates the use of free skin flaps. Materials and Methods Six free flap reconstructions for acute facial trauma defects over a 10-year period were reviewed. The defect location, associated injuries, flap choice, additional reconstructive procedures, and flap outcomes were analyzed. Results There were four males and two females with ages between 18 and 63 years. Four defects were located in the lateral face and scalp, and two in the lower central face. Defect size ranged between 96 and 346 cm 2 . There were fractures in three, facial nerve injuries in two, and loss of facial muscles in one. Five free flaps were anterolateral thigh flap; simple and composite, one was a radial artery forearm flap. Recipient pedicles were the superficial temporal vessels in two and facial vessels in four cases. There were no re-explorations but one flap necrosed on 7th postoperative day on account of invasive aspergillosis. Discussion Use of free flaps for ballistic wounds is common. In uncommon nonballistic traumatic facial defects, the location, nature of the defect, and type of associated injuries and need for simultaneous reconstructions may dictate the use of free flaps and permit a one stage debridement, flap coverage, and a simultaneous reconstruction of lost functional units. Conclusion Free flap coverage in high velocity acute facial trauma defects offers a better possibility for primary reconstruction of associated facial injuries and helps in achieving better functional outcomes.

Using Free Chimeric Anterolateral Thigh Flap For Reconstruction Of Composite Dorsal Hand Defect

Simultaneous repair of the extensor tendons and soft tissues in hand injuries remains challenging. The free chimeric anterolateral thigh (ALT) flap with fascia lata (FL) flap represents an alternative for hand reconstruction. This report describes the reconstruction of the extensor tendon and skin defects using free chimeric ALT flaps with FL. Eight patients (one female and seven male) underwent reconstruction of complex hand defects with free chimeric ALT and FL flaps. The defects were caused by crushing injuries, burns, snakebite scars, and animal bite wounds. The average skin defect was 116 cm2. Perforators were selected for the skin paddle and the FL flap. The thinning procedure was performed microsurgically. The skin paddle size ranged from 12 to 23cm in length and 6 to 11cm in width, and the FL flaps ranged from 3×5 to 12×5cm. The mean pedicle length was 7.88cm. Nine extensor tendons were repaired with FL flaps. The flap thickness after thinning was only 3-6mm. The donor site was closed primarily in six patients, and skin grafts were used in two cases. All flaps survived without complications. The follow-up period lasted from 17 to 80 months. Range of motion was achieved with satisfaction. The chimeric-thinned ALT and FL flap is a valuable material, and it should be considered a reconstructive option for hand soft tissue and extensor tendon reconstruction. This technique allows us to achieve a good appearance and extensor function without donor-site morbidity.

Ventricular Septal Defect (VSD) closure concomitant With Coronary Artery Bypass Grafting (CABG): a rare case

Link of Video Abstract: https://youtu.be/LZnyDExOr9w Background: Ventricular septal defect (VSD) is the most common congenital cardiac anomaly in children and the second most common in adults. It often coexists with other cardiovascular conditions, including hypertension, coronary artery disease (CAD), and heart failure. This presents unique challenges in diagnosis and treatment. Case Presentation: We present the case of a 46-year-old woman with a previously undiagnosed VSD complicated by a ventricular septal rupture and prior myocardial infarction. Coronary artery bypass grafting (CABG) and VSD repair were performed. Unexpectedly, the VSD turned out to be an atrial septal defect (ASD) of the muscular type. The repair was successful using mattress sutures and a 0.6mm PTFE patch. Two-coronary-artery bypass was also performed. The patient's recovery was uneventful, with no residual VSD. Conclusions: Discovering a large, asymptomatic VSD in an elderly patient is uncommon. Simultaneous repair of VSD and CAD yields favorable surgical outcomes, highlighting the importance of thorough preoperative evaluation in such cases.

Is simultaneous bariatric surgery and ventral hernia repair a safe and effective approach?

BackgroundThere is currently a lack of consensus regarding the timing of ventral hernia repair relative to bariatric surgery. ObjectivesTo compare outcomes between patients undergoing simultaneous and selectively deferred ventral hernia repair and bariatric surgery. SettingHigh volume UPPER gastrointestinal and Bariatric Unit. Sydney, Australia. MethodsA retrospective case series from a single institution’s prospectively collected database (2003-21) was performed to determine the characteristics and outcomes in patients having simultaneous and deferred hernia repair relative to their bariatric surgery. ResultsIn our patient cohort (N = 134), 111 patients underwent simultaneous repair and 23 had a deferred procedure. Of the simultaneous patients, 95 (85.6%) underwent resection bariatric surgery. The median operative time in the simultaneous versus deferred groups was 155 versus 287 minutes and the length of stay was 3 versus 7 days. There has been one (.9%) mesh infection requiring explant, in an open, simultaneous repair undertaken in a gastric band patient, 3 (2.8%) infected seromas, 1 (.9%) surgical site infection, and 8 (7.5%) hernia recurrences in the simultaneous group. The deferred group has had no mesh infections, no hernia recurrence, and 2 (9.5%) infected seromas to date. There was 1 mortality in the simultaneous cohort (simultaneous gastric bypass group), from a massive Pulmonary Embolism (<30 days postoperatively) and one in the deferred group from an interval small bowel obstruction. ConclusionsSimultaneous ventral hernia repair with bariatric surgery had a low rate of infection and a low mesh explant rate, even when coupled with resection bariatric surgery in this series. A combined approach may be safe, even in the clean-contaminated surgical context.

Delayed Diagnosis of Post-traumatic Temporal Lobe Meningo Encephalocele: A Rare Case Report of a Child

Introduction: Bone fracture after head trauma is common in children. When a fracture happens in the temporal bone, Cerebrospinal fluid (CSF) might leak and/or the temporal lobe protrude (named encephalocele) as a mass inside the middle ear or mastoid or both. Case Presentation: Here, a 10 year old presents with an initial diagnosis of bacterial meningitis. Three years ago after head trauma he had a forgotten bone fracture. Incomplete improvement after primary treatment was achieved. Finally, after seeing a bone fracture on the right roof of the tympani and soft tissue mass in brain High-Resolution Compound Tomography (HRCT),surgical exploration determined the CSF leakage from a right lobe temporal meningo encephalocele. The bone defect was repaired and the patient had complete improvement. Conclusion: In this case with forgotten post traumatic temporal bone fracture, temporal bone encephaloceles lead to CSF leakage inside the middle ear cavity and introduce bacterial meningitis. High-Resolution Compound Tomography (HRCT) of the cranial base defined the bone defect. In recent years, Magnetic Resonance Imaging(MRI) has been known as the best method for the diagnosis of brain tissue herniation in the middle ear cavity. Although to differentiate the encephalocele from other masses (e.g. granulation, cholesteatoma, cholesterol granuloma, etc.) inside the middle ear cavity in an MRI is not easy. Surgical multilayered closure of the dura and simultaneous repair of the bone defect is needed.

High temperature oxidation treated 3D printed anatomical WE43 alloy scaffolds for repairing periarticular bone defects: In vitro and in vivo studies

Reconstruction of subarticular bone defects is an intractable challenge in orthopedics. The simultaneous repair of cancellous defects, fractures, and cartilage damage is an ideal surgical outcome. 3D printed porous anatomical WE43 (magnesium with 4 wt% yttrium and 3 wt% rare earths) scaffolds have many advantages for repairing such bone defects, including good biocompatibility, appropriate mechanical strength, customizable shape and structure, and biodegradability. In a previous investigation, we successfully enhanced the corrosion resistance of WE43 samples via high temperature oxidation (HTO). In the present study, we explored the feasibility and effectiveness of HTO-treated 3D printed porous anatomical WE43 scaffolds for repairing the cancellous bone defects accompanied by split fractures via in vitro and in vivo experiments. After HTO treatment, a dense oxidation layer mainly composed of Y2O3 and Nd2O3 formed on the surface of scaffolds. In addition, the majority of the grains were equiaxed, with an average grain size of 7.4 μm. Cell and rabbit experiments confirmed the non-cytotoxicity and biocompatibility of the HTO-treated WE43 scaffolds. After the implantation of scaffolds inside bone defects, their porous structures could be maintained for more than 12 weeks without penetration and for more than 6 weeks with penetration. During the postoperative follow-up period for up to 48 weeks, radiographic examinations and histological analysis revealed that abundant bone gradually regenerated along with scaffold degradation, and stable osseointegration formed between new bone and scaffold residues. MRI images further demonstrated no evidence of any obvious damage to the cartilage, ligaments, or menisci, confirming the absence of traumatic osteoarthritis. Moreover, finite element analysis and biomechanical tests further verified that the scaffolds was conducive to a uniform mechanical distribution. In conclusion, applying the HTO-treated 3D printed porous anatomical WE43 scaffolds exhibited favorable repairing effects for subarticular cancellous bone defects, possessing great potential for clinical application.

Biocompatible and stretchable piezoelectric elastomer based on lactic acid for synchronous repairing and function monitoring of volumetric muscle loss

The treatment of volumetric muscle loss (VML) and the real-time monitoring of damaged muscle function have long posed challenges for clinicians. The novel in-situ electric stimuli therapy using piezoelectric materials for VML repairing has attracted numerous attentions. However, the reciprocating motion of the muscle requires the piezoelectric materials with both high piezoelectricity and stretchability. In this study, a biocompatible piezoelectric elastomer (VMLRE) was synthesized through the copolymerization of several bio-based diacids and diols. By controlling the chemical compositions and chain structure, the VMLRE possess elastic modulus accurately matching with that of muscle tissue, allowing the reciprocal deformation during muscle movements to realize function recovery evaluating. The backbone of VMLRE is enriched with CO dipoles to achieve excellent piezoelectric properties, which enable converting mechanical stimuli generated by physical activity into electrical energy, providing real-time and in situ electrical stimulation. The electric stimulation promotes myoblast proliferation and differentiation by potentially activating calcium/calmodulin signaling pathways, facilitating cell migration, and enhancing neovascularization. Consequently, the rate of VML repair is significantly improved. Our innovative piezoelectric elastomer enables simultaneous repair and real-time biofeedback monitoring of VML, offering a novel strategy for the treatment of volumetric muscle loss.

Treatment of long-segment congenital tracheal stenosis with congenital cardiovascular defects in infancy.

This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD). We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D+L) was used for estimate synthesis. A total of thirteen infants with a mean age of 5.6±3.1 months and a mean weight of 6.4±0.9Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p<0.001). The mean follow-up duration was 17.1±7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I2=0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I2=74%). Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.

Outcomes Following Combined Posterior Labral and SLAP Repair in Military Patients Younger Than 35 Years

Background: Members of the military are known to experience disproportionately high rates of both glenohumeral instability and superior labrum anterior-posterior (SLAP) tears when compared with civilian populations. Although the outcomes after simultaneous repair of Bankart and SLAP lesions have been well described, there is a paucity of literature available regarding the operative management of posterior instability with concomitant superior labral pathology. Purpose: To compare outcomes of combined arthroscopic posterior labral and SLAP repair with those of isolated posterior labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: All consecutive patients younger than 35 years who underwent arthroscopic posterior labral repair from January 2011 to December 2016 with a minimum follow-up of 5 years were identified. From this cohort of eligible patients, all individuals who had undergone combined SLAP and posterior labral repair (SLAP cohort) versus posterior labral repair alone (instability cohort) were then identified. Outcome measures including the visual analog scale score, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, Rowe instability score, and range of motion were collected pre- and postoperatively and scores were compared between groups. Results: In total, 83 patients met the inclusion criteria for the study. All patients were active-duty military at the time of surgery. The mean follow-up was 93.79 ± 18.06 months in the instability group and 91.24 ± 18.02 months in the SLAP group (P = .5228). Preoperative SANE and ASES scores were significantly worse in the SLAP group. Both groups experienced statistically significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no significant differences in any outcome scores or range of motion between groups. In total, 39 patients in the instability cohort and 37 in the SLAP cohort returned to preinjury levels of work (92.86% vs 90.24%, respectively; P = .7126), and 38 instability patients and 35 SLAP patients returned to preinjury levels of sporting activity (90.48% vs 85.37%, respectively; P = .5195). Two patients in the instability group and 4 patients in the SLAP group were medically discharged from the military (4.76% vs 9.76%; P = .4326), and 2 patients in each cohort had experienced treatment failure at the final follow-up (4.76% vs 4.88%; P > .9999). Conclusion: Combined posterior labral and SLAP repair led to statistically and clinically significant increases in outcome scores and high rates of return to active-duty military service that did not differ significantly from the results after isolated posterior labral repair. The results of this study indicate that simultaneous repair is a viable treatment option for the management of combined lesions in active-duty military patients <35 years of age.

Combined esophageal and duodenal atresia: A review of the literature from 1950 to 2020

The combination of duodenal atresia (DA) and esophageal atresia (EA) is very rare. With improvements in prenatal sonography and the use of fetal magnetic resonance imaging (MRI), these malformations can be diagnosed in a more accurate and timely manner; polyhydramnios remains the most common sign despite having a low specificity. The high rate of associated anomalies (in 85% of cases) can also impact neonatal management and increase the morbidity rate; thus, it is of paramount importance to look for every possible associated malformation, such as VACTERL and chromosomic anomalies. The surgical management of this combination of atresias is not well defined and changes according to the patient's clinical status, the type of EA, and the other associated malformations. Management ranges from a primary approach for one of the atresias with delayed correction of the other (56.8%) to a simultaneous repair of both atresias (33.8%) with or without gastrostomy, or total abstention (9.4%). We suggest that a simultaneous approach can be safely performed on patients in good physical condition, with a birth weight over 1500 g, and with no major respiratory distress; this method begins by closing the tracheoesophageal fistula to protect the lung and then repairing the DA. The mortality rate has decreased over the years, dropping from 71% before 1980 to 24% after 2001. In this review, we present the available evidence on these conditions, focusing mostly on the epidemiology, prenatal diagnosis, neonatal management strategies, and outcome, with the aim of determining how the different clinical features and surgical approaches may impact on morbidity and mortality.

Combined repair of scapholunate ligament (SL) and triangular fibrocartilage complex (TFCC) lesions in chronic trauma of the wrist: surgical treatment of 14 patients.

Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. All patients had a mean follow-up of 54months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3months after the initial surgery. The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.