Surgeon Preference Research Articles

Outcome of Olecranon Fracture Treated with Tension Band Wiring Versus Anatomical Locking Plate Fixation

Aim: Up to 10% of all upper limb fractures involve the olecranon, and this type of fracture is the most common osseous injury of the elbow joint. These show a bimodal distribution occurring in younger patients due to high-energy trauma and in elderly cohorts with low bone quality after low-energy falls. Objective: To compare functional outcome of tension band wiring versus anatomical locking plate fixation for reduction of olecranon fracture Materials and Methods: This randomized controlled trial study was conducted in the Department of Orthopedic, Lady Reading Hospital, Medical Teaching Institute Peshawar from December 2022 to June 2023. Non-probability consecutive sampling technique was used in this study. Sample size was calculated using WHO calculator keeping 95% confidence interval 80 % power of study, 10% absolute precision, mean Mayo elbow score was 84.0±9.3 in the TBW group and 88.3±9.1 in the locking plate fixation group (4). Expected sample size is 32 patients in each group, total 72 patients. Patients of both genders have age range from 20 to 70 year with Mayo type 2A olecranon fractures, more than 2 mm of joint displacement determined on X-ray elbow, and elbow extension loss determined on physical examination presented within 7 days of the injury were included in the study while Patients with open fracture and revision surgery were excluded from the study. Results: In this study age distribution among 72 patients was analyzed as n= 20-30 Years 17(27.4%) 31-40 Years 14(22.6%) 41-50.Years 11(17.7%) 51-70 Years 20(32.3%). Mean age was 47.1 Years with SD ± 2.87. Gender wise Distribution among 72 Patients was analyzed as Male were 31(50.0%) and female were 31(50.0%). Distribution of duration of disease among 72 patients were analysed as n= 1-2 weeks were 47(75.8%) and 3-4 weeks were 15(24.2%) Practical Implication: There are no established guidelines for the treatment of olecranon fracture in our institution. Most olecranon fractures are treated according to surgeon preferences and surgical experience of the surgeon. Previous studies showed variables results with no consensus. We will provide rationale basis for universal use of standard treatment of olecranon fracture. Conclusion: Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group. Keywords: Anatomical locking plate; complications; eyelet wire; olecranon fracture; tension band wiring.

Clinical outcomes of minimally invasive (laparoscopic and robotic) versus open extended cholecystectomy: A multicenter propensity score matched study.

This multicenter study aimed to compare the clinical outcomes of minimally invasive extended cholecystectomy (MI-EC) versus open EC (O-EC) for patients with gallbladder cancer (GBC). Patients who underwent EC (cholecystectomy, wedge resection of the liver bed, and regional lymphadenectomy) for GBC between 2010 and 2020 in three centers were included in the study. The clinicopathological data were compared after propensity score matching. Additional subgroup analysis on laparoscopic and robotic EC (L-EC and R-EC) was performed. A total of 377 patients were included: 308 for O-EC and 69 for MI-EC, respectively. The MI-EC group had a longer operative time (188.9 vs. 238.1 min, p < .001) and shorter hospital stay (9.0 vs. 7.2 days, p = .007), although no differences were found in operative blood loss, complication rate and survival outcome. In subgroup analysis, L-EC patients had a longer operative time (264.4 vs. 202.0 min, p = .001), compared to R-EC patients with comparable perioperative and survival outcomes. Although patients with MI-EC had a longer operation time and higher medical costs, the advantages were enhanced recovery with comparable short- and long-term outcomes. The operation time was less for R-EC patients than for L-EC patients, though the high cost still remains. The surgery type for EC can be selected according to the patient's condition, social status and surgeon's preference.

Optimization of intraoperative lumpectomy specimen labeling

BackgroundAccurate lumpectomy specimen orientation is critical as incorrect orientation may result in excision of the wrong lumpectomy margin. Our goal was to determine if specimen orientation achieved by labeling three surfaces is superior to two. MethodsThis was a prospective single-institution study including 22 breast surgical oncologists. Intraoperative labeling of either two or three surfaces of the lumpectomy specimen was based on surgeon preference. The specimen was delivered to Pathology where it was oriented by the pathology team and the surgeon then determined if the specimen was correctly oriented or if re-orientation was required. Surgeons subsequently recorded orientation technique and if re-orientation was required. Specimen weight, patient age, and BMI were recorded. Fisher’s exact test and two-sample Wilcoxon rank-sum test were used to determine p-values. ResultsOf 268 specimens, 40 (14.9%) required re-orientation. Labeling specimens on three surfaces was superior to two (22 of 195 (11.2%) versus 18 of 73 (24.6%), p = 0.01). Specimens requiring re-orientation were more likely to be heavier (36 g vs. 24 g, p = 0.02). In multivariable analysis, labeling specimens on three surfaces resulted in a 70% reduction in discordance rates between the surgeon and pathology team (OR 0.3, p = 0.001). Using mean weight of lumpectomy specimens, specimens >33 g were more likely to require reorientation (OR 2.8, p = 0.004). Age and BMI did not impact the need for re-orientation. ConclusionLumpectomy specimen labeling using three surfaces was superior to two. Surgeons should routinely orient their specimens on three or more surfaces to decrease discordance rates.

Single port robot-assisted pyeloplasty: An early comparative outcomes analysis.

The treatment paradigm for ureteropelvic junction obstruction (UPJO) has shifted towards minimally invasive pyeloplasty. A comparison Single Port (SP) and Multi Port (MP) robot-assisted pyeloplasty (RAP) was performed. Data from consecutive patients undergoing SP RAP or MP RAP between January 2021 and September 2023 were collected and analysed. Co-primary outcomes were length of stay (LOS), Defense and Veterans Pain Rating Scale (DVPRS), and narcotic dose. The choice of the robotic system depended on the surgeon's preference and availability of a specific robotic platform. A total of 10 SP RAPs and 12 MP RAPs were identified. SP RAP patients were significantly younger [23years (20-34)] than MP RAP [42years (35.5-47.5), p<0.01]. No difference in terms of OT (p=0.6), LOS (p=0.1), DVPRS (p=0.2) and narcotic dose (p=0.1) between the two groups was observed. SP RAP can be implemented without compromising surgical outcomes and potentially offering some clinical advantages.

Tripod Fixation of Periacetabular Metastatic Lesions Using the IlluminOss Device.

Percutaneous tripod fixation of periacetabular lesions is performed at our institution for patients with metastatic bone disease and a need for quick return to systemic therapy. We have begun to use the IlluminOss Photodynamic Bone Stabilization System instead of the metal implants previously described in the literature because of the success of the IlluminOss implant in fixing fragility fractures about the pelvis. At our institution, the procedure is performed in the interventional radiology suite in order to allow for the use of 3D radiographic imaging and vector guidance systems. The patient is positioned prone for the transcolumnar PSIS-to-AIIS implant and posterior column/ischial tuberosity implant or supine for the anterior column/superior pubic ramus implant. Following a small incision, a Jamshidi needle with a trocar is utilized to enter the bone at the chosen start point. A hand drill is utilized to advance the Jamshidi needle according to the planned vector; alternatively, a curved or straight awl can be utilized. The 1.2-mm guidewire is placed and reamed. We place both the transcolumnar and posterior column wires at the same time to ensure that there is no interference. The balloon catheter for the IlluminOss is assembled on the back table and inserted according to the implant technique guide. The balloon is inflated and observed on radiographs in order to ensure that the cavity is filled. Monomer is then cured, and the patient is flipped for the subsequent implant. Following placement of the 3 IlluminOss devices, adjunct treatments such as cement acetabuloplasty or cryoablation can be performed. Alternative treatments include traditional open fixation of impending or nondisplaced acetabular fractures in the operating room, or percutaneous implant placement in the operating room. Implant placement may be performed with the patient in the supine, lateral, or prone position, depending on surgeon preference. Alternative implants include standard metal implants such as plates and screws, or cement augmentation either alone or with percutaneous screws. Finally, ablation alone may be an alternative option, depending on tumor histology. Open treatment of acetabular fractures is a more morbid procedure, given the larger incision, increased blood loss, longer time under anesthesia, and increased length of recovery. Percutaneous fixation may be performed in either the operating room or interventional radiology suite, depending on the specific equipment setup at an individual institution. At our institution, we prefer utilizing the interventional radiology suite as it allows for more precise implant placement through the use of an image-based vector guidance system and 3D fluoroscopy to accurately identify safe corridors. The use of percutaneous fixation allows for faster recovery and earlier return to systemic therapy. Because the IlluminOss implant is radiolucent, it allows for better evaluation of disease progression and can better accommodate nonlinear corridors or fill a lytic lesion to provide stability. Postoperatively, we expect the patient to be weight-bearing as tolerated with use of an assistive device. We expect the small incisions to fully heal within 2 weeks. Patients should be able to return to systemic therapy as indicated earlier than with an open procedure. The use of a hand drill with the Jamshidi needle and trocar can help adjust a drilled pathway and allow for close adherence to a planned vector.Vector guidance systems can be useful to fully capture the area at risk for fracture and to provide maximal stability with the expandable implant, but they are not necessary to perform the procedure.Placing both posterior implants at the same time can be helpful to avoid interference. This is accomplished by drilling and placing the guidewire for both implants prior to reaming and placing the balloon implant. CT = Computed tomographyPSIS = posterior superior iliac spineAIIS = anterior inferior iliac spine.

Choice of Surgeons in Retractors used in Cleft Lip and Palate Surgery: An Original Research.

To ensure optimal exposure and enable precise tissue manipulation, cleft lip and palate abnormalities require surgical repair utilizing retractors. Different retractors may affect surgical outcomes; however, this is not yet evident. Examining surgeon preferences for retractors in cleft lip and palate surgery and assessing their impact on patient outcomes were the goals of this study. The patients who underwent primary cleft lip and palate repair were retrospectively analyzed. This study evaluated three widely used retractors: the Langenbeck, Gelpi, and Moult Mouth Gag retractors. This study looked at demographic information, surgical results (including scarring, aesthetic outcomes, and wound healing issues), and surgeon preferences for retractors. The study identified differences in surgical outcomes related to various retractor types. Both Group A (Langenbeck retractor) and Group B (Gelpi retractor) demonstrated similar favorable results, such as little wound healing issues, less scarring, and pleasing cosmetic results. The wound healing issues, scarring, and cosmetic outcomes were all worse in Group C (Moult Mouth Gag retractor). Retractors were not always preferred by surgeons doing cleft lip and palate surgery. The type of retractor had an impact on the surgical results; the Moult Mouth Gag retractor performed less well than the Langenbeck and Gelpi retractors. These results highlight the value of using evidence-based criteria to select retractors more effectively and enhance surgical methods for better patient outcomes in cleft lip and palate repair.

Rib resection versus rib division in two-stage oesophagectomies: a retrospective cohort study

Background: Rib resection (removal of a portion of one rib) and rib division are different approaches used to gain exposure and access to the thoracic cavity in the two-stage oesophagectomy. The analgesic requirement, respiratory complications and physiotherapy and rehabilitation requirements of rib resection and rib division in two-stage oesophagectomy procedures for oesophageal carcinoma were compared. Methods: Patients who underwent two-stage oesophagectomy between 2017 and 2022 were retrospectively identified. The patients were analysed in a rib resection group (n=14) and a rib division group (n=14) with regards to patient demographics, engagement with the institution’s acute pain service, analgesic requirement, incidence of pneumonia, physiotherapy and rehabilitation requirements. Results: The overall amount of opioid analgesia used was greater in the rib division group compared to the rib resection group (674.6 versus 528.0 mg, p=0.3799). There were no significant differences in the incidence of pneumonia between the two groups (n=4 versus 1, p=0.3259). There was a trend towards longer ventilation times (0.643 versus 0.357 days, p=0.3333), increased physiotherapy (9.93 versus 9.71 days, p=0.4700), rehabilitation requirements (n=0 versus 2, p=0.1422) within the rib division compared to the rib resection group. Conclusions: The differences in outcomes between the rib resection and rib division groups are not statistically significant and have been shown to be non-inferior in this dataset. The choice of approach should be based on individual patient factors and the surgeon's preference.

Pedicle Selection and Design in Reduction Mammaplasty: The Role of Preoperative Fluorescence Imaging.

Breast reduction has a wide selection of pedicles but often relies on the surgeon's preference and experience. Necrosis of the nipple-areola complex (NAC) is a catastrophic complication of breast reduction surgery. To solve the above problem objectively, we applied fluorescence imaging technology to the pedicle selection and design of breast reduction surgery for the first time, so that the dominant vessels of the NAC were included in the designed pedicle. We retrospectively enrolled 120 patients with breast reduction (a total of 239 breasts). We compared 60 patients who underwent breast reduction without fluorescence imaging for pedicle selection (Group A) with 60 patients who underwent pedicle selection with fluorescence imaging (Group B). The NAC blood supply was monitored after the operation. In this study, 60 Group A cases (119 breasts) and 60 Group B cases (120 breasts) were analyzed. There were no statistically significant differences in patient demographic data or intraoperative resection weights. There were 7 cases of NAC necrosis in Group A (1 case of complete necrosis and 6 cases of partial necrosis), while no NAC necrosis occurred in Group B. There was a significant difference in the rate of NAC necrosis between the 2 groups. Preoperative fluorescence imaging can guide the selection and design of breast reduction, significantly reducing postoperative NAC blood supply obstacles and necrosis.

Does plate position influence the outcome in midshaft clavicular fractures? A multicenter analysis

PurposeTo date, it remains unclear whether superior or anterior plating is the best option for treating midshaft clavicular fractures. The aim of this study was to compare both techniques with regard to the incidence of implant removal due to implant irritation, risk of complications, time to union, and function.MethodsIn this retrospective cohort study, all midshaft clavicular fractures treated operatively between 2017 and 2020 in two hospitals in Switzerland were analyzed. The participating hospitals differed with regard to their standard practice; one offered superior plating only, while the other predominantly employed an anterior plate. The primary outcome was the incidence of implant removal for irritation. Secondary outcomes were time to union, complications, re-interventions, and range of motion during the follow-up period of at least 6 months.ResultsIn total, 168 patients were included in the study of which 81 (48%) received anterior plating and 87 (52%) superior plating. The overall mean age was 45 years (SD 16). There was no significant difference between anterior and superior plating with regard to implant removal (58.5% versus 57.1%, p = 0.887), infection (5.7% versus 1.8%, p = 0.071), and time to union (median 48 weeks versus 52 weeks, p = 0.643). Data on range of motion were available in 71 patients. There was no significant difference in anteflexion (median 180 degrees anterior versus 180 degrees superior) and abduction (median 180 degrees anterior versus 180 degrees superior) between the two groups.ConclusionThis retrospective cohort study did not find sufficient evidence to recommend one implant position over the other for midshaft clavicular fractures with regard to removal due to irritation. Time to union was similar and Infections were equally rare in both groups. Notably, a considerable number of patients in both groups had their implants removed due to irritation. Larger prospective studies are needed to determine how much plate position contributes to the occurrence of irritation and whether other patient or implant-related factors might play a role. Until this is clarified, implant position should be based on surgeons preference and experience.

Management preferences of orthopedic surgeons in developmental dysplasia of the hip under 1 year of age in Türkiye: Results of a nationwide cross-sectional survey.

This study aimed to evaluate the diagnosis and treatment preferences of orthopedic surgeons in developmental dysplasia of the hip (DDH) cases under the age of 1 in Türkiye with a higher incidence of DDH, estimated to be around 5-15 per 1000 live births. This was a nationwide cross-sectional survey. A link for the online survey, including 16 multiple-choice questions, was sent to the email group of the National Orthopedic Society. Among 233 filled-out surveys, 211 met the inclusion criteria. Half of the participants had experience of <10 years as orthopedic surgeons, managed <25% of pediatric patients in daily practice, and treated <25 DDH cases per year before walking age. Ninety-seven percent used more than one method, hip ultrasound the most common, for exact diagnosis of DDH under 6 months. Pavlik harness was the most commonly preferred brace, but the use of Tübingen orthosis increased among experienced surgeons. The uppermost age limit for bracing was higher in surgeons dealing with more pediatric patients and treating more DDH cases. Dislocated hips and hips requiring closed/open reduction were more commonly referred to other surgeons by less experienced surgeons in terms of years, number of pediatric patients, and treated DDH cases per year. The lowest age limit for intervention under general anesthesia was lower in surgeons treating >25 DDH cases per year. Over one-third used both anterior and medial approach open reduction, but a trend to anterior open reduction alone was more evident in surgeons treating >50 DDH cases per year. More experienced surgeons were more prone to check the intraoperative reduction with postoperative computed tomography or magnetic resonance imaging. Diagnosis and treatment ages of DDH cases did not significantly change during the coronavirus disease 2019 pandemic. Management preferences of orthopedic surgeons in DDH before walking age primarily depend on the rate of pediatric patients in daily practice and the number of treated DDH cases per year.

Posterolateral or Direct Lateral Surgical Approach for Hemiarthroplasty After a Hip Fracture

Hip fractures in older adults are serious injuries that result in disability, higher rates of illness and death, and a substantial strain on health care resources. High-quality evidence to improve hip fracture care regarding the surgical approach of hemiarthroplasty is lacking. To compare 6-month outcomes of the posterolateral approach (PLA) and direct lateral approach (DLA) for hemiarthroplasty in patients with acute femoral neck fracture. This multicenter, randomized clinical trial (RCT) comparing DLA and PLA was performed alongside a natural experiment (NE) at 14 centers in the Netherlands. Patients aged 18 years or older with an acute femoral neck fracture were included, with or without dementia. Secondary surgery of the hip, pathological fractures, or patients with multitrauma were excluded. Recruitment took place between February 2018 and January 2022. Treatment allocation was random or pseudorandom based on geographical location and surgeon preference. Statistical analysis was performed from July 2022 to September 2022. Hemiarthroplasty using PLA or DLA. The primary outcome was health-related quality of life 6 months after surgery, quantified with the EuroQol Group 5-Dimension questionnaire (EQ-5D-5L). Secondary outcomes included dislocations, fear of falling and falls, activities of daily living, pain, and reoperations. To improve generalizability, a novel technique was used for data fusion of the RCT and NE. A total of 843 patients (542 [64.3%] female; mean [SD] age, 82.2 [7.5] years) participated, with 555 patients in the RCT (283 patients in the DLA group; 272 patients in the PLA group) and 288 patients in the NE (172 patients in the DLA group; 116 patients in the PLA group). In the RCT, mean EQ-5D-5L utility scores at 6 months were 0.50 (95% CI, 0.45-0.55) after DLA and 0.49 (95% CI, 0.44-0.54) after PLA, with 77% completeness. The between-group difference (-0.04 [95% CI, -0.11 to 0.04]) was not statistically significant nor clinically meaningful. Most secondary outcomes were comparable between groups, but PLA was associated with more dislocations than DLA (RCT: 15 of 272 patients [5.5%] in PLA vs 1 of 283 patients [0.4%] in DLA; NE: 6 of 113 patients [5.3%]) in PLA vs 2 of 175 patients [1.1%] in DLA). Data fusion resulted in an effect size of 0.00 (95% CI, -0.04 to 0.05) for the EQ-5D-5L and an odds ratio of 12.31 (95% CI, 2.77 to 54.70) for experiencing a dislocation after PLA. This combined RCT and NE found that among patients treated with a cemented hemiarthroplasty after an acute femoral neck fracture, PLA was not associated with a better quality of life than DLA. Rates of dislocation and reoperation were higher after PLA. Randomized and pseudorandomized data yielded similar outcomes, which suggests a strengthening of these findings. ClinicalTrials.gov Identifier: NCT04438226.

Factors influencing same-day discharge after minimally invasive hysterectomy for malignant and non-malignant gynecological diseases: a systematic review and meta-analysis.

To explore the factors influencing the successful implementation of same-day discharge in patients undergoing minimally invasive hysterectomy for malignant and non-malignant gynecological diseases. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and Clinical Trials.gov from inception to May 23, 2023. We included case-control and cohort studies published in English reporting same-day discharge factors in patients undergoing minimally invasive hysterectomy for malignant and non-malignant gynecological diseases. STATA 16.0 was used for the meta-analysis. Risk factors were assessed using odds ratios (OR) (relative risk (RR)/hazard ratios (HR)) with 95% confidence intervals (CI), and logistic regression determined the same-day discharge rate (%). We analyzed 29 studies with 218192 patients scheduled for or meeting same-day discharge criteria. The pooled rates were 50% (95% CI 0.46-0.55), and were similar for malignant and non-malignant gynecological diseases (48% and 47%, respectively). In terms of basic characteristics, an increase in age (OR: 1.03; 95% CI: 1.01-1.05), BMI (OR: 1.02; 95% CI: 1.01-1.03), and comorbidities including diabetes and lung disease were risk factors affecting SDD, while previous abdominal surgery history (OR: 1.54; 95% CI: 0.93-2.55) and hypertension (OR: 1.53; 95% CI: 0.80-2.93) appeared not to affect SDD. In terms of surgical characteristics, radical hysterectomy (OR: 3.46; 95% CI: 1.90-6.29), surgery starting after 14:00 (OR: 4.07; 95% CI: 1.36-12.17), longer surgical time (OR: 1.03; 95% CI: 1.01-1.06), intraoperative complications (OR: 4.68; 95% CI: 1.78-12.27), postoperative complications (OR: 3.97; 95% CI: 1.68-9.39), and surgeon preference (OR: 4.47; 95% CI: 2.08-9.60) were identified as risk factors. However, robotic surgery (OR: 0.44; 95% CI: 0.14-1.42) and intraoperative blood loss (OR: 1.16; 95% CI: 0.98-1.38) did not affect same-day discharge. An increase in age, body mass index, and distance to home; certain comorbidities (e.g., diabetes, lung disease), radical hysterectomy, surgery starting after 14:00, longer surgical time, operative complications, and surgeon preference were risk factors preventing same-day discharge. Same-day discharge rates were similar between malignant and non-malignant gynecological diseases. The surgery start time and body mass index have a greater impact on same-day discharge for malignant diseases than non-malignant diseases.

Does cryotherapy decrease the local recurrence rate in the treatment of an aneurysmal bone cyst? A comparative assessment.

Curettage with or without the use of adjuvants is the standard of care in the treatment of an aneurysmal bone cyst (ABC). Historically, our approach combined curettage, high-speed burr drilling, and cryoablation. However, treatments varied based on age, tumor location, and surgeon preference. We asked: (1) Does cryoablation in addition to curettage and burr drilling decrease the local recurrence rates? (2) Are there any risk factors for the local recurrence rate? (3) Does cryoablation improve postsurgical functional outcomes in these patients? Patients treated for an ABC, between January 2006 and December 2019 were included in this retrospective analysis. Patient and surgical characteristics, such as age, gender, tumor location, type of treatment, time of follow-up, recurrence rate, and functional outcome measured by the Musculoskeletal Tumor Society Score 1993 (MSTS93) score were compared between those treated with and without cryoablation. Both groups, without cryoablation (n = 88) and with cryoablation (n = 42), showed no significant difference in local recurrence rates (9.1% vs. 7.1%, p = 0.553) and functional outcomes as measured by the MSTS93 score (28.9 vs. 27.8, p = 0.262). Risk factors analyzed did not significantly affect local recurrence risk, except for secondary ABC diagnosis (p = 0.017). The cryoablation group had a more extended follow-up (45.6 vs. 73.2 months, p < 0.001), reflecting a shift in practice over time. We found no significant difference in local recurrence rate or functional outcome in patients treated with or without cryoablation. Formal curettage with additional high-speed burr drilling provides effective tumor control and favorable functional outcomes, negating the need for adjuvant cryoablation.

Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?—CoDIG 2 (ColonDx Italian Group)

BackgroundColon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH).MethodsCoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago.ResultsA total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%).ConclusionsThis analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized.Trial registration (ClinicalTrials.gov) ID: NCT05943951.

Endoscopic submucosal dissection vs transanal endoscopic surgery for rectal tumors: A systematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) and transanal endoscopic submucosal dissection (TES) are widely employed surgical techniques. However, the comparative efficacy and safety of both remain inconclusive. To comprehensively analyze and discern differences in surgical outcomes between ESD and TES. We conducted a systematic search of the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and CINAHL from inception till August 2023. We analyzed outcomes including recurrence rate, en bloc resection, R0 resection rate, perforation rate, procedure length, and hospital stay length applying a random-effects inverse-variance model. We assessed publication bias by conducting an Egger's regression test and sensitivity analyses. We pooled data from 11 studies involving 1013 participants. We found similar recurrence rates, with a pooled odds ratio of 0.545 (95%CI: 0.176-1.687). En bloc resection, R0 resection, and perforation rate values were also similar for both ESD and TES. The pooled analysis for procedure length indicated a mean difference of -4.19 min (95%CI: -22.73 to 14.35), and the hospital stay was on average shorter for ESDs by about 0.789 days (95%CI: -1.671 to 0.093). Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes. Our findings show that individualized patient and surgeon preferences, alongside specific clinical contexts, can be considered when selecting between these two techniques.

Small bowel anastomosis in emergency surgery.

Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small-bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. During the 3.5-year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30-day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small-bowel to colon 3.0% and for small-bowel to small-bowel 0.6%. A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.

Variance of Alpha Angle with Use of Intramedullary Guide – Long or Short Intramedullary Alignment Guide (IAG)

Introduction: Total Knee Replacement is common surgery to treat osteoarthritis in present day. This is important to restore the daily activities of living and at times it also helps to patients to go further with daily activities of earning in their old age. This surgery also reduces the burden of old people in the society. With advancements in TKR surgery, every aspect of alignment of prosthesis needs to be measured to determine acceptability of implant. Further this can help in refinement to improve the movement and acceptance of implant, better patient satisfaction. Aim: We here by propose null hypothesis that use of long or short Intramedullary Alignment Guide (IAG) during the distal femur cut cannot influence the alpha angle of femur. Materials and Methods: This is a radiological evaluation study done in BIRRD (T) Hospital. All the patients admitted into BIRRD for TKR in unit III were evaluated pre operatively. Surgery was performed by different surgeons based upon their training and using of IAG (short or long). There were no indications for use of short or long IAG. This is totally based on surgeon preference on using. Later alpha angle was measured post operatively. Observation and Results: A total of 243 patients were included into the study. Data was collected based the surgeons experience and preference in use of long and short IAG device. There were 96 and 147 patients were long and short IAG devices used respectively. It was found that alpha angle of 93.6o (+ 2.7) and 93.4o (+ 3.04) respectively with long and short IAG. Conclusion: We found that there is no significant statistical difference in alpha angle with use of long and short IAG during femur cuts in TKR. Hence null hypothesis is accepted.

Delayed presentation of lower cervical facet dislocations: What to learn from past reports?

Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5-C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon's judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.

Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis.

Femoral shaft fractures are one of the most prevalent fractures found in clinical practice. Numerous operative and non-operative options are readily available for the treatment of such fractures with intra-medullary nailing being the gold standard. To date, no consensus has been reached favoring one approach over the other. Thus, this meta-analysis aims to compare the outcomes between an antegrade and retrograde intra-medullary nailing for the treatment of femoral shaft fractures. PubMed, Cochrane, Google Scholar (page 1-20), and Embase were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, reoperations, hip and knee pain, and surgery-related parameters. Higher rates of hip pain, and heterotopic ossification (p=0.0003, and p=0.0002 respectively) was observed with antegrade nailing. However, a higher rate of knee pain (p=0.02) was appreciated in retrograde nailing. There was no statistically significant difference in the remaining analyzed outcomes such as operative time, reoperation rate or other complications. Despite a higher rate of heterotopic ossification using the antegrade nailing technique, both the antegrade and retrograde nailing techniques yield overall similar outcomes. Therefore, the decision to choose one or the other should be based on patient-related factors, and the surgeon's experience and preference.

Combined cataract and vitreoretinal surgery

Combined cataract surgery and vitrectomy is a surgical technique used to address both cataract and vitreoretinal disorders. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This technique offers several advantages over separate surgeries, including reduced surgical time and anaesthesia exposure, as well as quicker visual rehabilitation. However, the optimal timing and approach for combined cataract surgery and vitrectomy remain controversial.Indications for combined cataract surgery and vitrectomy include various vitreoretinal conditions, such as retinal detachment, diabetic retinopathy, macular holes, and epiretinal membranes. The timing of surgery depends on the severity of the cataract and the vitreoretinal pathology, as well as the surgeon's preference. The most common surgical techniques include phacoemulsification with posterior chamber intraocular lens implantation, followed by pars plana vitrectomy. The filling of the vitreous cavity is possible with several types of tamponades, such as different gases, but in extreme cases even with silicone oil. After gas tamponade, proper positioning of the patient is of great importance.Complications associated with combined cataract surgery and vitrectomy include posterior capsule rupture, intraocular lens dislocation, postoperative inflammation, and intraocular pressure elevation. However, the overall complication rate is low, and the visual outcomes are generally favourable.In conclusion, combined cataract surgery and vitrectomy is a useful technique for managing various vitreoretinal conditions. Proper patient selection, careful surgical planning, and close postoperative monitoring are critical for achieving optimal outcomes.