Successful Surgical Repair Research Articles

Oropharyngeal stenosis: A rare complication following adenotonsillectomy

Oropharyngeal stenosis (OPS) is a narrowing of the oropharynx as a result of adhesions from the base of tongue to the anterior tonsillar pillars and inferior tonsillar fossa [1]. OPS is a rare complication of oropharyngeal surgery and can cause dysphagia, sleep disordered breathing, velopharyngeal incompetence due to tethering of the soft palate, and dyspnea. Whereas OPS occurred historically following oropharyngeal infection, the advent of antibiotic treatment for common infectious agents in the early 20th century has made OPS an extremely rare condition [1,2]. OPS has been associated with multilevel, single-stage upper airway surgery involving lingual tonsillectomy and in conjunction with nasopharyngeal stenosis [2]. OPS is mentioned historically anecdotally after simple adenotonsillectomy but to our knowledge this is the first case report of a patient who developed OPS following routine adenotonsillectomywith no other risk factors. She underwent successful surgical repair which included scar division and palatal scar lengthening with local advancement flap. This

Developing a Simple Proof of Concept Clinical Decision-Making Tool for Predicting Surgical Outcomes after Obstetric Fistula Repair in a Developing Country

Introduction: Obstetric fistula is a serious injury resulting from obstructed labor causing significant maternal morbidity in women in developing countries. In order to maximize probability of successful surgical repair, it is important to identify women at-risk for poor surgical outcomes so that they can be given appropriate care. The goal of this study is to explore additional factors associated with fistula repair outcomes, as well as determine whether statistical modeling can be used to create a clinical decision-making tool for predicting a successful repair. Methods: Medical records for 82 patients surgically treated for obstetric fistula in Benin were retrospectively reviewed to collect demographic and clinical information related to their condition and procedure. Individuals were grouped into 3 main outcomes: successful closure with continence, successful closure with residual incontinence, and failed repair. A backwards stepwise selection methodology and logistic regression were used to select factors and examine their associations with the surgical outcomes. Structural equation modelling was used to develop a prediction tool for successful repair. Results: Location of fistula (vesicovaginal, vesicouterine, ureteroalvaginal, ureterouterine, and rectovaginal) (OR=7.6 (2.39, 24.36)), being married (OR=3.45 (1.09, 10.90)), parity of 1 to 3 (OR=2.99 (0.94, 9.49)), duration of fistula less than 10 years (OR=2.07 (0.88, 8.25)), and no previous repair attempt (OR=2.40 (0.79, 7.25)) were found to favor a successful closure with continence. We developed a prediction tool to sort women with obstetric fistula into 5 different categories based on probability of success. Our model suggests that marital status affects successful repair through a mediating factor not yet identified. Conclusion: This study classified fistulous women into clinically relevant categories based on the probability of a successful repair. The results from the present study may inspire further research on identifying fistulas with poor prospect of success, which might benefit from more specialized care.

A Successful Surgical Repair of Left Carotid Artery and Jugular Vein Injuries after Penetrating Neck Trauma

A Successful Surgical Repair of Left Carotid Artery and Jugular Vein Injuries after Penetrating Neck Trauma

Synthetic surgical meshes used in abdominal wall surgery: Part II-Biomechanical aspects.

This work reports the second part of a review on synthetic surgical meshes used for abdominal hernia repair. While material and structural characteristics, together with mesh-tissue interaction, were considered in a previous article (Part I), biomechanical behavior is described here in more detail. The role of the prosthesis is to strengthen the impaired abdominal wall, mimicking autologous tissue without reducing its compliance. Consequently, mesh mechanical properties play a crucial role in a successful surgical repair. The main available techniques for mechanical testing, such as uniaxial and biaxial tensile testing, ball burst, suture retention strength, and tear resistance testing, are described in depth. Among these methods, the biaxial tensile test is the one that can more faithfully reproduce the physiological loading condition. An outline of the most significant results documented in the literature is reported, showing the variety of data on mesh mechanical properties. Synthetic surgical meshes generally follow a non-linear stress-strain behavior, with mechanical characteristics dependant on test direction due to mesh anisotropy. Ex-vivo tests revealed an increased stiffness in mesh explants due to the gradual ingrowth of the host tissue after implant. In general, the absence of standardization in test methods and terminology makes it difficult to compare results from different studies. Numerical models of the abdominal wall interacting with surgical meshes were also discussed representing a potential tool for the selection of suitable prostheses. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 892-903, 2017.

A comparison of quality of life before and after successful repair of genitourinary fistula: Is there improvement across all the domains of WHOQOL-BREF questionnaire?

ObjectiveTo compare preoperative quality of life (QoL) scores using World Health Organization WHOQOL-BREF quality of life assessment with postoperative QoL scores following successful repair of genitourinary fistula. Patients and methodsThe WHOQOL-BREF questionnaire was used as a tool to evaluate the quality of life before and after surgical repair. All patients, who underwent genitourinary fistula repair between January 2011 and December 2013 were included. Women with complaints of continuous leakage of urine per vagina following obstetric or gynaecological procedures were included in this study. Women with rectovaginal fistula, malignant fistula or radiation induced fistula were excluded from this study. Patients with co-morbidities affecting QoL and those who did not give consent to participate were excluded. Patients whose questionnaire was incomplete were also excluded. ResultsOf the 106 women admitted for treatment of genitourinary fistula during the time period; 101 were included. The preoperative score of physical, psychological, social and environmental health domains were 15.04±2.56, 16.42±4.4, 51.75±11.91 and 34.81±6.89 respectively. The postoperative scores in physical, psychological, social and environmental health domains were 83.61±5.09, 75.79±6.33, 76.17±8.53 and 33.88±6.13 respectively. On comparison between the preoperative and postoperative QoL scores; there was significant improvement in physical, psychological and social health domains in the postoperative period (p<0.01) but the environmental health domain scores remained static. ConclusionThere is marked improvement in the overall quality of life, especially the physical, psychological and social health domains of WHOQOL-BREF questionnaire after successful surgical repair of genitourinary fistula. The environmental health domain remained unchanged even after successful repair.

Percutaneous repair of acquired Gerbode defect complicated by hemolysis and acute kidney injury

The past decade marks a new era of percutaneous intervention for structural heart disease. Left ventricular (LV) to right atrial (RA) shunts – also known as Gerbode defects – are uncommon cardiac lesions described by Gerbode et al. as either a deficiency in the atrioventricular membranous septum, or shunting initially through a ventricular septal defect (VSD) with atrial shunting through a deficiency of the tricuspid valve [ [1] Gerbode F. Hultgren H. Melrose D. Osborn J. Syndrome of left ventricular–right atrial shunt: successful surgical repair of defect in five cases, with observation of bradycardia on closure. Ann. Surg. 1958; 148: 433 Crossref PubMed Scopus (185) Google Scholar ]. Despite good evidence supporting safety and efficacy of percutaneous ASD and VSD closure in adults [ [6] Warnes C.A. Williams R.G. Bashore T.M. Child J.S. Connolly H.M. Dearani J.A. et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J. Am. Coll. Cardiol. 2008; 52: e143-e263 Abstract Full Text Full Text PDF PubMed Scopus (538) Google Scholar ] and increasing experience in percutaneous closure of Gerbode defects, there remains a paucity of evidence to guide patient selection for percutaneous closure of this condition with most clinicians using past experience and anatomical considerations (e.g. how close to the aortic valve the defect is) to predict likelihood of success. Aside from anatomical factors, there are no current data to guide cases with higher percutaneous closure success. We report a case of an acquired Gerbode defect where percutaneous closure was complicated by severe hemolytic anemia and acute kidney injury (AKI) that ultimately required definitive surgical closure. We believe that this case highlights some of the potential (though not frequently reported) risks when adopting a percutaneous strategy in such cases.

Partial Anomalous Pulmonary Venous Return With Persistent Angina: Simulating Coronary Artery Disease

Partial anomalous pulmonary venous return (PAPVR) is an uncommon adult congenital heart disease caused by an abnormal return of one or more, but not all, of the pulmonary veins to the right atrium or indirectly through venous connections from the anomalous pulmonary vein. Presentations vary from incidental findings to severe heart failure and diagnosis could easily be missed. We report a case of PAPVR in a 51-year-old male with a history of coronary artery bypass surgery presenting with exertional dyspnea and chest discomfort which were initially interpreted as angina in light of patient’s known coronary disease and prior revascularization. Patient underwent surgical repair with redirection of the pulmonary connection to the left atrium. On follow-up, patient had symptomatic improvement and decrease in pulmonary artery pressures. Diagnosis of PAPVR may be particularly elusive when patient also has a more common diagnosis, such as coronary disease. Unexplained pulmonary hypertension should alert physicians to consider additional differential diagnoses including congenital heart disease despite the patient’s adult age. As evidenced in this patient, successful surgical repair can lead to gratifying results and improved prognosis. J Med Cases. 2015;6(11):485-487 doi: http://dx.doi.org/10.14740/jmc2309w

Fixation of a complete scapular neck fracture in a foal using two 3.5 mm locking compression plates

SummaryThis report describes the successful surgical repair of a transverse, displaced scapula fracture in a foal. A 3.5 mm locking compression plate (LCP) was used on either side of the spine of the scapula. The suprascapular nerve was apparent upon dissection as it passed directly over the fracture line and care was taken to leave it intact, although the fracture line itself caused some irritation. The foal recovered without long‐term nerve damage and is sound at 1.5 years post surgery.

Laryngeal clefts

Laryngeal clefts

Successful Surgical Repair of Aged Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connection: A Case Report

Successful Surgical Repair of Aged Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connection: A Case Report

58. Double coronary balloon angioplasty of the aorta in an infant

We are reporting the first case of double coronary balloon usage in infants. A 10 weeks old male infant underwent successful surgical repair for severe coarctation of the aorta at the age of 14 days with end to end anastamosis. Later on, developed significant symptomatic recoarctation. During cardiac catheterization, the narrowed segment appeared long. He did not respond to a pliable low pressure balloon dilatation. Because of the weight of the infant (4.0 kg) and to avoid vascular injury we elected to use 2 high pressure coronary balloons through one 4F sheath. The procedure was successful with drop in pressure gradient from 30 mmHg to 3 mmHg, and significant angiographic improvement. Nine months post procedure there was no recoarctation and the infant is stable, asymptomatic and thriving well. Conclusion: high pressure coronary balloons can be used safely and effectively in small infants to avoid the use of larger introducers and hence avoid arterial vascular injury.

Pseudoaneurysm and aorto-bronchial fistula following balloon dilation of recoarctation

This case report documents the successful surgical repair of an aorto-bronchial fistula and a giant aortic pseudoaneurysm at the proximal anastomosis of a dacron interposition tube graft that was balloon dilated for recurrent coarctation. Balloon dilation for recoarctation of a dacron interposition tube graft may lead to serious complications.

Uretero-Uterine Fistula

Primary cyclic hematuria occurring with the onset of menstruation can be a presenting symptom of a fistula between the Mullerian structures (uterus/cervix/upper vagina) and the urinary tract. When occurring, these fistulas are most often vesicovaginal connections caused by congenital Mullerian anomalies. We present a case of a fistula occurring between a bicornuate uterus and the ureteral stump that had been ligated at the time of ureteral reimplantation during childhood. The presenting symptom was cyclic hematuria beginning at the age of 14 years with the onset of menarche. Cystoscopy and retrograde pyelogram showed a fistula connecting the ureteral stump (which had been ligated at the time of ureteral reimplantation) to the small horn of the bicornuate uterus. Computed tomographic scan showed bilateral single orthotopic kidneys and collecting systems. The patient underwent successful transvaginal and transvesical surgical repair of the fistula, with complete resolution of her cyclic hematuria. We review genitourinary embryology in discussion of this unusual case.

A fatal complication after repair of post-infarction ventricular septal rupture: heparin-induced thrombocytopenia with thrombosis: case report

Heparin-induced thrombocytopenia (HIT) is a rare but potentially devastating and life-threatening complication from using heparin. HIT not only causes thrombocytopenia, but it also carries an increased risk for fatal thrombotic complications. In this report, we describe the case of a patient in whom fatal HIT developed after successful surgical repair of a posterior post-infarction ventricular septal rupture with cardiopulmonary bypass.

Stenting of Native Right Ventricular Outflow Tract Obstructions in Symptomatic Infants.

To assess feasibility, safety and effectiveness of right ventricular outflow tract (RVOT) stenting in symptomatic young infants. Multicentre evaluation of 35 patients intended to undergo RVOT stenting in 11 pediatric cardiac centres from 2009 to August 2011. Median age and weight at the time of first stent implantation were 8 weeks and 3.3 kg, with 40% of patients <3 kg. A total of 19 patients had suffered from hypoxemic spells, 8 patients were ventilated, 6 on inotropic support and 5 on prostaglandin infusion. Severe concomitant malformations were present in 11 patients, and acute infections in 2. Stenting of the RVOT was successfully performed in 33 patients, improving oxygen saturation from a median of 77 to 90% 2 days after intervention. Besides the 2 patients in whom RVOT stenting was not successful for technical reasons, there were no procedural complications. In 17 of 33 patients, 1-3 reinterventions were performed during follow-up, less than half of those were reinterventions in the RVOT. A total of 27 patients have undergone successful surgical repair 4-162 (median 19.5) weeks after initial RVOT stent implantation, 2 patients are still waiting. There were no perioperative deaths. Stenting of the RVOT provides a safe and effective management strategy for initial palliation in symptomatic young infants, including those patients not suitable or at higher risk for surgical therapy.

Healthcare providers’ perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo

ObjectiveTo understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. MethodsIn a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. ResultsOverall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients’ ability to lead a normal life by all providers. Family acceptance—especially from the husband—was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. ConclusionProviders view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair.

Multislice computed tomography and X-ray correlation of the classical secondary vascular adaptive features associated with aortic coarctation

Coarctation of the aorta is a discrete narrowing of the vessel which most commonly presents juxtaductal, distal to origin of the left subclavian artery. Its etiology is generally congenital and the resulting pressure overload can result in several adaptive vascular features. Here we present a case of a Hispanic male patient who presented with a subarachnoid hemorrhage due to malignant hypertension which was the result of a long standing undiagnosed coarctation. Due to the long standing nature of this patients congenital defect he had a striking example of many of the vascular adaptations associated with coarctation. Ultimately, a successful open surgical repair was undertaken which restored normal perfusion to the lower extremities and normalized upper extremity blood pressure.

Health-related quality of life among women in rural Bangladesh after surgical repair of obstetric fistula

ObjectiveTo identify factors influencing health-related quality of life (QOL) among women in Bangladesh after successful surgical repair of obstetric fistula. MethodsIn 2012, a cross-sectional study was conducted of women who had undergone a successful surgical repair of an obstetric fistula at a hospital in northwest Bangladesh between June 2005 and May 2012. Sociodemographic, obstetric, and fistula-related information was collected by interview. Health-related QOL was assessed using the 36-item Short Form Health Survey (SF-36). ResultsA total of 113 women were included. Linear regression analysis showed that discrimination experiences negatively affected four of the eight scales of SF-36, as well as both the physical and mental component summaries (P<0.05 for all). Married status had a positive effect on four scales and the mental component summary (P<0.05 for all). Age inversely affected two scales and the physical component summary (P<0.01 for all). Internalized stigma negatively influenced two scales (P<0.05 for both). Not having living children and experiencing two or more previous stillbirths negatively influenced one scale (P<0.05 for both). ConclusionSeveral factors influence health-related QOL after obstetric fistula repair; a comprehensive approach is needed to address these issues.

Inadvertent vascular injury of the aorta or vena cava caused by acupuncture.

Major visceral vascular injury after acupuncture is a rare but serious complication. We recently treated two patients with an inferior vena cava or an abdominal aorta injury caused by acupuncture. Although both patients underwent successful surgical repair, the highly invasive nature of the operations led to complications, including infection and chyle leakage. Vascular surgeons should be aware that acupuncture can cause serious damage to the vena cava or aorta due to direct injury or subsequent infection.

Contraceptive practice after surgical repair of obstetric fistula in southeast Nigeria

ObjectiveTo determine the contraceptive practices of women after surgical repair of obstetric fistula and to assess determinants of uptake and the pregnancy rate in the first year. MethodsA prospective cohort study enrolled women who had a successful surgical repair of obstetric fistula at a center in Nigeria between 2011 and 2013. Patients were followed up for 1year. Data were obtained through record review and completion of a semi-structured questionnaire. ResultsAmong 188 participants, 180 (95.7%) were aware of contraception, but only 70 (37.2%) used contraceptive methods after surgery. The most commonly used methods were the male condom (50 [71.4%] of 70) and hormonal injections (14 [20.0%]). The main reasons for non-use were fear of adverse effects (48 [40.7%] of 118 women), future desire for more children (35 [29.7%]), religious prohibition (26 [22.0%]), cultural beliefs (29 [24.6%]), and partner disapproval (42 [35.6%]). The risk of unplanned pregnancy in the first year was significantly lower among women who used contraceptives than among those who did not (relative risk 0.14, 95% confidence interval 0.02–1.06; P=0.03). ConclusionContraceptive uptake for birth control after fistula repair surgery was low because of socioeconomic reasons, religious and cultural beliefs, and myths, resulting in unplanned pregnancies.