Success Rate Of Repair Research Articles

Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managed at a Teaching Hospital in Zambia: A Retrospective Cross Sectional Study

Background: The obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and in most cases treatable. Surgical repair is the mainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia.
 Methods: A retrospective review of medical records for all women who underwent obstetric fistula repair surgery at Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer’s exact test was used to measure association between surgical outcomes and variables in the model.
 Results: In total, 18 out of 29 records of patients who underwent fistula repair were retrieved and analyzed. Ages ranged from 15 to 47 years, mean age 29 years. Over two thirds (72.23%) were multiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83% at 2 weeks post-operative. Study findings were inadequate to show a significant association between successful repair and factors in the model.
 Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by cesarean section and poor birth outcomes. The success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2 weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.

Tragus Perichondrium-Cartilage Island and Temporalis Muscle Fascia for Repairing Tympanic Membrane Perforation Under the Otoendoscope: A Randomized Controlled Trial.

To compare the clinical effects of repairing tympanic membrane perforation (TMP) with the tragus perichondrium-cartilage island and temporalis muscle fascia (TMF) under the otoendoscope. The clinical data of 84 patients (total 84 ears) with TMP repaired by otoendoscopy from March 2019 to April 2021 were analyzed. The patients were randomly divided into the control group (n = 42, TMF repair) and the experimental group (n = 42, perichondrium-cartilage island repair). The intraoperative blood loss, operation time, length of hospital stay, success rate of the TMP repair, mean air-conducted sound, and air-bone gap before and after surgery were compared between the two groups. The mean air-bone gap and mean air-conducted hearing threshold in the experimental group were significantly lower after surgery at all frequencies than those of the control group (all P < .05). The reduction of the mean air-conducted hearing threshold in the experimental group was significantly higher than that of the control group (P < .001). The surgery time of the experimental group was significantly shorter than the control group (78.04 ± 2.23 vs. 84.27 ± 1.67minutes, P < .001). The success rate of the TMP repair was 95.24% (40/42) in the experimental group and 92.86% (39/42) in the control group, indicating that there was no significant difference in the success rate of TMP repair between the two materials (risk ratio = 1.75; 95% confidence interval: .31-12.04; P = .71). Repairs with the tragus perichondrium-cartilage island have a short operation time, high healing rate, and more significant postoperative hearing improvement, which makes it a more effective method of TMP repair.

Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study.

IntroductionChoanal atresia (CA) is an uncommon congenital anomaly. There are various syndromes that are associated with CA. The purpose of this study is to determine the differences in CA's presentation and outcome when associated with other congenital anomalies and syndromes.MethodThis is a retrospective review study of all children (18 years and younger) who underwent CA repair in a tertiary referral healthcare center from January 2005 to April 2022. Demographics, comorbidities, radiological testing, operative reports, and outpatient reports were collected. Success was determined as a child with bilateral patent choana that is able to breathe from both nostrils comfortably.ResultTwenty-four patients met the criteria for inclusion in this study. Bilateral CA was present in 15 (62.5%) patients. Mixed CA was the most common variant. There were various congenital anomalies in association with CA patients who are yet to be classified into a syndrome. The most common congenital anomaly was cleft lip and palate. Bony and mixed types were significantly associated with non-syndromic patients (p<0.05). Twenty patients (83%) were diagnosed with CA at age of less than one year, and four patients were diagnosed after one year of age. There were 36 surgeries performed on 24 patients, of which 27 were endoscopic and nine were using Hugher dilator. The overall success rate for CA repair was 50%. The median number of revisions per patient was 0.5.ConclusionCA is a challenging anomaly to repair. There are various factors that influence the outcome of children with CA. Otolaryngologists should counsel the patient and their families regarding possible need for revision especially in those with other craniofacial anomalies.

The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study.

BackgroundObstetric fistula recurrence predisposes to a decreasing success rate of fistula repair and accounts for the continued incidence of obstetric fistulas in low-income countries. Evidence has revealed that there are women’s intent gaps in the prevention of obstetric fistula recurrence. Assessments of predictors of intent to prevent obstetric fistula recurrence among women with fistula are scarce.ObjectiveThis study assessed the intent to prevent obstetric fistula recurrence and its predictive factors among women with obstetric fistula in Ethiopia.MethodsFacility-based cross-sectional study was conducted from April 01, 2019, to August 01, 2019, with consecutively selected 478 women with fistulas in five fistula treatment centers in Addis Ababa and Oromia regions. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS 23 software. Simple and multiple linear regression models were fitted for data analysis.ResultsMean score of intent to prevent obstetric fistula recurrence among women with obstetric fistula was 27.72 ± 5.06. Living in a rural setting (β =−2.27; 95% CI: −3.62, −0.93), being married (β =1.71, 95% CI: 0.56, 2.85), having one previous repair (β =2.14, 95% CI: 0.19, 4.08), high self-esteem (β =1.42, 95% CI: 0.09, 2.74), psychological health (β =0.05, 95% CI: 0.26, 3.79), living with fistula ≥5 years (β =1.82, 95% CI: 0.44, 3.21), high knowledge of risk factors (β =3.12, 95% CI: 1.99, 4.25), and a positive attitude (β =2.33, 95% CI: 1.12, 3.54) were significant predictors of the intent to prevent obstetric fistula recurrence.ConclusionIntent to prevent obstetric fistula recurrence among women with obstetric fistula was low. This indicates an urgent need to create awareness among women with an obstetric fistula on the risk factors of obstetric fistula recurrence, attitudinal changes towards prevention of obstetric fistula recurrence, and the availability of prevention measures.

Clinical Efficacy and Safety of Different Dental Prosthetic Membranes in Guided Bone Regeneration during Dental Implants: A Meta-Analysis.

Objective. To evaluate clinical efficacy and safety of absorbable and non-absorbable dental restorative membranes in guided bone regeneration (GBR). Articles concerning absorbable and non-absorbable prosthetic membrane-related studies of GBR were screened from multiple databases. In the end, 526 postoperative patients who met eligibility criteria were screened for the study from eight trials. The results showed that the repair success rate of the experimental group (absorbable dental restorative membrane) was higher than that of the control group (non-absorbable dental restorative membrane) (RR = 1.18, 95% CI [1.11,1.26], and the total physical therapy effect was P < 0.0001, I2 = 0%), and the height of bone graft in the experimental group was higher than that in the control group (MD = 0.67, 95% CI [0.11, 1.23]). The thickness of bone graft in the experimental group was higher than that in the control group (MD = 0.43, 95% CI [0.30,0.56], P < 0.00001, I2 = 61%), and the adverse events in the experimental group were less than those in the control group (RR = 0.31, 95% CI [0.18, 0.51], P < 0.00001, I2 = 13%). Absorbable prosthetic membrane is superior to non-absorbable prosthetic membrane in clinical efficacy and safety.

Factors Associated with Vesicovaginal Fistula and Their and Treatment Outcome

Vesicovaginal fistulas (VVF) also known as vesicovaginal fistula, have become a growing public health concern especially of developing countries. The most cited reason in literature of VVF is by prolonged and obstructed labor. With improvement in quality care delivery in health around the globe, the etiology of VVF too evolving in the country. Objective: This study was done to find out the factors associated with vesicovaginal fistula and to determine the success rate of operative procedure for treatment of vesicovaginal fistula. Method: This cross sectional study was carried out in Department of Gyneacology and Obstetrics in Liaquat University Hospital, Hyderabad from January 2021 to December 2021 among 60 women at different ages suffering from vesicovaginal fistula due to gynaecological or obstetrical causes or malignancy. Result: Majority of the patients were “young primipara with short stature and malnourished, coming from lower socioeconomic condition of rural areas. Prolonged labor 24 (40%) was the most common cause of vesicovaginal fistula, followed by gynaecological surgeries mainly hysterectomies 18 (30%) and malignancy 4 (6.6%) rare cause. The success rate of repair following first and second attempt was 92% and 8% respectively. Overall success rate was 48 (96%) and functionally failed with a failure in 2(4%) cases. This study showed main cause for developing fistula showing prolonged labor and majority of patient were treated pervaginally. Most of the cases (96%) had successful repair which is very encouraging and correlates well with recently published series. Conclusion: Fistula can be totally preventable by proper antenatal care identification of high risk cases, timely referral, proper intranatal, postnatal care, and proper training. So improvement of health care services and dedication will prevent this type of morbidity. The best results are obtained when repair of vesicovaginal fistulae is carried out under optimal conditions”.

Does the History of Tracheoesophageal Fistula Repair Alter Outcomes of Laryngeal Cleft Repair?

Tracheoesophageal fistula and esophageal atresia (TEA) and laryngeal cleft (LC) can coexist in some patients. The surgery-specific success rate of LC repair in children with associated TEA has not been well described. The aim of the study is to determine if the history of TEA alters the LC repair outcomes. Case series with chart review. Single-institution academic medical center. A retrospective review was conducted of patients with LC with and without TEA repair between January 2001 and November 2020. Data collected and analyzed included demographics and clinical characteristics, LC type, and LC with TEA timing of repairs. An overall 282 patients met the inclusion criteria of LC repair: LC (n = 242, 85.8%) and LC + TEA (n = 40, 14.2%). Revision repair was required in 43 patients (15.2%) with 8 (2.8%) needing a second revision repair. The first LC revision rate in the LC group was 36/242 (14.9%) as compared with 7/40 (17.5%) in the LC + TEA group (P = .67). The second LC revision rate in the LC and LC + TEA groups was 7 (2.9%) and 1 (2.4%), respectively. The median time to revision was 5.1 months (interquartile range, 3.45-10.6) in the LC group as compared with 29.2 months (interquartile range, 4.8-44.2) in the LC + TEA group (P = .06). The incidence of TEA and LC was 14.2% in our study. Based on our findings, history of TEA repair is not associated with a higher revision rate vs LC alone. The history of TEA repair did not alter the outcomes of LC repair.

V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES

You have accessJournal of UrologyCME1 May 2022V01-09 URETEROCALICOSTOMY IN TWO PATIENTS WITH MULTIPLE FAILED PYELOPLASTIES Michael Gross, Jason Scovell, and Robert Stein Michael GrossMichael Gross More articles by this author , Jason ScovellJason Scovell More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Success rates for primary repair of a ureteropelvic junction obstruction (UPJO) are excellent, however recurrent strictures do occur in a subset of patients. Secondary UPJO presents complex and variable surgical challenges and there is no one-size-fits all solution. Ureterocalicostomy, where a healthy segment of ureter is anastomosed to a lower pole calyx, is a reasonable approach as shown in two recent patients. METHODS: Case one is a 25 year old female with a history of left UPJO who underwent primary laparoscopic pyeloplasly followed by endopyelotomy for recurrent UPJO. She additionally experienced severe gross hematuria necessitating embolization of a lower pole branch renal artery. The resulting area of ischemia and parenchymal thinning presented a particularly favorable location for ureterocalicostomy to circumvent her UPJO. This was also felt to be a more anatomic drainage pattern in an otherwise malrotated kidney. The second case is a 31 year old female with UPJO repaired with open pyeloplasty followed by robotic pyeloplasty 13 years later for secondary UPJO who presented with persistent pain and hydronephrosis. This patient was not initially planned for ureterocalicostomy, however the ureter was severely scarred to the lower pole and the more proximal tissue did not appear dissectible or suitable for a buccal mucosal graft and the decision to proceed with ureterocalicostomy was reached intraoperatively. RESULTS: Both patients recovered without complications and experienced symptomatic resolution. Beyond standard principles for dissecting the ureter in pyeloplasty, there is a role for ultrasound in these cases to identify the optimal location for the calicostomy. A nephropexy can also be utilized to reposition the kidney and decrease tension on the anastomosis. Meticulous suturing technique is necessary to ensure apposition of the mucosa to minimize scarring and failure of the repair. CONCLUSIONS: Ureterocalicostomy is a feasible option in select patients and may be an elegant solution to circumvent dense scar tissue and to take advantage of pathologic anatomy. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e54 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Gross More articles by this author Jason Scovell More articles by this author Robert Stein More articles by this author Expand All Advertisement PDF DownloadLoading ...

Meniscal Repair Outcomes at Greater Than 5 Years: A Systematic Review and Meta-Analysis.

The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair. We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model. A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54). Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Meniscal Preservation is More Likely When Performed with Acute Anterior Cruciate Ligament Repair Rather Than with Anterior Cruciate Ligament Reconstruction.

Rupture of the anterior cruciate ligament (ACL) often occurs in conjunction with meniscal tears. In this study, we investigate the rates and outcomes of meniscal repair surgery performed with ACL reconstruction compared with acute ACL repair surgery. Data was collected for all patients undergoing surgery for ACL ruptures between 2012 and 2018, including ACL reconstruction with hamstring autograft and primary ACL repair augmented with suture tape. Patients undergoing multi-ligament surgery were excluded. Meniscal injury was evaluated intraoperatively and the treatment was determined by type of tear, reducibility, and quality of meniscal tissue. If possible, tears were repaired using all-inside anchors and all others were resected. There were 272 ACL reconstructions and 134 ACL repairs, and mean age was 28 (±9) and 35 (±14) years, respectively (p <0.01). The mean Tegner activity score was 6.6 in both groups. The mean interval from injury to surgery was longer in the reconstruction group (26.2 vs. 1.3 months, p <0.01). Fifty-five percent of reconstructions and 43% of ACL repairs required meniscal surgery at the time of their ACL procedure. In the reconstruction group, 123 (70%) were meniscectomies and 53 (30%) were meniscal repairs, compared to 31 (50%) of each in the ACL repair group. Meniscal repair was more likely to be possible when carried out as part of acute ACL repair surgery, c2(1, n=238)=7.94, p <0.01. The success rate of meniscal repair was 97% in both groups. The rate of meniscal repair is 67% higher when performed early with ACL repair. When ACL reconstruction is performed, meniscal resection was more likely. Rates of post-traumatic osteoarthritis are high after ACL reconstruction when performed with meniscal resection. Furthermore, the success rate of meniscal repair in conjunction with ACL surgery is high (97%). Therefore, meniscal repair should be encouraged whenever possible to improve long-term outcomes.

Surgical repair of nasal septal perforations: A systematic review and meta-analysis.

A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes. PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes. The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p<0.01), with moderate heterogeneity between studies (I2 =42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes. Nasal septal perforation surgical repair success rates are comparable regardless of technique.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus.

This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Retrospective study. University hospital. This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton's types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Improving GNSS triple-frequency cycle slip repair using ACMRI algorithm

The processing of GNSS triple-frequency cycle slips is an important prerequisite for providing high-precision location services. Cycle slip detection is achieved by constructing a group of detection combinations, namely two geometry-free phase combinations and one pseudo-range phase combination of GNSS observations. However, cycle slip estimation would be strongly affected by ill-conditioned equations, which means that even a slight fluctuation in the observations will cause large biases to the final results. To deal with this problem, a new cycle slips estimation algorithm of adjusting coefficient matrix based on residual information (ACMRI algorithm) is proposed. In our algorithm, a parameter k is utilized to adjust the coefficient matrix of the normal equation to compensate for the deviation of the observations, so as to reduce the influence of the ill-conditioned normal equation. However, it is significantly challenging to search for the value of k. To solve this difficulty, we firstly developed a new way to obtain the search region of the parameters using the method of statistics–verification–optimization based on numerous experiments. Then, a new two-order search method, based on the principle of minimum least-square residual and rounding residual, is proposed. Once the cycle slips are determined, the two residuals are used as the reliability index of cycle slips repair. Two geometry-free phase combinations [1 1– 2], [1 –2 1] and one pseudo-range phase combination [1 4 –5] are selected for the experiments using BDS2, BDS3, GPS, and Galileo observations. Experimental results show the proposed algorithm improves the success rates of triple-frequency cycle slips repair from least-squares solution rates of 89.3% (Galileo), 14.5% (BDS2), and 48.1% (BDS3) to 100% for all systems, and reduces the RMS error of the residual between the float solutions of cycle slips and their true values more than 90% compared with the least-squares method. To further evaluate the feasibility of the algorithm, 60 groups of combinations are set for the four GNSS systems. Results indicate that the proposed algorithm can significantly improve the triple-frequency cycle slip estimation and the success rate of cycle slip repair for all combinations of all the four systems.

Minimal Invasive Thoracoscopic Mitral Valve Surgery.

The totally thoracoscopic approach for mitral valve (MV) disease is a minimally invasive method. We investigated the procedure's feasibility, safety and effectiveness when it was performed by an experienced operator. We retrospectively analysed 96 consecutive patients with MV disease treated between March 2016 and November 2019 by minimally invasive procedures. The procedures were performed on a femoral artery-vein bypass through two ports, including a main operation port and a thoracoscopic port. The clinical data of patients were collected, including preoperative cardiac function, operative data, postoperative complications, and follow-up. A total of 96 patients (57 male patients; average age, 49.7±14.5 years; left ventricular ejection fraction, 65.6±7.7%) were enrolled in this study. No intraoperative conversion incision or death occurred. The cardiopulmonary bypass and aortic cross-clamp times were 163.8±50.6 minutes and 119.7±38.9 minutes, respectively. Postoperative chest tube drainage in the first 24 hours was 232.8±108.1 ml. The ventilation time and length of intensive care unit stay were 13.2±6.2 hours and 2.9±2.2 days, respectively. One patient died of disseminated intravascular coagulation and prosthesis thrombosis 3 days after the operation, fearing anticoagulant-related hemorrhage. The overall success rate of valve repair during 1-year follow-up was 97.9%. The totally thoracoscopic procedure on mitral valves by an experienced surgeon is technically feasible, safe, effective and worthy of widespread adoption in clinical practice.

Martius Graft Repair of Vesico-Vaginal Fistula: Experience at A Tertiary Care Center in Bangladesh

Background: Vesico-Vaginal Fistula (VVF) is a pathology with severe social repercussions. Resolution of VVF can be achieved through multiple surgical, abdominal or vaginal techniques, which will generally depend on the fistula's characteristics and the surgeon's experience. In this study we describe our experience with vaginal approach to treat VVF using Martius graft repair.&#x0D; Materials and methods: This prospective observational study included 50 VVF patients operated in the fistula center of Chittagong Medical College Hospital, during the period of January 2013 to December 2014. The success rate and complications of Martius graft repair of VVF.&#x0D; Results: The leading age group was 26 to 35 years (50.0%) and age range from 16 to 60 years with a mean age of 32.1 (±SD 8.10) years. The majority (72.0%) was from low socioeconomic class and had short stature (64.0%).48% fistula was midvaginal, 28% was juxtracervical and 54% was &lt;2 cm in size and 40% were associated with vaginal stenosis and urethral avulsion. In 36% cases postoperative complication were developed. 82% patients were fully cured, 6% cured with urethral incontinence, 2% cured with vaginal stenosis and in 10% cases surgery was failed.&#x0D; Conclusions: The vaginal technique for the treatment of VVF reinforced by Martius graft is safe and effective with low rate of complications.&#x0D; JCMCTA 2021 ; 32 (2) : 85-89

Effect of deprivation and ethnicity on primary macula-on retinal detachment repair success rate and clinical outcomes: A study of 568 patients.

PurposeSocio-economic deprivation and ethnic variation have been frequently linked to poorer health outcomes. We collected a large series of primary macula-on rhegmatogenous retinal detachment (RRD) cases and analysed the effect of socio-economic deprivation and ethnicity on both six-month retinal re-detachment rate and visual outcomes.Materials and methodsRetrospective consecutive case series of 568 patients attending Birmingham and Midlands Eye Centre from January 2017–2020. Multiple Indices of Deprivation (IMD) deciles were used for deprivation status and split to two groups: IMD-A (Decile 1–5) and IMD-B (Decile 6–10). The two largest subgroups of ethnicities were compared, White and South Asians (SA).ResultsWe report an overall retinal re-detachment rate of 8.5%. IMD-A re-detached significantly more than IMD-B (11.2% vs 6.0% respectively, p = 0.034). No statistical significance was found between White and SA re-detachment rate (9.1% and 5.6% respectively, p = 0.604). SA median age significantly lower at 49 years (IQR: 37–61) compared to White patients at 57 years (IQR: 50–65) (p = <0.001). IMD-A median age of 55 years (IQR: 46–64) was significantly lower to IMD-B median age of 58 years (IQR: 51–65) (p = 0.011). No differences in final visual outcomes were detected across all groups.ConclusionWe demonstrated an increased retinal re-detachment rate in our more deprived patients according to IMD and a younger cohort of SA compared to White ethnicity. Further prospective studies are required to demonstrate the link between socio-economic deprivation and surgical success.

Frequency of Success in Surgery of Vesicovaginal Fistula by Layered Closure with Graft Repair

Introduction: Vesicovaginal fistulae is abnormal communication between bladder and vagina that cause continous dribling of urine. It is physically, mentally and socially distressing condition. There are various approaches for surgeries of these urogenital fistulae with different success-rate that depend upon the experience of surgeon and surgical procedures. This study can help us to estimate the success rate of layered repair with graft in vaginal route to make stragedy to adopted in severe patient. Objective: To determine frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures among patients admitted in Isra University. Setting: Obstetrics &amp; Gynecology department in Isra university hospital Duration: 6 months from 10.2.2014 to 10.8.2014 Study Design: Case series Subject and methods: A total of 100 patients after having surgery for vesicovaginal fistula by layered closure with graft repair was included in this study. History and examination of all subjects were taken. The follow up visit was planned after 3 weeks of surgery. All women was questioned for recurrence of continuous urinary leakage and that without such symptoms proved by absence of leakage on methylene blue dye test was labeled as ‘success’. Results: - Frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures was observed in 88% cases. Conclusion: The success rate of VVF repair by layered closured with graft repair procedures is high. It is concluded that obstetric urogenital fistula is a preventable condition. Keywords: Vesicovaginal fistulae, Layered closured, Graft repair, urogenital fistula

Rectourethral Fistula Induced by Localised Prostate Cancer Treatment: Surgical and Functional Outcomes of Transperineal Repair with Gracilis Muscle Flap Interposition

BackgroundTransperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects. ObjectiveTo assess surgical and functional outcomes of this treatment of RUF. Design, setting, and participantsA retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020. Surgical procedureThe standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures. MeasurementsFistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark’s score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality. Results and limitationsThe median (interquartile range) follow-up was 27 (8–47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark’s score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations. ConclusionsThe present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate. Patient summaryWe performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes.

DeGIR Quality Report 2019: Report on the treatment quality of minimally invasive methods – Interventional therapy (EVAR) of abdominal aortic aneurysms

To analyze the quality of endovascular aortic aneurysm repair using the data of the DeGIR quality management system. Comparison of data between 2011 and 2019. A retrospective analysis of all data registered in the DeGIR quality management system of the year 2019 was performed regarding the treatment quality for endovascular aortic aneurysm repair. Registration of data was voluntary. As quality parameters indication, treatment process data and quality of results were examined. The latter was judged by treatment success, complication rates and radiation exposure. Out of 189 590 data sets overall 1639 cases of EVAR were registered; compared to 2011 this was an increase of 472 cases. 5.9 % of these cases encompassed emergency treatments. The most frequent indication was an abdominal aneurysm with 72 % of cases. In 54 % of cases, the aortic diameter ranged 50-70 mm. The rates for technical success, over all complications and major complications were 92.8 %, 6.7 % and 6.0 % respectively for all EVAR including emergency indications. In general, EVAR yielded a mortality rate of 1.2 % while emergency procedures had a mortality rate of 7.3 %. Median dose area product and fluoroscopy time were 10 503 cGy × cm2 and 20 minutes respectively at a mean procedure time of 114 minutes. Data analysis of the DeGIR quality management system persistently showed a very high technical success rate for endovascular aortic aneurysm repair performed by interventional radiologists accompanied by a low complication rate. · The voluntary DeGIR quality assurance-system has reached high acceptance among interventional radiologists.. · The database has nearly 200 000 submissions on record for 2019.. · EVAR by interventional radiologists has shown very high technical success as well as a low complication rate.. · Frenzel F, Bücker A, Paprottka P et al. DeGIR Quality Report 2019: Report on the treatment quality of minimally invasive methods - Interventional therapy (EVAR) of abdominal aortic aneurysms. Fortschr Röntgenstr 2022; 194: 49 - 61.

Endoscopic endonasal cerebrospinal fluid rhinorrhea repair: a cohort study in Iraq

BackgroundCerebrospinal fluid (CSF) rhinorrhea is a condition where the protective fluid that surrounds the brain finds its way into the nose and sinuses, often appearing as a very watery runny nose. The main surgical approaches for the surgical repair of CSF leaks are intracranial and extracranial. Over the last decade, endoscopic surgery has established itself as the most widely used technique for the repair of CSF fistula. The current study aimed to describe the use of nasal endoscopic technique in the management of cerebrospinal fluid rhinorrhea repair.ResultsResults of our study showed that in addition to CSF leak, 40% of the patients had headache and 17.5% had repeated meningitis. Half of the etiologies for the CSF leak were spontaneous, 35% were congenital, and 15% were traumatic. The more frequent site of leak was left cribriform plate (37.5%). In the majority of patients, 37/40 (92.5%), the type of graft was tensor fascia lata and fat, while in the remaining 3 patients, type of graft was tensor fascia lata and bone, bone and fat, and tensor fascia lata. The repair succeeded in 35 patients giving a success rate of 87.5%.ConclusionIt can be concluded that wide range of age groups from 2–62 years presented as CSF rhinorrhea with female predominance, and there was high success rate of endoscopic CSF rhinorrhea repair with low morbidity.