Simultaneous Surgical Management Research Articles

Uterine and Rectal Prolapse, case report in simultaneous surgical management at the National Hospital of Itauguá. 2018-2022

El prolapso uterino es una patología frecuente en la población femenina a medida que aumenta la longevidad, si tomamos en cuenta el prolapso rectal concomitante que pueden tener estas pacientes, vemos una frecuencia no muy alta, si bien ambos forman parte de los trastornos del piso pélvico, el tratamiento quirúrgico combinado puede ser una opción válida para mejorar la calidad de vida de estas pacientes. Presentamos los resultados de 3 pacientes sometidas a histerectomía transvaginal y operación de Delorme en un solo tiempo con resultado satisfactorio.

Simultaneous surgical management of malignancy and coronary heart disease.

Coronary heart disease and cancer are the most common causes of mortality across the globe. It has been a dilemma for the surgical team to decide which surgical procedure should be done first when a patient needs surgery for both. This is a single-center retrospective observational study. Six patients who underwent simultaneous coronary artery bypass graft (CABG) and oncological surgeries between January 2018 and July 2021 were included in the study. One patient underwent lung bilobectomy via the same sternotomy incision; one underwent surgery for breast cancer, stomach cancer, and colon cancer; and one patient each of buccal mucosa carcinoma and tongue carcinoma. The median age was 65 years (59-70). Median blood loss was 550 ml (400-800). The median intensive care unit (ICU) stay was 60 h (46-130) and hospital stay was 7.5 days (6-14). The median follow-up of the present study was 31.5 months (6-38). One patient with lung carcinoma developed recurrence after 6 months and the patient is in remission after a follow-up of 32 months. Simultaneous CABG and oncological resection can be performed effectively and safely by an experienced team of cardiothoracic surgeons, surgical oncologists, and anesthetists after good patient selection.

Simultaneous surgical management of renal cancer with atrial thrombotic extension and severe chronic coronary artery disease: a case report

BackgroundRenal cell carcinoma accounts for 2–3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus.Case presentationWe present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient’s heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day.ConclusionsRadical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.

Carotid endarterectomy for the management of carotid stenosis occurring concurrently with head and neck cancer.

Currently, most patients with concurrent head and neck cancer (HNC) and carotid stenosis (CS) are treated disjointedly for their oncologic and vascular lesions. The purpose of this review is to evaluate literature exploring a novel approach to these cases that poses several advantages, in which carotid endarterectomy (CEA) is performed simultaneously with surgical resection of HNC. Carotid stenosis is a common comorbidity of patients presenting with head and neck cancer as these pathologies have overlapping risk factors. Adjuvant oncologic therapy such as radiation therapy to the site of the lesion is known to increase development or progression of carotid stenosis. Performing simultaneous surgical management of CS and HNC decreases total procedures for the patient, provides a less challenging surgical field, and eliminates prioritization of treatment initiation for one pathology over the other. There has been limited reporting of simultaneous CEA with oncologic resection of HNC in the literature. However, of the 21 cases reviewed here, no perioperative strokes were reported with only one perioperative death from myocardial infarction. Available literature supports that simultaneous CEA with oncologic resection of HNC is safe and may offer several advantages, although larger studies are required.

Ureteropelvic junction obstruction and renal calculi: Simultaneous treatment by robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy. Technique description and early outcomes.

Ureteropelvic junction obstruction (UPJO) and renal calculi are associated in 20 to 30% of cases and treatment is mandatory. The simultaneous surgical management is a therapeutic challenge that is still a source of controversy. We describe our technique combining robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde flexible ureteroscopy (fURS), assessing the feasibility of simultaneous treatment through an original technique. This single centre series reports our initial experience with 12 patients. From January 2014 to September 2018, 12 patients underwent robot-assisted laparoscopic pyeloplasty with simultaneous fURS for UPJO and renal calculi. Mean age was 46 years (24-68). 92% had multiple renal stones and the mean cumulative stone diameter was 31,3mm. Robot-assisted pyeloplasty was performed with peroperative transcutaneous retrograde fURS through a ureteral access sheath introduced in an incision on the bassinet through a subcostal trocar. Stone extraction was performed using a basket. All patients underwent surgery successfully, achieving UPJ repair and complete stone extraction. Mean operating time was 92,5min (85-110). All reported Clavien-Dindo complications were grade 1. Non-contrast enhanced abdominal CT performed 1 month after surgery confirmed the absence of residual stones in all patients. Mean follow-up time was 10 months with no recurrence of UPJO. This small series confirms the feasibility with good surgical results of concomitant robot-assisted laparoscopic pyeloplasty and transcutaneous retrograde fURS stone extraction. No major complications were observed. This technique is easily reproducible but requires 2 experienced urologists to be achieved in a contained operative time.

The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture.

To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.

METÁSTASIS HEPÁTICAS DE ORIGEN COLORRECTAL SINCRÓNICAS: ¿INTERVENCIÓN SIMULTÁNEA O SECUENCIAL?

simultaneous or sequential treatment of liver metastases of colon cancer? experience in 76 patients Background: Synchronous liver metastases of colon cancer can be managed with sequential or si multaneous surgical management of the primary tumor and the metastases. aim: To compare the evolution of patients whose liver metastases were treated sequentially or simultaneously. Material and Methods: Retrospective analysis of 76 patients aged 63 ± 11 years (67% males). In 25, metastases were managed simultaneously and in 51 there were treated sequentially after a period of chemotherapy. All interventions were performed by the same surgeon. results: Patients treated sequentially had a higher number of metastases and more lymph nodes involved than their counterparts treated simultaneously. The overall resectability index was 78%. Eighteen major and 28 minor hepatic resections were carried out. Significantly more major resections were carried out in the sequential treatment group. Mean hospital stay was 11 days and 20% of patients had complications, with no differences between groups. Survival at one, three and five years was 75, 45 and 36% in the simultaneous treatment and 76, 49 and 29% in the sequential treatment group (with no significant di fferences between groups). conclusions: In this group of patients no differences in complications or survival were observed when liver metastases were treated simultaneously or sequentially. However groups were not homogeneous.

Ureteropelvic obstruction and renal stones: etiology and treatment.

The simultaneous surgical management of ureteropelvic junction obstruction (UPJO) with concomitant renal stones has evolved the last 20 years; hence, the ideal minimally invasive technique is still controversial. Laparoscopic and robot-assisted laparoscopic operations allow precise surgical maneuvers and were thought to simplify the reconstruction steps of the procedure, especially in the treatment of complex cases with large stones. The aim of this study was to summarize the available perioperative and functional outcomes of minimally invasive available techniques. A non-systematic review of the literature was performed using a free-text protocol in the MEDLINE database. The terms used were "ureteropelvic junction obstruction," "renal calculi" and "renal stones." Furthermore, other significant relevant studies cited in the reference lists of the selected papers were also evaluated in the structure of this review. Currently, available evidence suggests that both laparoscopic and robotic-assisted techniques offer excellent surgical solutions in the field of UPJO reconstruction and renal stones removal. In the hands of experienced surgeons, laparoscopic and robotic pyeloplasty with concomitant stone removal is a safe procedure with high stone-free rates and UPJ patency. Minimally invasive pyeloplasty should constitute the first choice of treatment for concomitant renal stones and ureteropelvic junction obstruction.

MANEJO QUIRÚRGICO SIMULTÁNEO DE UNA PACIENTE CON CÁNCER DE PÁNCREAS DISTAL, TUMORES DEL ESTROMA GASTROINTESTINAL (GIST) GÁSTRICOS Y HEMANGIOMA HEPÁTICO

Simultaneous surgical management of a patient with distal pancreatic cancer, gastric gastrointestinal tumors (GIST) and hepatic hemangioma Introduction: The occurrence of gastric Gastrointestinal Stromal Tumors (GIST) associated to pancrea- tic adenocarcinoma has been reported in 0.2% pancreatic cancers. There are no published reports on distal pancreatic adenocarcinoma associated to gastric antral GIST and the surgical management of this clinical condition. Case report: Herein, we discuss a 75 years-old female patient who was admitted to our institution with upper digestive hemorrhage. The endoscopy showed large, superficial erosions over the cardia and on the posterior wall of the antrum a rounded sub-mucosal non-eroded lesion suspected of gastric GIST. An ab- dominal computed tomography scan found a hepatic hemangioma on the left hepatic lobe. In the pancreatic distal body and tail a solid exophytic lesion was identified. In the gastric antrum a rounded submucosal tumor in close contact with the pancreatic lesion was found. The patient was subjected to distal pancreatectomy, splenectomy, and distal gastrectomy. The biopsy identified a well-differentiated ductal adenocarcinoma locali - zed in the pancreatic tail and the proximal part of the body, resected with negative margins. The gastric tumor was positive for CD117, CD34, and DOG-1; it had a positive Ki67 in less than 2%, and 2 or less mitoses per 50 high-power fields. Conclusion. This uncommon case illustrates the occurrence of synchronous tumors of different cellular origins incidentally diagnosed and their simultaneous surgical treatment. The individual incidence of these tumors is low and if associated they probably will continue to be found incidentally.

Simultaneous management of renal carcinoma with caval vein thrombosis and double coronary artery disease

Recent advances in surgical and anesthesiology techniques allow simultaneous thoracic and abdominal operations to be performed for severe heart disease and benignant or malignant abdominal diseases. The simultaneous surgical management in a 75-year-old patient suffering from severe double coronary artery disease and a renal cell carcinoma with extended intravascular growth into the inferior vena cava is reported. The postoperative course was uneventful. Simultaneous surgery proved to be beneficial and safe, showing optimal results in our patient.

Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes

We report on 22 patients with chronic grade-2 valgus laxity of the knee combined with chronic anterior cruciate ligament (ACL) insufficiency, in whom the two lesions were addressed at the same surgical setting. At a minimum follow-up of 24 months, clinical and functional variables had improved significantly (P < 0.001), and 20 of the 22 patients (91%) had returned to sport at pre-injury level. There were no operative complications in this series. In selected athletes with chronic symptomatic valgus laxity of the knee combined with ACL insufficiency, surgical repair of the MCL in association with ACL reconstruction is a suitable and reliable option to restore knee stability and allow return to pre-injury activity level.

TUR simultaneous surgical management of BPH and bladder tumor

Objective To present our expreient on the TUR management of BPH and bladder tumors synchronouly. Methods 13 cases of patients had undergone synchronouly TURBT and PKRP, Results Among the 10 cases followed up from 1-5 years ,2 cases had reccurents. No tumor cell implantain at prostate pit, posteri-or urethra and incision was noted. Conclusion TUR simultaneous surgical management of BPH and bladder tumor is available. Key words: Benigien prostatic hyperplasia; Bladder tumor; TUR therapy

Combination therapy for male erectile dysfunction and urinary incontinence

Urinary incontinence (UI) and erectile dysfunction (ED) are both very prevalent conditions. Insertion of an artificial urinary sphincter (AUS) and penile prosthesis (PP) is an effective and proven method of treatment for both conditions. With advancing age, as well as with increasing populations of patients radically treated for prostate cancer, the occurrence of both conditions found in the same patient is increasing. The purpose of this article was to analyze the available evidence for simultaneous surgical management of male ED and UI using prosthetic devices. The existing literature pertaining to dual implantation of AUS and PP was reviewed. The concomitant insertion of the PP with the male perineal sling was also considered. Concurrent ED and UI are increasingly seen in the post radical prostatectomy population, who are often younger and less willing to suffer with these conditions. Insertion of an AUS and PP, either simultaneously or as a two-stage procedure, appears to be a safe, efficacious and long-lasting method of treatment. The improvements in design of both the AUS and PP as well as the development of the single transverse scrotal incision have made simultaneous insertion of these prostheses possible. Dual implantation of the PP and male sling looks promising in a selected population. In conclusion, the insertion of the AUS and PP for the treatment of concurrent UI and ED is safe and effective. Simultaneous insertion of these prostheses in the same patient offers potential advantages in operative and recovery time and is associated with high patient satisfaction. Combination therapy should therefore be included in the arsenal of treatment of these conditions.

61: Simultaneous Surgical Management of Associated Gynecologic and Extragenital Diseases

61: Simultaneous Surgical Management of Associated Gynecologic and Extragenital Diseases

Simultaneous Surgical Management of Achalasia and Morbid Obesity

Achalasia presenting in the context of morbid obesity is rare. The case is presented of a woman with achalasia and morbid obesity who was treated with simultaneous laparoscopic esophageal myotomy and gastric bypass. The sparse literature addressing these rare patients is reviewed and management considerations discussed. Simultaneous laparoscopic esophageal myotomy and gastric bypass is safe, feasible and provides good results.

Coexistent coronary and cerebrovascular disease: results of simultaneous surgical management in specific patient groups

Objective: Results of synchronous combined revascularization were examined in specific patient groups with coexistent coronary and cerebrovascular diseases. Methods: Between 1.1.1980 and 31.12.1998, 408 patients underwent a synchronous combined carotid endarterectomy (CEA)+myocardial revascularization (CABG). In 259 (63.5%) patients, carotid disease was asymptomatic. Remaining patients presented with a previous stroke ( n=35) or a transient ischemic episode (TIA) ( n=114). In 245 (60%) patients, carotid stenosis was bilateral (Group A: bilateral ≥80% stenosis, Group B: contralateral occlusion, Group C: contralateral subcritical disease). A synchronous ipsilateral CEA+CABG was performed in all patients with an unilateral disease ( n=163) and also in all Group B ( n=33) and Group C ( n=142) patients with bilateral disease. A simultaneous bilateral CEA+CABG was performed in 12 high risk Group A patients. Remaining Group A patients ( n=58), initially underwent an ipsilateral CEA for most dominant lesion+CABG, soon followed by the contralateral CEA. Results were examined in above specific patient Groups. Results: Overall combined hospital mortality from stroke+myocardial infarction was 2.45%. No independent predictor of stroke was identified. In general, initial prophylactic CEA, subdued the risk of subsequent strokes for 7–8 yr. Predictors of a late stroke were: progression of bilateral ( P=0.007) and intracranial ( P=0.04) cerebrovascular disease. Highest risk of an early stroke was recorded in Group A patients. A composite high risk group of patients with multiple risk factors ( n=155) demonstrated a higher risk of both early and late strokes, as compared to the remaining patients ( n=253) ( P<0.04). Observed risk of early and late strokes, in specific patient groups was lower than standard predictions. Conclusions: A regular use of combined approach was justified in the above patient groups.

Coexistent Coronary and Cerebrovascular Disease: Results of Simultaneous Surgical Management in Specific Patient Groups

Objective: Results of synchronous combined revascularization were examined in specific patient groups with coexistent coronary and cerebrovascular diseases. Methods: Between 1.1.1980 and 31.12.1998, 408 patients underwent a synchronous combined carotid endarterectomy (CEA) + myocardial revascularization (CABG). In 259 (63.5%) patients, carotid disease was asymptomatic. Remaining patients presented with a previous stroke ( n = 35) or a transient ischemic episode (TIA) ( n = 114). In 245 (60%) patients, carotid stenosis was bilateral (Group A: bilateral ≥ 80% stenosis. Group B: contralateral occlusion, Group C: contralateral subcritical disease). A synchronous ipsilateral CEA + CABG was performed in all patients with an unilateral disease ( n = 163) and also in all Group B ( n = 33) and Group C ( n = 142) patients with bilateral disease. A simultaneous bilateral CEA + CABG was performed in 12 high risk Group A patients. Remaining Group A patients ( n = 58), initially underwent an ipsilateral CEA for most dominant lesion + CABG, soon followed by the contralateral CEA. Results were examined in above specific patient Groups. Results: Overall combined hospital mortality from stroke + myocardial infarction was 2.45%. No independent predictor of stroke was identified. In general, initial prophylactic CEA, subdued the risk of subsequent strokes for 7–8 yr. Predictors of a late stroke were: progression of bilateral ( P = 0.007) and intracranial ( P = 0.04) cerebrovascular disease. Highest risk of an early stroke was recorded in Group A patients. A composite high risk group of patients with multiple risk factors ( n = 155) demonstrated a higher risk of both early and late strokes, as compared to the remaining patients ( n = 253) ( P &lt; 0.04). Observed risk of early and late strokes, in specific patient groups was lower than standard predictions. Conclusions: A regular use of combined approach was justified in the above patient groups.

Simultaneous surgical management of aortic and renovascular disease

The results of simultaneous elective infrarenal aortic reconstruction and renovascular surgery were retrospectively reviewed in 102 patients who consecutively underwent operation. The perioperative mortality rate (0 to 54 days) was 5% (5 of 102). Renal function had returned to baseline or was improved at discharge in 89 of 97 (92%) surviving patients. The intraoperative use of renal hypothermia was an independent predictor of improved postoperative renal function, by multivariate analysis. Twenty-five of 29 (86%) patients with severe hypertension had improvement in their blood pressure on the same or fewer medications postoperatively (p = 0.0005). A retroperitoneal incision was associated with less intraoperative crystalloid fluid administration (p = 0.03), more rapid postoperative resumption of an oral diet (p = 0.04), and better long-term survival (p = 0.02) when compared with a transperitoneal incision. We conclude that the simultaneous repair of infrarenal aortic pathology and renovascular lesions is associated with an acceptable perioperative morbidity and preserves or improves renal function in the majority of patients. The frequent use of renal hypothermia and careful consideration of the route of operative exposure will lead to optimal results.

Combined carotid-vertebral arterial trauma.

Eight patients with simultaneous penetrating trauma to the carotid and vertebral arteries among 129 carotid and 53 vertebral arterial injuries have been treated in the last 14 years. In contrast to a 10% mortality with isolated carotid or vertebral trauma, the mortality associated with this injury complex was 50%. This high mortality directly related to the overall complexity of the trauma sustained by these patients. The liberal use of arteriography to assess penetrating cervical trauma has enhanced the diagnosis of these injuries. We recommend simultaneous surgical management of the carotid and vertebral arterial injury through an extended anterior cervical approach.

Simultaneous surgical management of cataract and glaucoma.

This paper reports and analyses 70 combined cataract and trabeculectomy operations carried out on 50 patients by the two authors from 1973 to mid 1979. Control of glaucoma was achieved by surgery alone in 86%, the remaining 14% required additional medical therapy to achieve control. This therapy was less than that used preoperatively. Where the preoperative control was good 96% achieved post operative control without therapy. In eyes with poor preoperative control, 80% achieved post operative control without therapy. The complication rate was low and no eyes were lost in the series. The literature for alternatives for managing cataracts and glaucoma has been reviewed and analysis of this shows the following percentage control by surgery without additional medical therapy. (a) Cataract extraction alone 40.5%. (b) Drainage procedure followed by lens extraction 65.5%. (c) Combined cataract and glaucoma surgery other than trabeculectomy 79%. (d) Combined cataract and trabeculectomy 91%. The latter combined procedure is recommended for all eyes with coexistent cataract and glaucoma.