Complication Of Surgery Research Articles

Drug‐induced choroidal effusion: Cases review

Purpose: Choroidal effusion is a well‐known complication of intraocular surgery, but it can happen as a drug adverse effect.Methods: We present three clinical cases of choroidal effusion as a result of systemic treatments.Results: 82‐years‐old woman presents with pain and loss of vision in left eye. She was treated with acenocumarol. She had bilateral phacoemulsification two months ago with normal development. Visual acuity (VA) was 0.8 right eye and 0.3 left eye, intraocular pressure (IOP) was 16/18 mmHg and anterior segment exploration was normal. She had a complete choroidal effusion and a temporal serous retinal detachment in her left eye. After one week of topical steroids and atropine, fundus alterations had disappeared.65‐years‐old male presents with blurred vision and photopsias in right eye since one week. The patient has a history of type II diabetes and benign prostatic hyperplasia, treated with tamsulosine. First day exploration was: AV 0.3 right eye and 0.5 left eye, he was phakic and IOP was 16 mmHg both eyes. On right eye fundus, there where severe choroidal effusion. Topical and oral steroid treatment was started and cycloplegia. After one month, choroidal effusion had disappeared and VA improved.86‐years‐old male had bilateral painless loss of VA. He was diagnosed of Parkinson's disease and treated with rotigotine. First day exploration was: VA 0.5 right eye and 0.3 left eye, no alterations in anterior segment and IOP was 12 mmHg both eyes. On fundus examination, bilateral nasal choroidal effusion were found. Topical steroid and cycloplegia were the treatment and rotigotine was suspended. Seven days after rotigotine's interruption, both eyes choroidal effusion had disappeared.Conclusions: Drug‐induced choroidal effusion must be on the differential diagnosis if there are no antecedents of IOP alterations or recent surgeries. Ophthalmology patients are increasingly older and pluripathologic so drug adverse effects will be more common.

Factors Influencing Surgeons' Decision for Diverting Ileostomy and Associated Complications in Ovarian Cancer Cytoreductive Surgery

Factors Influencing Surgeons' Decision for Diverting Ileostomy and Associated Complications in Ovarian Cancer Cytoreductive Surgery

Robotic and thoracoscopic surgeries for anterior mediastinal neoplasms

To evaluate the efficacy and safety of robot-assisted (RATS) and video-assisted thoracoscopic (VTS) minimally invasive surgeries for anterior mediastinal neoplasms. The study involved 74 patients who underwent surgeries for anterior mediastinal neoplasms between 2020 and 2023. Patients were divided into two groups: group 1 (RATS, 33 patients) and group 2 (VTS, 41 patients). The following parameters were evaluated: surgery time, incidence of postoperative complications, pain syndrome and recovery time. Duration of RATS was significantly shorter (mean 120 min) compared to VTS (140 min) (p< 0.05). Postoperative pain was also lower in the RATS group (4.5 vs. 6.0 points) (p< 0.05). The incidence of complications was lower in the same group that contributed to earlier recovery. Robot-assisted surgeries are preferable for anterior mediastinal tumors. The advantages of RATS include shorter surgery time, lower pain and complication rate. Thus, this approach is more advisable in high-risk patients.

Surgical Outcomes of Concurrent Intraperitoneal Onlay Meshplasty and Laparoscopic Cholecystectomy: A Retrospective Observational Study

Introduction: Laparoscopic Cholecystectomy (LC) and Intraperitoneal Onlay Meshplasty (IPOM) have established themselves as standard and popular surgeries for gallstone disease and ventral hernia, respectively. However, their concurrent performance for co-existing gallstone disease and ventral hernia has never been studied. Aim: To determine the outcomes of the concurrent performance of LC and IPOM in patients with co-existing gallstone disease and ventral hernia. Materials and Methods: This retrospective observational study was conducted at the Department of General and Laparoscopic Surgery, Dr. L H Hiranandani Hospital, Mumbai, India from August 2005 to July 2024. Over 19 years, 15 patients with coexisting gallstone disease and ventral hernia (primary/recurrent) were operated upon in a single sitting. The following outcomes were studied: duration of surgery, intra and postoperative complications including mesh infection, duration of hospital stay, recurrence of hernia, time taken to resume normal activity, and cost of treatment. Proportions, percentages, and means were calculated. Results: The mean age of the patients was 55±12.36 years (range 35-77 years). The average duration of surgery was 62 minutes (range 48-70 minutes). There was no conversion to open surgery. The mean postoperative stay was 2.5 days. Total 3 (20%) patients developed seromas, which were identified on day 10. All three seromas were small in size, managed conservatively, and resolved by six weeks. No patient experienced any significant intra- or postoperative haemorrhage. There was no superficial or deep surgical site infection, and there was not a single case of mesh infection. There was no recurrence of the hernia. Patients resumed normal activity in an average of seven days. The total cost of concurrent treatment for both conditions was reduced by 28% compared to the sum of costs, if both operations had been done separately in two separate hospital stays at present Institution. Conclusion: Concurrent LC and IPOM is a safe, practical, and cost-effective procedure in carefully selected patients.

Global research interest and publication trends on guided surgery in implant dentistry: A metrics-based analysis.

Digital surgical guides improve precision by detailing the direction, position, and angle of implants, which reduces surgery time and complications. A bibliometric analysis of guided surgery in implant dentistry is lacking. The aim of this metrics-based analysis was to analyze the trends and key characteristics of articles related to guided surgery in implant dentistry. The search was conducted in February 2024 on the Web of Science. The main characteristics of the studies were extracted and analyzed. Collaborative networks were generated using the Vosviewer software program. Dimension was consulted to measure Altmetric data. Correlation among data was determined by using the Spearman test. A total of 799 articles published between 1993 and 2023 were included. Most were case reports or series (n=26) using static guided surgery (n=672), primarily for dental implant placement (n=754). The studies typically employed a combination of cone beam computed tomography (CBCT) and digital scanning (n=316) for surgical planning. The most frequently used software program was coDiagnostiX (n=89), and the most commonly used guide type was the printed guide (n=161). The country with the most articles was the USA (n=137), though Europe stood out as the leading continent (n=398). The Vosviewer demonstrated strong collaborations among authors. According to Dimensions, significant mentions were identified in Mendeley, news outlets, and X. An emerging trend in guided implant dentistry research was identified over the past 30 years through the use of software programs and 3D-printers for the fabrication of surgical guides. Europe showed the greatest interest in this topic, predominantly conducting research on static guided surgery for implant placement. Additional clinical studies and systematic reviews are needed.

Orthopaedic Surgery Complications at a Tertiary Care Hospital in a Low- and Middle-Income Country: A National Surgical Quality Improvement Project Analysis

Orthopaedic Surgery Complications at a Tertiary Care Hospital in a Low- and Middle-Income Country: A National Surgical Quality Improvement Project Analysis

Risk of Cataract Surgery Complications in Patients with Prior Intravitreal Injection Therapy.

To compare the rate of cataract surgery complications in patients with and without prior intravitreal injection (IVI) pharmacotherapy. A retrospective cohort study was performed using the TriNetX (Cambridge, MA) aggregated electronic health records research network. Patients with a history of IVI therapy within twenty years of cataract surgery were compared to a control group using propensity score matching (PSM) to balance for baseline demographics, systemic, and ocular co-morbidities. Patients with a history of lensectomy or pars plana vitrectomy (PPV) prior to cataract surgery were excluded. IVI therapy within twenty years of cataract surgery. Rate of retinal detachment (RD), RD repair, anterior vitrectomy, retained lens, dislocated intraocular lens (IOL), need for a secondary lens procedure, and endophthalmitis within 14, 30, and 90 days of cataract surgery. Prior to PSM, 16,356 and 512,152 patients did and did not, respectively, have IVI pharmacotherapy prior to cataract surgery. After PSM, both groups had 14,240 patients. A higher rate (RR 1.34; 95% CI, 1.16-1.54; p<0.0005) of aggregate complications within 90 days of cataract surgery was found in the group with prior IVI (447/13,719 = 3.3%) relative to controls (340/13,945=2.4%). The exposure group saw an increased risk of RD repair at 30 days (RR 1.84; 95% CI, 1.27-2.66; p=0.001) and 90 days (RR 2.05; 95% CI, 1.65-2.54; p<0.0005). No other complications were associated with IVI. In particular, IVI was not associated with higher rates of anterior vitrectomy except in patients with diabetic retinopathy (DR) at 90 days (RR 1.24; 95% CI, 0.85-1.79; p=0.001). Patients with DR and prior IVI had a higher risk of lensectomy, RD repair, and secondary procedures (p < 0.0005 for all) compared to DR patients without prior IVI. Patients with prior IVI saw more complications following cataract surgery, primarily for RD. IVI treatment history should be considered in pre-operative planning.

Trends and Outcomes in Reporting and Grading Complications of Urological Surgery: A Retrospective Analysis

Introduction: Complications in urological surgery can range from minor, self-limiting issues to severe, life-threatening events requiring significant medical intervention. This study aimed to assess the reporting and grading of complications in urological surgery, focusing on current trends and future perspectives. Methodology: Conducted at the Institute of Kidney Diseases, Peshawar, from 2022–2023. This retrospective study included 165 patients diagnosed with vesicovaginal fistula (VVF) or bladder urethral stricture and hypoplasia (BURSH) requiring surgical intervention. Patients with prior surgeries that could interfere with complication assessment or incomplete medical records were excluded. Results: Various surgical procedures were performed, tailored to the individual’s medical history, fistula location, and size. Surgical approaches included transvaginal repair, transabdominal repair, or laparoscopic repair. The mean age of patients was 49.23 years (range 26–74), with 90% females and 10% males. Comorbidities included diabetes (20%), hypertension (25%), and other chronic illnesses (15%), with an average BMI of 24. A history of smoking and alcohol consumption was reported in 15% and 10% of patients, respectively, while 30% had undergone prior urological surgeries. Discussion: Post-surgery, 70% achieved satisfactory urinary control, 20% experienced mild to moderate incontinence, and 10% reported persistent control issues. Minimal to moderate pain was noted in 60%, while 25% experienced transient discomfort resolving within three months, and 15% reported chronic pain. Conclusion: The findings highlight the importance of personalized surgical approaches, with minimally invasive techniques reducing complication rates and improving outcomes in urological surgeries for VVF and BURSH.

Outcome of Modified Weis Procedure Versus Jones Procedure in Senile Entropion at Tertiary Eye Centre of Western Nepal

Introduction: Involutional lower eyelid entropion is a common condition of eyelid that affects ageing population. Various surgical procedures have been described for correction of involutional entropion of the lower eyelid that addresses one or more of the anatomical factors. Aims: This study evaluate the success rate, recurrence, and postoperative complications between the two procedures modified Weis versus Jones procedure for involutional lower lid entropion. Methods: A prospective, cross section- al study. All patients with senile entropion who met the inclusion criteria were randomly divided into Group A (modified Weis group) and Group B Jones group Patients were evaluated on the 1st and 14 postoperative day and followed up at 6 months. The surgical outcomes were normal eyelid position at rest, recurrence and complications of surgery. Results: 59 patients (64 eyelids) with involutional entropion that met the inclusion criteria underwent surgical repair. Left eyelid (29) was more involved than the right eye (25). 5 patients had bilateral entropion repair. There were no major intraoperative complications except bleeding which occurred in 8 eyelids (12.5%). Postoperative period was uneventful. The success rate of Modified Weis procedure at 6 months was 93.7% whereas it was 100% in Jones procedure. The success rate was same at 3 months and 6 months duration. Conclusion: The functional and surgical outcome for involutional entropion with either transconjunctival modified Weis approach or external Jones approach was same. But Jones procedure has comparatively high success rate and minimal or no recurrence.

Large-Scale Analysis of Trends and Complications in Lumbar Spondylolisthesis Surgery: A Commentary on "National Trends in Lumbar Degenerative Spondylolisthesis With Stenosis Treated With Fusion Versus Decompression".

Large-Scale Analysis of Trends and Complications in Lumbar Spondylolisthesis Surgery: A Commentary on "National Trends in Lumbar Degenerative Spondylolisthesis With Stenosis Treated With Fusion Versus Decompression".

Predictors associated with Clavien-Dindo complications in lung cancer surgery: A retrospective cohort study.

To highlight the risk assessment tool associated with postoperative cardiopulmonary complications of Clavien-Dindo (CD) ≥ II in elderly patients who underwent lung cancer surgery. In patients ≥ 60 years admitted during 2020-2023 and having undergone lung cancer surgery, postoperative cardiopulmonary complications were examined using the CD classification as groups (CD grade I versus ≥ II), and the risk factors were analyzed using logistic regression and receiver operating characteristic (ROC) curves. Of the 239 elderly patients, 29.3% had postoperative complications (CD ≥ II). Subgroup analysis revealed that patients aged ≥70 years had a higher rate of postoperative complications compared to those aged 60-69 years, however, this relationship was not statistically significant in the multivariable model (OR: 2.03, 95% CI: 0.95-4.36, p = 0.068). The CD grade ≥ II group had longer surgical time (p = 0.002), greater postoperative pulmonary complications (p < 0.001), and longer length of hospital stay (p < 0.001); CD grade ≥ II was more likely in patients with older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.02-1.15, p = 0.011), COPD (OR: 4.41, 95% CI: 1.55-13.44, p = 0.005) and smoking history (OR: 2.85, 95% CI: 1.12-7.24, p = 0.028), having undergone pneumonectomy (OR: 14.89, 95% CI: 1.71-334.9, p = 0.045), and who converted to open thoracotomy (OR: 16.33, 95% CI: 2.13-169.71, p = 0.007). The area under the ROC curve was 0.81. Older age (≥70 years) is associated with higher rates of postoperative complications (CD classification ≥ II) but is not an independent predictor when adjusting for other factors. Comorbidities such as COPD and surgical factors, including pneumonectomy and conversion to thoracotomy, are significant contributors. These findings emphasize the need for comprehensive, multifactorial risk assessments to guide perioperative management and improve outcomes in elderly lung cancer patients.

Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion.

To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001-1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001-1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205-19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109-1.164; p<0.001) were significant risk factors for PJF development. A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

“Journey Beyond Tomorrow”: Navigating Regulation of AI-Powered Cyber Operations in the Realm of the Use of Force

INTRODUCTION. Artificial intelligence (AI) can significantly strengthen cybersecurity systems of States, as well as serve an additional technical means for malicious actions in the so-called cyberspace. Recognizing this, States have started investing in defensive and offensive autonomous cyber capabilities to protect their interests and deter potential adversaries; this has further fuelled the increase in inter-State cyber operations as nations seek to gain a competitive edge in the digital realm. This paper focuses not only on the problems of applying existing norms of international law to situations of malicious use of AI by States, but also on the process of these norms’ interpretation by different actors and, through this interpretation, crystallization of a common (or at least converging) understanding of their applicability. More specifically, this paper examines the path to understanding of how the norms on the use of force apply to AI-enabled cyber operations.MATERIALS AND METHODS. The present study is based on the works of both Russian and foreign specialists on the law of international information security, as well as analysis of documents and materials of groups of governmental experts under the auspices of the United Nations and the positions of States. In addition to general scientific methods (analysis, synthesis, induction and deduction), the theory of transnational legal process is applied to this study, which considers ongoing discussions of relevant issues on various platforms, and, more generally, the interaction of various actors regarding the formation of a pool of rules for responsible use of AI by States through interaction, interpretation and internalization of the interpreted legal ideas and practices into the domestic legal systems.RESEARCH RESULTS. The international efforts to develop a universal set of rules for responsible State behaviour in cyberspace have enjoyed rather modest success. The analysed history of cyber-related debate suggests that the AI-focused discussion for the foreseeable future will progress outside the area of developing a comprehensive treaty framework. Instead, the legal landscape of AI applications will appear to emerge from soft law instruments and private sector initiatives, which would lead to fragmentation of interpretation and State practice.DISCUSSION AND CONCLUSIONS. The complication of inter-State cyber operations by AI technology raises additional questions about the application of international law, in particular its norms on the use of force, to AI-powered cyber incidents. The deployment of lethal autonomous weapons systems and commitment of AI-powered cyber operations could potentially lead to another ‒ this time, AI ‒ arms race, as nations seek to develop and acquire these systems to maintain strategic parity. This could destabilize global security and increase the risk of conflict escalation. This and other political and ethical considerations argue in favor of limiting the discretion of States in the use of AI. However, to date, the incentives for NATO States, China and Russia to agree on an international binding instrument limiting the use of AI for malicious purposes appear illusory. One could argue that corresponding discussions on AI will probably take place outside of the development of an international treaty, given the historical debate surrounding the application of international law in cyberspace and the development of norms governing responsible States behaviour in the use of information and communication technologies. Further analysis of this development, thus, will require examining how transnational norms, such as those emerging from soft law instruments, customary practices, and private sector initiatives, will shape the international legal landscape of the AI application.

Popliteal Artery Injury After Arthroscopic Knee Surgery: A Retrospective Multicenter Cohort Study.

Popliteal artery injury is a rare but serious complication of arthroscopic knee surgery. The absence of comprehensive data and standardized guidelines underscores the urgent need for further investigation. This study examines the incidence, risk factors, management strategies, and long-term outcomes of popliteal artery injury in the context of arthroscopic knee procedures. We conducted a retrospective cohort study utilizing data from 21 medical institutions in Hunan Province, China, from January 2018 to December 2022. We identified patients who underwent arthroscopic knee surgery and complained of postsurgical popliteal artery injury. Patients were followed up for 43.1 ± 13.23 months (ranging from 22 to 58 months). The primary outcome was joint function, which was evaluated by a postoperative range of motion (ROM), International Knee Documentation Committee (IKDC) scores, Lysholm knee scores, and Visual Vascular Quality of Life Questionnaire (VascuQoL) scores. These data from different postoperative periods were compared via paired t-test to assess postoperative recovery. The secondary outcome was vascular patency of the affected limb, which was evaluated through vascular color Doppler ultrasound. Among the 17,000 knee arthroscopic procedures analyzed, 10 patients were identified with popliteal artery injury (0.059%). The surgeries performed included arthroscopic cystectomy for popliteal cysts, cruciate ligament reconstruction, and posterior horn of the lateral meniscus repair. Treatments for popliteal artery injury included percutaneous intravascular stent implantation (one patient), direct suture repair (four patients), allograft vascular transplantation (one patient), and reconstruction with an autogenous greater saphenous vein (four patients). After a mean follow-up time of 43.1 ± 13.23 months (ranging from 22 to 58 months), no complications were reported. Compared with patients at 1 month after surgery, patients at 2 years after surgery presented improved knee function and ROM. The average Lysholm score increased significantly from 13.8 ± 4.21 to 68.2 ± 15.50, the IKDC score increased from 11.6 ± 2.46 to 48.1 ± 11.75, and the VascuQoL score improved from 54.8 ± 9.54 to 92.5 ± 15.90. Knee extension improved from 13.3° ± 2.36° to 3.5° ± 4.12°, and knee flexion increased from 49.5° ± 12.57° to 107° ± 21.63°. All patients successfully resumed daily activities postoperatively. Popliteal artery injury is a catastrophic complication that warrants significant attention during knee arthroscopy. This injury can occur in various types of arthroscopic knee procedures. Prompt diagnosis and effective intervention are crucial for minimizing the potential detriment associated with popliteal artery injury.

Intraglandular botulinum toxin in postoperative head and neck fistula: a retrospective analysis.

Orocervical (OCF) or pharyngocutaneous fistula (PCF) are one of the disastrous complications of head and neck cancer surgery. Conventional standards of management are predominantly conservative. Though a majority of such patients respond to conservative management, it nevertheless causes significant delay in wound healing. This study explores the role of intraglandular Botulinum toxin injection in shortening the time to fistula healing. Retrospective case-control study at a tertiary care oncology center in South Asia from January 2021 to December 2023 on all consecutive patients of OCF/PCF. Patients with any history of head and neck radiation were excluded. The case group received intraglandular (parotid+/-submandibular gland) botulinum toxin injection and conservative management and the control group received only conservative management. The time taken for the fistula to heal was the primary outcome. 31 patients in case and 104 patients were in control group. The mean time from fistula diagnosis till injection was 5.8 ± 3.1 days and the mean fistula healing time in case group was 18.5 ± 7.15 days (Range:10-34 days). The mean total dose of botulinum toxin was 59.2 ± 22.4 MU (Range: 40 to 100 MU). For control group, the mean time taken for the fistula to heal was 26 ± 15 days (Range:15 to 75 days). The difference was statistically significant (p-0.008, 95% CI: -9.0 to -2.0). Adverse effects attributable to botulinum toxin injection were: pain at the injection site (n = 3) and xerostomia (n = 1). On multivariate analysis, intervention with intraglandular botulinum toxin emerged as an independent variable impacting the time taken for fistula closure. This is the largest study to show the efficacy of intraglandular botulinum toxin injection in reducing the time taken for healing of postoperative salivary fistula with a tolerable adverse effect profile.

Analysis of risk factors for surgical site infection in spinal surgery patients and study of direct economic losses

BackgroundSurgical site infection (SSI) is a serious complication of spine surgery, leading to prolonged hospital stays, re-operations, and economic losses. The aim of the study was to explore the types and quantities of pathogenic bacteria involved, the incidence of SSI, and to identify the independent risk factors and direct economic impact on patients with postoperative SSI in spine surgery.MethodsThe medical records of spine surgery patients from January 2023 to April 2024 at two hospitals in Xinjiang were retrospectively reviewed. Patients with SSIs were included in the case group, and patients without SSIs were matched 1:1 based on hospital, department, age ± 5 years, primary diagnosis, and the specific surgery type. They were then subjected to univariate and multivariate paired logistic regression analyses. The Wilcoxon signed-rank test was used to compare differences in hospitalization costs and duration of stay between the two groups.ResultsA total of 38 individuals, or 0.63% of the 6018 adults who had spinal procedures, experienced SSI. Findings from the univariate analysis demonstrated a statistically significant correlation between SSI (p < 0.05), intraoperative bleeding of 300 ml or more, and the duration of indwelling drain use. Many separate risk variables for SSI were found by multivariate regression analysis: combined underlying diseases (OR 2.634, 95% CI 1.02–6.78), days with an indwelling urinary catheter (OR 1.38, 95% CI 1.01–1.88), and days with an indwelling drain (OR 1.449, 95% CI 1.01–2.07). The most prevalent bacteria identified as causing skin infections were Staphylococcus aureus and Staphylococcus epidermidis. About $1,688.50 in direct economic loss was attributable to SSI in patients undergoing spine surgery.ConclusionsThe presence of combined underlying diseases, extended use of indwelling urinary catheters, and prolonged use of indwelling drains significantly increase the risk of SSI in spine surgery patients.

Outcome of Restorative Surgery of Fecal Diversion, a Prospective Observational Study of 50 Cases in a Teaching Hospital

Background: An intestinal stoma is a planned opening made in the intestine to divert feces and flatus to the abdominal wall where they can be collected in external appliances. Either colostomy or ileostomy, most of the time acts as the best lifesaving surgical procedure for certain emergencies as well as routine small intestinal and colorectal surgery. Objective: To see the outcome of intestinal stoma closure surgery and the factors that influence the outcome of surgery. Study Design: This is a descriptive type of-cross sectional study. Department of Surgery, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMUH), Dhaka, Bangladesh, which were done over a period of twelve months from April, 2012 to March, 2013. Results: 50 patients with intestinal stoma were admitted in different surgical wards of BSMMUH, Dhaka for intestinal stoma closure surgery. Out of 50 patients 30 patients presented with ileostomy &amp; 20 patients presented with colostomy. After restoration of bowel continuity, in case of ileostomy closure, out of 30 patients 23(77%) patients were recovered uneventfully &amp; 7(23%) patients recovered with some complications. Out of complicated cases, 2(7%) patients developed febrile illness, 2(7%) patients’ intestinal obstruction, 1(3.33%) patient developed anastomotic leakage, 1(3.33%) urinary retention &amp; 1(3.33%) patient post-operative ileus. In case of colostomy closure, out of 20 patients 14(70%) patients were recovered uneventfully &amp; 6(30%) recovered with some events; 3(15%) patients developed wound infection, 1(5%) patient post-operative ileus, 1(5%) patient diarrhea &amp; 1(5%) patient febrile illness. Over all Out of 50 patients, post-operative recovery of 37 (74%) patients were uneventful &amp; 13(26%) patients were recovered with complications. 3(6%) patients developed febrile illness, 3(6%) patients wound infection, 2 (4%) patients’ adhesive obstruction, 2(4%) patients post-operative ileus, 1(2%) patient developed anastomotic leakage, 1(2%) patient urinary retention &amp; 1(2%) patient developed diarrhoea. Conclusion: Complications of Intestinal stoma reversal surgery is associated with nutritional status of the patients, anaemia, electrolyte imbalance, acquired complications in stoma site, duration of stoma, nature of operation and last of all surgical skill. So Intestinal stoma closure surgery should be performed after adequate nutritional build up, correction of anaemia, correction of electrolyte imbalance, stoma with adequate duration and by a surgeon who is technically skilled and experienced to minimize the incidence of post-operative complication.

Internal septa of the maxillary sinus and their significance in the planning of endodontic interventions, sinus lifting and dental implantation using a collagen matrix scaffold

INTRODUCTION. The study of the structure of the septa in the area of the maxillary sinus floor is important when planning implantation and sinus lifting operations. The height, number and location of the septa can affect the course of the sinus lifting operation. The aim is to study the structure of the maxillary sinus septa, their height, size, localization in order to prevent complications during surgical interventions.MATERIAL AND METHODS. The article analyzes CBCT data from 444 patients for the presence of septa in the area of the lower wall of the maxillary sinus. The subjects were divided into two groups: with the presence of premolars and molars (288 CBCT) and with the absence of at least one chewing tooth (156 CBCT). A study of 48 passportized skulls was conducted, the anterior wall of the maxillary sinus was sawed out, the structure of the sinus floor and septa was studied in detail. The ratio of the volume of compact and spongy bone substance in the premolar and molar areas was also measured.RESULTS. The obtained research data allowed us to obtain new information about the number of septa in the case of a complete dentition and partial tooth loss. Due to changes in the processes of sinus pneumatization, the number of septa increases with partial tooth loss. Their presence increases the risk of perforation of the Schneiderian membrane during sinus lift surgery, including the use of scaffolds based on a collagen matrix. However, when installing an implant in the base of the septum, its stability can be ensured, since the septa are some kind of buttresses of the maxillary bone. The ratio of the volume of spongy and compact bone substance in the premolar and molar area changes with age.CONCLUSION. The study found that the presence of coronal septa can cause complications of sinus lift surgery in the form of perforation of the Schneiderian membrane. At the same time, septa, being buttresses of the maxillary bone, can serve as a basis for installing an implant. With partial loss of teeth, the number of coronal septa increases. With age, the ratio of spongy and compact bone substance changes, towards a decrease in the volume of trabecular and an increase in the volume of compact bone.

A novel generative multi-task representation learning approach for predicting postoperative complications in cardiac surgery patients.

Early detection of surgical complications allows for timely therapy and proactive risk mitigation. Machine learning (ML) can be leveraged to identify and predict patient risks for postoperative complications. We developed and validated the effectiveness of predicting postoperative complications using a novel surgical Variational Autoencoder (surgVAE) that uncovers intrinsic patterns via cross-task and cross-cohort presentation learning. This retrospective cohort study used data from the electronic health records of adult surgical patients over 4 years (2018-2021). Six key postoperative complications for cardiac surgery were assessed: acute kidney injury, atrial fibrillation, cardiac arrest, deep vein thrombosis or pulmonary embolism, blood transfusion, and other intraoperative cardiac events. We compared surgVAE's prediction performance against widely-used ML models and advanced representation learning and generative models under 5-fold cross-validation. 89246 surgeries (49% male, median [IQR] age: 57 [45-69]) were included, with 6502 in the targeted cardiac surgery cohort (61% male, median [IQR] age: 60 [53-70]). surgVAE demonstrated generally superior performance over existing ML solutions across postoperative complications of cardiac surgery patients, achieving macro-averaged AUPRC of 0.409 and macro-averaged AUROC of 0.831, which were 3.4% and 3.7% higher, respectively, than the best alternative method (by AUPRC scores). Model interpretation using Integrated Gradients highlighted key risk factors based on preoperative variable importance. Our advanced representation learning framework surgVAE showed excellent discriminatory performance for predicting postoperative complications and addressing the challenges of data complexity, small cohort sizes, and low-frequency positive events. surgVAE enables data-driven predictions of patient risks and prognosis while enhancing the interpretability of patient risk profiles.

The Use of Fibrin Sealants in Reducing Postoperative Complications in Skull Base Surgery: A Systematic Review and Meta-Analysis

Abstract Objective To determine if using fibrin sealants (FS) during skull base (SB) surgery reduces complications. Methods PubMed, Cochrane, Web of Science, and Embase databases were searched for studies of patients who underwent SB surgery with use of an FS. A systematic review was conducted according to PRISMA guidelines. Primary outcomes included incidence of cerebrospinal fluid (CSF) leak, revision surgery, infection, and drain placement. Methods for meta-analysis were performed including tests of homogeneity and both fixed-effects and random-effects models. Results A total of 30 articles met the inclusion criteria. There were 3,681 patients, including 2,220 patients who received FS and 1,461 patients who did not. The most common surgical approaches were posterior fossa (27.4%) and transsphenoidal (18.2%). The FS group was less likely to have a lumbar drain placed (1.7% versus 8.1% of the control group). The difference in drain placement incidence between groups for the studies which included both groups was −0.135 (95% CI [−0.285, 0.016], p = 0.079) for the random-effects model and −0.038 (95% CI [−0.068, −0.008], p = 0.014) for the fixed-effects model. The incidence of CSF leak was 11.3% in the control group and 6.8% in the FS group. The rate of infection was higher in the control group (6.1%) compared with the FS group (3.3%), although not statistically significant. The rate of revision surgery was similar between the two groups (3.0% in the control group versus 2.4% in the FS group). Conclusion Patients who underwent SB surgery with FS may have lower incidences of drain placement than patients whose surgery did not involve FS.