Statistical Difference In Complication Rates Research Articles

Prospective study of surgical fixation of radial head fractures using cannulated headless compression screws for simple and complex radial head fractures.

Fixing the two-part Mason II radial head fracture using screws is becoming a popular practice. However, the screw fixation efficacy for three-part Mason III and IV fractures is controversial. The purpose of this study is to determine the effectiveness of using a uniform technique of headless compression screw fixation in simple, isolated Mason II and complex three-part Mason III and IV radial head fractures in terms of functional outcome, treatment efficiency and assessment of complications with the procedure. A prospective evaluation were performed on 31 adult patients with closed, non-pathological Mason II, III and IV radial head fractures sustained due to trauma and who underwent fixation using either two or three cannulated headless compression screws of 2.0 to 2.5 mm, and all patients were followed up for 2 years after the injury. They were divided into simple Mason II fracture group and complex three-part Mason III-IV fracture group. Operation time, time to discharge and radiological union were used as parameters for assessment of clinical outcome, while Mayo Elbow Performance Score, range of motion and complications were used to assess the functional outcomes. Twelve cases of two-part simple fracture group and 18 cases of complex fracture group were identified. The mean age of 39 years is comparable between the two groups. Both groups had comparable days to union, mean hospital stay and operation time. In the simple fracture group, the mean Mayo Elbow Score was 97 (80-100), which is better than the complex fracture group score of 89 (75-100), p = 0.035. Both groups had no statistical difference in complication rates. All fractures united in our series. The mean range of motion for the simple fracture group was significant, with 133° ± 17.0° for flexion-extension arc, 85° ± 5° in pronation and supination as compared to the complex fracture group with 120° ± 20° flexion-extension arc, 69° ± 10° in pronation and 70° ± 8° in supination, p = 0.068. Overall clinical and functional outcomes of this technique are satisfactory in both simple and complex fracture groups, with simple Mason II fracture group doing better than the complex three-part Mason III and IV fractures in terms of Mayo Elbow Score and range of motion. Screw fixation has the advantage of less periosteal stripping and less impingement compared to other fixation methods and also allows for flexible fixation in constrained areas. Headless compression screw fixation can be considered as a method of fracture fixation for both simple and complex three-part radial head fractures.

Radiofrequency vs Microwave Ablation After Neoadjuvant Transarterial Bland and Drug-Eluting Microsphere Chembolization for the Treatment of Hepatocellular Carcinoma

To retrospectively compare the initial response, local recurrence, and complication rates of radiofrequency ablation (RFA) vs microwave ablation (MWA) when combined with neoadjuvant bland transarterial embolization (TAE) or drug-eluting microsphere chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). A total of 35 subjects with Barcelona Clinic Liver Cancer (BCLC) very early and early-stage HCC (range: 1.2-4.1cm) underwent TAE (23) or TACE (12) with RFA (15) or microwave ablation (MWA) (20) from January 2009 to June 2015 as either definitive therapy or a bridge to transplant. TAE and TACE were performed with 40-400μm particles and 30-100μm plus either doxorubicin- or epirubicin-eluting microspheres, respectively. Initial response and local progression were evaluated using modified response evaluation criteria in solid tumors. Complications were graded using common terminology criteria for adverse events version 5.0. Complete response rates were 80% (12/15) for RFA + TAE/TACE and 95% (19/20) for MWA + TAE/TACE (P = 0.29). Local recurrence rate was 30% (4/12) for RFA + TAE/TACE and 0% (0/19) for MWA + TAE/TACE. Durability of response, defined as local disease control for duration of the study, demonstrated a significant difference in favor of MWA (P = 0.0091). There was no statistical difference in complication rates (3 vs 2). MWA and RFA when combined with neoadjuvant TAE or TACE have similar safety and efficacy in the treatment of early-stage HCC. MWA provided more durable disease control in this study; however, prospective data remain necessary to evaluate superiority of either modality.

PWE-157 EUS Guided Trans-Gastric Pancreatic Pseudocyst Drainage- Does Standard Use of Fluoroscopy Just Complicate Things?: Abstract PWE-157 Table 1

Introduction Endoscopic pancreatic pseudocyst drainage is effective and associated with lower morbidity and mortality compared to surgical or percutaneous methods. EUS guidance is now the gold standard intervention due to a higher success rate and lower complication rate compared to blind puncture with fluoroscopic assistance. Many centres still use fluoroscopic guidance with EUS for all cyst-gastroscopy procedures. We present single centre experience of EUS guided pseudocyst drainage and complication rates comparing complication rates with and without fluoroscopic assistance. Methods All EUS guided trans-gastric and trans-duodenal pseudocyst and acute pancreatic fluid collections drainage procedures from 2010 to January 2016 were included. Demographics, use of fluoroscopy and initial success of drainage with stent placement were recorded. All procedures were performed with midazolam and fentanyl sedation without endotracheal tube insertion. Standard trans-gastric drainage was attempted if there was good luminal/gastric wall apposition (cyst distance Results 71 procedures were performed in 68 patients (mean age 50.8, SD 16.1). Immediate drainage was achieved in 69/71 (97.1%) of cases (2 procedures were abandoned due to bleeding). 2 procedures used fully covered metal stents, the remainder used two plastic stents. 2 procedures were performed via the duodenum due to cyst position. 9 patients experienced complications. Although the complications in the fluoroscopy group were more frequent there was no significant statistical difference in complication rates on comparing the two groups (p = 0.25). Conclusion Although fluoroscopy could be helpful in certain circumstances, the routine additional use of fluoroscopy does not reduce complications for EUS guided trans-gastric drainage of pancreatic pseudocysts. Disclosure of Interest None Declared

ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes?

Most of the studies concerning enhanced recovery after surgery (ERAS) protocols in colorectal surgery include heterogeneous groups of patients undergoing open or laparoscopic surgery, both due to colonic and rectal cancer, thus creating a potential bias. The data investigating the differences between patients operated for either colonic or rectal cancer are sparse. The aim of the study was to compare short-term outcomes of laparoscopic surgery for colonic and rectal cancer with ERAS protocol. The analysis included consecutive prospectively registered patients operated for a colorectal cancer between January 2012 and September 2015. Patients were divided into two groups (colon vs. rectum). The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilization and time to first flatus). Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. Patients in Group 1 (150 patients) were discharged home earlier than in Group 2 (82 patients)—median LOS 4 versus 5 days, respectively. There was no statistical difference in complication rate (27.3 vs. 36.6 %) and readmissions (7.3 vs. 6.1 %). Compliance with the protocol was 86.9 and 82.6 %, respectively. However, in Group 1, the following procedures were used less frequently: bowel preparation (24 vs. 78.3 %) and postoperative drainage (23.3 vs. 71.0 %). There were no differences in recovery parameters between the groups. Univariate logistic regression showed that the type of surgery, drainage and stoma creation significantly prolonged LOS. In a multivariate logistic regression model, only a bowel preparation and drainage were shown to be significant. Although functional recovery and high compliance with ERAS protocol are possible irrespective of the type of surgery, laparoscopic rectal resections are associated with a longer LOS.

ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma – Are there differences in short-term outcomes?

Most of the studies concerning enhanced recovery after surgery (ERAS) protocols in colorectal surgery include heterogeneous groups of patients undergoing open or laparoscopic surgery, both due to colonic and rectal cancer, thus creating a potential bias. The data investigating the differences between patients operated for either colonic or rectal cancer are sparse. The aim of the study was to compare short-term outcomes of laparoscopic surgery for colonic and rectal cancer with ERAS protocol. The analysis included consecutive prospectively registered patients operated for a colorectal cancer between January 2012 and September 2015. Patients were divided into two groups (colon vs. rectum). The measured outcomes were: length of stay (LOS), complication rate, readmission rate, compliance with ERAS protocol elements and recovery parameters (tolerance of early oral diet, mobilization and time to first flatus). Group 1 (colon) consisted of 150 patients and Group 2 (rectum) of 82 patients. Patients in Group 1 (150 patients) were discharged home earlier than in Group 2 (82 patients)—median LOS 4 versus 5 days, respectively. There was no statistical difference in complication rate (27.3 vs. 36.6 %) and readmissions (7.3 vs. 6.1 %). Compliance with the protocol was 86.9 and 82.6 %, respectively. However, in Group 1, the following procedures were used less frequently: bowel preparation (24 vs. 78.3 %) and postoperative drainage (23.3 vs. 71.0 %). There were no differences in recovery parameters between the groups. Univariate logistic regression showed that the type of surgery, drainage and stoma creation significantly prolonged LOS. In a multivariate logistic regression model, only a bowel preparation and drainage were shown to be significant. Although functional recovery and high compliance with ERAS protocol are possible irrespective of the type of surgery, laparoscopic rectal resections are associated with a longer LOS.

Transthoracic Computed Tomography–Guided Lung Nodule Biopsy: Comparison of Core Needle and Fine Needle Aspiration Techniques

PurposeTo determine if there is a statistically significant difference in the computed tomography (CT)–guided trans-thoracic needle biopsy diagnostic rate, complication rate, and degree of pathologist confidence in diagnosis between core needle biopsy (CNB) and fine needle aspiration biopsy (FNAB). MethodsA retrospective cohort design was used to compare the diagnostic biopsy rate, diagnostic confidence, and biopsy-related complications of pneumothorax, chest tube placement, pulmonary hemorrhage, hemoptysis, admission to hospital, and length of stay between 251 transthoracic needle biopsies obtained via CNB (126) or FNAB (125). Complication rates were assessed using imaging and clinical follow-up. Final diagnosis was confirmed via surgical pathology or clinical follow-up over a period of up to 10 years. ResultsCNB provided diagnostic samples in 91% and FNA in 80% of biopsies, which was statistically significant (P < .05). The sensitivities for CNB and FNAB were 89% (85 of 95) and 95% (84 of 88), respectively. The specificity of CNB was 100% (21 of 21) and for FNAB was 81% (2 of 11) with 2 false positives in the FNAB group.The differences in complication rate was not statistically significant for pneumothorax (50% vs 46%; determined by routine postbiopsy CT), chest tube (2% vs 4%), hemoptysis (4% vs 6%), and pulmonary hemorrhage (38% vs 47%) between FNAB and CNB, respectively. Seven patients requiring chest tube were admitted to hospital, 2 in the FNAB cohort for an average of 2.5 days and 5 in the CNB cohort for an average of 4.6 days. ConclusionsCNB provided more diagnostic samples with no statistical difference in complication rate.

Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study

BackgroundOver the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation. ObjectiveThe aim of our study was to identify the complication rate of power morcellation at our institution. Study designWe performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded. ResultsA total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall complication rate of laparoscopic supracervical hysterectomy was 4.3% (n=8). Need for reoperation after laparoscopic supracervical hysterectomy was necessary in 7 patients (3.8%), with cervical amputation being the most common type of reoperation (n=5). In the laparoscopic-assisted vaginal hysterectomy group there were significantly more adhesiolysis performed (n=4). Parasitic myomas were discovered in 1 patient two years after morcellation (0.5%). ConclusionOur study showed no injuries directly related to morcellation. There were no unexpected malignancies morcellated and only one case of parasitic myomas (0.5%).

Feasibility of short term drainage for diagnostic thoracoscopy

Thoracoscopy is a diagnostic tool superior to other available techniques for the assessment of pleural effusions. There are numerous publications that describe the technique in detail but there is very little published on the optimal time of chest drain removal post procedure. Our aim was to retrospectively study all cases of diagnostic thoracoscopy and to ascertain the time of chest drain removal, length of hospital stay and associated complications. All patients who underwent thoracoscopy during a 6-year period were identified from a computerised database. Patients who received talc for pleurodesis were excluded as they required longer drainage time. A review of the remaining patients' charts and radiology was performed to ascertain the predefined outcomes. 124 patients had a diagnostic thoracoscopy. The time to chest drain removal was documented as less than four hours, four to 24 hours, 24 to 48 hours and greater than 48 hours in 66 (53.2%), 29 (23.4%), 12 (9.7%) and 17 (13.7%) of patients respectively. The median length of stay for all patients was one day (interquartile range, 1-4 days). There was a statistically significant difference in overall length of hospital stay between the early (<4 hours) and late (>48 hours) chest drain removal groups, p=0.0028. The overall complication rate was 15.9%. There was no statistical difference in complication rates between the two groups. This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes

To compare the ablation volume, local tumour progression rate and complication rate of radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) using 15-G and 17-G single electrodes. This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed percutaneous RFA cases for HCCs using 15-G or 17-G electrodes without multiple overlapping ablations. A total of 36 pairs of HCCs matched according to tumour size and active tip length were included. We compared ablation volume and complication rate between the two electrode groups. Cumulative local tumour progression rates were estimated using the Kaplan–Meier method and compared using the log-rank test. Tumour size and ablation time were not significantly different between the 15-G and 17-G groups (p50.661 and p50.793, respectively). However, ablation volume in the 15-G electrode group was larger than that in the 17-G group (14.465.4cm3 vs 8.762.5cm3; p,0.001). No statistical difference in complication rates between the two electrode groups was found. The 10- and 20-month local tumour progression rates were not significantly different between the two groups (2.8% and 5.6% vs 11.1% and 19.3%; p50.166). Ablation volume by the 15-G electrode was larger than that by the 17-G electrode. However, local tumour progression rate and complication rate were not significantly different between the two electrode groups. RFA of HCC using a 15-G electrode is useful to create larger ablation volumes than a 17-G electrode.

Quality of life change in elderly patients undergoing open inguinal hernia repair

A growing proportion of inguinal hernia patients are at least 65 years old. Assessing operational benefits versus risks in this group of elderly patients merits research. Patients in two prospective trials (1:n = 134, 89 elderly; 2:n = 398, 70 elderly) completed RAND-36 questionnaires preoperatively (response rate 100 and 98.5 %, respectively) and at 3 (98.5 %) or 12 months (89.6 %) after open inguinal hernia repair. In both groups, preoperative and postoperative quality of life data were statistically compared within age categories. Quality of life change was compared between age categories. Immediate complications were recorded. The dimensions physical functioning and pain improved significantly in the elderly and under 65-year-olds. Role functioning/physical and social functioning showed improvement as well, but less constantly. No statistical difference in complication rates was found across age groups. Inguinal hernia surgery improves physical and social dimensions of quality of life among elderly and under 65-year-olds similarly.

Revision Extension to the Pelvis versus Primary Spinopelvic Instrumentation in Adult Deformity: Comparison of Clinical Outcomes and Complications

To evaluate the outcomes and complications of patients with adult spinal deformity treated in a primary versus revision fashion with long fusions to the sacropelvis. A retrospective review was performed of a multicenter consecutive series of patients with adult spinal deformity requiring fusion to the sacropelvis, either primarily or as revision, with minimum 2-year follow-up. Clinical (Scoliosis Research Society [SRS] 22 questionnaire) and radiographic parameters (including sagittal vertical axis [SVA], coronal Cobb angle, lumbar lordosis, and thoracic kyphosis) were compared between the groups. There were 63 patients who met inclusion criteria; mean patient age was 51.9 years, and mean follow-up was 43 months. Patients requiring primary fusion were older (58.0 years vs. 49.5 years, P=0.01) and at baseline had a lower SVA (2.1 cm vs. 6.8 cm, P=0.01) and greater thoracolumbar Cobb angle (51.2 degrees vs. 36.5 degrees, P=0.003). At last follow-up, patients undergoing primary fusion and patients undergoing revision treatment had similar SVA (2.9 cm vs. 1.8 cm, P=0.32) and lumbar lordosis (-42.3 degrees vs. -43.4 degrees, P=0.82); patients undergoing revision treatment had more favorable SRS 22 scores (3.65 vs. 3.14, P=0.005). There was no statistical difference in complication rates between the groups (44.4% vs. 35%, P=0.68). Patients requiring revision extension of instrumentation to the pelvis can be treated with the same expectation of radiographic and clinical success as patients treated primarily with fusion to the sacropelvis. The complication rate for the revision procedure is not insignificant and may be similar to a primary procedure that includes pelvic fixation.

Use of the tabbed expander in latissimus dorsi breast reconstruction

Latissimus dorsi (LD) myocutaneous flap breast reconstruction with a tissue expander/implant is a post-mastectomy option often used as a salvage procedure for a failed tissue expander (TE). The patient is traditionally placed in the lateral decubitus position for flap dissection and is re-prepped and re-draped in the supine position for placement of the tissue expander. A new generation of anatomically-shaped, tabbed tissue expanders are increasingly being used in place of traditional untabbed expanders. The innovative suture tabs allow for more predictable and controlled expander placement while the patient is in the lateral decubitus position, eliminating the need to reposition the patient intraoperatively. The objective of this study was to evaluate the use of tabbed tissue expanders in latissimus dorsi breast reconstruction, with respect to total operative time, complication rates, and aesthetic outcomes. The outcomes of 34 LD breast reconstruction procedures with tissue expanders were evaluated. Eight patients received tabbed tissue expanders with no position change, while 26 patients underwent an intraoperative position change. Demographic information, total operative time, and follow-up complication data were collected. Aesthetic outcomes were evaluated by three blinded individuals using a validated scoring scale. The mean operative time for procedures with no position change was 107 minutes. The mean operative time for position change cohort was 207 minutes. There was no statistical difference in complication rates or aesthetic outcomes between the two groups. In conclusion, tabbed tissue expanders decrease operative time by eliminating the need for an intraoperative position change without influencing complication rates while maintaining equivalent aesthetic outcomes.

Does Size Really Matter? Analysis of the Effect of Large Fibroids and Uterine Volumes on Complication Rates of Uterine Artery Embolisation

The purpose of this study was to determine whether there is a correlation between large uterine fibroid diameter, uterine volume, number of vials of embolic agent used and risk of complications from uterine artery embolisation (UAE). This was a prospective study involving 121 patients undergoing UAE embolisation for symptomatic uterine fibroids at a single institution. Patients were grouped according to diameter of largest fibroid and uterine volume. Results were also stratified according to the number of vials of embolic agent used and rate of complications. No statistical difference in complication rate was demonstrated between the two groups according to diameter of the largest fibroid (large fibroids were classified as > or = 10 cm; Fisher's exact test P = 1.00), and no statistical difference in complication rate was demonstrated according to uterine volume (large uterine volume was defined as > or = 750 cm(3); Fisher's exact test P = 0.70). 84 of the 121 patients had documentation of the number of vials used during the procedure. Patients were divided into two groups, with > or = 4 used defined as a large number of embolic agent. There was no statistical difference between these two groups and no associated increased risk of developing complications. This study showed no increased incidence of complications in women with large-diameter fibroids or uterine volumes as defined. In addition, there was no evidence of increased complications according to quantity of embolic material used. Therefore, UAE should be offered to women with large fibroids and uterine volumes.

Lateral Orbicularis Oculi Muscle Plasty in Conjunction with Face Lifting for Periorbital Rejuvenation

The purpose of this study was to evaluate the lateral orbicularis oculi muscle plasty as an alternative periorbital rejuvenation technique during face lift. The authors conducted a retrospective review of patients who underwent face lifts between 2004 and 2007. Postoperative follow-up, complications, aesthetic outcome, and patient satisfaction were recorded. The patients were further divided into four groups for the analysis: lateral orbicularis oculi muscle plasty with lower blepharoplasty (group 1), lower blepharoplasty without lateral orbicularis oculi muscle plasty (group 2), lateral orbicularis oculi muscle plasty without lower blepharoplasty (group 3), and neither lateral orbicularis oculi muscle plasty nor lower blepharoplasty (group 4). A total of 76 patients were identified as having had a midface lift with or without lateral orbicularis oculi muscle plasty in the study period. Sixty-eight percent of the patients had a lateral orbicularis oculi muscle plasty procedure. Group 3 showed the lowest complication rate followed by group 4, but there were no statistical differences in complication rates among the study groups. The higher aesthetic result and patient satisfaction were obtained by groups 3 and 4 (p < 0.01). Group 2 had the highest complication rate and lowest overall outcomes. The authors have been able to demonstrate that lateral orbicularis oculi muscle plasty is a safe technique that may be considered a good alternative for periorbital rejuvenation and may help in avoiding lower lid incisions or extensive dissections during face lifting in some cases.

Percutaneous Imaging-Guided Solid Organ Core Needle Biopsy: Coaxial Versus Noncoaxial Method

The purpose of our study was to compare the diagnostic yield and complication rate of coaxial technique with those of noncoaxial technique in percutaneous imaging-guided renal and hepatic core biopsies. We also compared bleeding complication rates with and without absorbable gelatin sponge occlusion of the biopsy track. The records of 1,060 consecutively registered patients who underwent percutaneous imaging-guided hepatic or renal biopsy at two hospitals were retrospectively reviewed. Core specimens were obtained in all biopsies. Indications for biopsy included acquisition of general tissue specimens to evaluate for hepatic (n = 495) or renal disease (n = 243) and acquisition of specimens of specific hepatic (n = 289) and renal (n = 33) lesions. Samples were acquired with a coaxial set of needles (n = 764) or with a noncoaxial needle (n = 296 patients). Absorbable gelatin sponge was injected before removal of the outer needle in 269 of the 764 coaxial biopsies. Gelatin sponge was not injected in the other 495 coaxial biopsies. Complication rates were evaluated in a comparison of the two methods and of the coaxial biopsies with and without postprocedural injection of gelatin sponge. Complications were considered minor if follow-up imaging in the 7 days after the procedure showed a complication that did not necessitate treatment other than conservative pain management. Complications were considered major if treatment such as blood product transfusion or surgery was needed or if the patient died. Specimens were immediately given to a pathologist, who typically was present during the procedure. Specimens were evaluated and judged adequate for a specific diagnosis by the histopathology staff. The rates of minor complications were 3.4% (10/296) for the noncoaxial method and 2.6% (20/764) for the coaxial method. The rates of major complications were 1.0% (3/296) for the noncoaxial method and 0.9% (7/764) for the coaxial method. Six cases of major complications necessitating blood product transfusion were documented for the coaxial method and one case for the noncoaxial method. One (0.1%) of the patients undergoing coaxial biopsy died. One patient undergoing noncoaxial biopsy needed surgical repair of an arterial injury that was refractory to blood transfusion, and another developed pancreatitis and needed a blood transfusion. The percentage of minor complications of the coaxial method with absorbable gelatin sponge injection was 3.7% (10/269), and that of major complications was 0.7% (2/269). There was no statistical difference in complication rates between the various methods of percutaneous hepatic and renal biopsy. In regard to complications, there are no differences between coaxial and noncoaxial biopsy methods or between the coaxial method with or without injection of absorbable gelatin sponge.

NS13P A PROSPECTIVE COMPARISON OF TWO CERVICAL INTERBODY FUSION CAGES

Purpose For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction.Methodology Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B‐Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre‐ and post‐operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients.Results A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow‐up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups.Discussion Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end‐plate subsidence.

Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger

We performed a non-randomized controlled clinical trial of 59 clinical cases to compare percutaneous transverse K-wire fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. Twenty-nine patients were treated by percutaneous transverse K-wire fixation and 30 patients were treated with intramedullary K-wires. They were reviewed at a mean follow-up of 24 months for radiological and functional outcome in terms of union rate, union time, complication rate, pain, movement and grip strength. Radiographs did not show any significant differences in the union rate and union time. There was no statistical difference in complication rate, pain scores, total active motion and grip strength between the two groups. The authors suggest that both methods are comparable, good and safe methods of treating closed, displaced fractures of the metacarpal neck of the little finger, without significant complications.

The Optimal Timing of Laparoscopic Cholecystectomy in Mild Gallstone Pancreatitis

The optimal timing of laparoscopic cholecystectomy (LC) in patients with biliary pancreatitis is not standardized. Our objective was to determine if patients with mild gallstone pancreatitis (three or fewer Ranson's criteria) can safely proceed to LC as soon as serum amylase is decreasing and abdominal tenderness is improving. We reviewed the charts of all adults admitted to our institution with gallstone pancreatitis from January 1999 until June 2002 who had LC performed by either surgeon 1 (group 1) or surgeon 2 (group 2). Surgeon 1 preferred to delay surgery until normalization of amylase and complete resolution of abdominal tenderness, whereas surgeon 2 preferred to proceed to LC as soon as serum amylase was decreasing and abdominal tenderness was improving. The two groups were well matched for sex, age, Ranson's criteria, and percentage requiring endoscopic retrograde cholangiopancreatography. Average total hospital stay was 4.7 days in group 1 versus 3.5 days in group 2 (P = 0.01). There was no statistical difference in complication rate between the two groups (10% in group 1 vs 11% in group 2, P = 0.12). The data suggest that hospital stay can be shortened with no increased complication rate if patients with mild biliary pancreatitis proceed to LC as soon as serum amylase is decreasing and abdominal tenderness is improving.

Surgical outcome in 87 patients with Zenker's diverticulum.

Surgical treatment of Zenker's diverticulum is controversial because many different procedures exist. We retrospectively reviewed 87 consecutive patients surgically treated for Zenker's diverticulum at a tertiary care institution from 1976 through 1993. Four surgical procedures were performed: cricopharyngeal myotomy alone (n = 16), excision (hand-sewn) plus myotomy (n = 51), excision (stapler) plus myotomy (n = 11), and diverticulopexy plus myotomy (n = 9). There were three surgical mortalities (3.5%) and a complication rate of 24%. Eighty patients (92%) were available for follow up. Sixty-eight patients (78%) reported excellent relief of symptoms, 10 (13%) reported improvement with occasional symptoms, and two (3%) described persistent dysphagia. No statistical difference in complication rate was found among surgical groups (P = 0.15). Myotomy alone patients had worse outcomes (P = 0.04) compared with the other surgical groups. Median follow-up was 7.5 months.

A Prospective Trial Comparing the Efficacy and Complications of the Modified Dornier HM3 and MFL 5000 Lithotriptors for Solitary Renal Calculi

A prospective randomized study of 198 patients was conducted to compare the efficacy of the modified Dornier HM3 lithotriptor to the MFL 5000 lithotriptor. Entrance criteria included solitary stones at any location within the upper collecting system that had not previously been treated with lithotripsy. Following lithotripsy the patients were evaluated by a blinded radiologist with a plain abdominal film, tomograms and renal ultrasound at 1, 4 and 12 weeks. Patients were classified at 12 weeks after lithotripsy as failing treatment if any stone fragments were imaged. Of the patients 170 were available for complete 3-month followup. No statistical or clinical difference in stone-free rates was apparent for calculi in the ureter or renal pelvis in either group. Of patients with lower caliceal stones 80 percent had no residual fragments visualized at 12 weeks when treated with the modified HM3 device versus 56 percent with the MFL 5000 lithotriptor (p = 0.05). Treatment time on the MFL 5000 unit was significantly prolonged compared with the modified HM3 device (0.7 hours versus 0.4 hours, respectively) resulting in fewer patients being treated in a given day (p less than 0.001). No statistical difference in complication rates could be found between the 2 machines. Steinstrasse were noted in 10 percent of the patients treated with the modified HM3 device and 6 percent of the MFL 5000 group. Subcapsular hematomas were noted in 4 percent of the MFL 5000 treatment arm compared to 1 percent in the modified HM3 group. Overall, the MFL 5000 lithotriptor was believed to offer no significant clinical advantage over the modified HM3 device in terms of lithotripsy efficacy, although the multifunctional table did offer more versatility for stone treatment. For a busy lithotripsy center, the modified HM3 lithotriptor is still the most efficacious.