Operative Bleeding Research Articles

Sternotomy versus Mini-Sternotomy in Pediatric Patients undergoing Modified Blalock-Taussig Shunt

Abstract Background In the present era, primary correction is the preferred approach to the neonate or young infant with a cardiac anomaly who has two ventricles. However, when only one functional ventricle is present or pulmonary blood flow is reduced, an initial palliative systemic-to-pulmonary arterial shunt is mandatory. In this study we compare post-operative short term outcomes of sternotomy versus mini-sternotomy approaches in pediatric patients undergoing Modified Blalock Taussig Shunt. Patients and Methods A prospective randomized study was conducted on 90 patients who were schedueled for MBT shunt due to a group of cyanotic heart disease. They comprised 2 groups G1: sternotomy group (n = 45) and G2: ministernotomy group (n = 45). Results Mean age was 11± 3.39 months and mean weight was 6.75±1.96 kg in the sternotomy group, while for ministernotomy group the mean age was 10.55± 4.65 and mean weight was 7.00±2.03 kg. The change (%) between preoperative and postoperative oxygen saturation was 35.6% for sternotomy group and 43.8% for ministernotomy group. There were seven cases of mortality (15.6%) in sternotomy grouped compared to three cases of mortality (6.7%) in ministernotomy with P value of 0.314. Superficial wound infection occurred in one case (2.2%) in each group. Mean duration of ventilation was 52.53 ± 15.76 h for sternotomy group and 46.93±19.23 h for ministernotomy group with P value of 0.025, mean ICU stay was 7.42 ± 2.94 days for sternotomy group and 5.13± 2.37 days for ministernotomy with P value of < 0.001. Conclusion Upper ministernotomy is a safe alternative approach for MBT shunt in pediatric patients. It provides the advantages of less ventilation time, less post operative bleeding, and ICU stay.

Intra-arterial Balloon Occlusion to Reduce Operative Bleeding for Placenta Previa Accreta Spectrum.

Cesarean section for placenta previa accreta spectrum carries a significant risk of massive hemorrhage. Hence, it is necessary to understand the various hemostatic procedures, damage control surgery and resuscitation for massive hemorrhage, and systemic management against hypovolemic shock and coagulopathy. In cases of placenta previa with previous cesarean section, the operation should be performed in a tertiary medical facility with well-trained staff and blood availability for transfusion. Preoperative placement of an intra-arterial balloon occlusion catheter in the common iliac artery or aorta is useful for preventing massive hemorrhage.

145 ADVANTAGES OF MINIMALLY INVASIVE TRANSMEDIASTINAL ESOPHAGECTOMY IN ELDERLY PATIENTS WITH ESOPHAGEAL CANCER

Abstract Esophagectomy for esophageal cancer (EC) is one of the most invasive surgical procedures and, especially for elderly patients, postoperative respiratory complication (PRC) is still frequent and life-threatening. We started esophagectomy by a laparoscopic transhiatal approach in 2009, and single-port mediastinoscopic cervical approach in 2014. Nowadays, we have performed total mediastinal lymph node dissection without thoracic approach. The purpose of this study was to evaluate transmediastinal esophagectomy (TME) for the prevention of PRC in elderly patients. Methods 1) Patients with EC performed TME (n = 238) were compared with those performed the right thoracotomy (n = 185). 2) Outcomes of TME for elderly patients (75 years and older, n = 48) was evaluated by comparing with non-elderly patients (n = 190). 3) Elderly patients performed subtotal esophagectomy were divided into 2 groups according to the presence (n = 12) or absence (n = 51) of PRC. The two groups were compared about clinicopathological factors, and risk factors of PRC were analyzed. Results 1) Percentage of elderly patients was higher in TME group (20.2% vs 8.1%). The operative time and bleeding were decreased by TME. The number of resected LNs and pR0 rate were not different between two groups. In TME groups, the occurrence of PRC was significantly reduced (10.1% vs 28.1%). 2) 81.3% of elderly patients were able to extubation on 0POD, and there was no significant difference in PRC between two groups. 3) Univariate analysis showed that surgical approach was significantly different between two groups. Multivariate analysis showed that thoracotomy was the strongest risk factor of PRC for elderly patients. Conclusion This study showed that our surgical procedure was less invasive during operation and resulted in a safe en-bloc mediastinal lymph node dissection. For elderly patients, TME was the effective minimally invasive approach and was able to reduce the occurrence of PRC.

152 SURGICAL PROCEDURE AND OUTCOME OF MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER

Abstract We started performing mediastinal lymph node dissection by a laparoscopic transhiatal approach (LTHA) in 2009. To date, 371 patients had undergone our method during various esophageal surgical procedures, including esophagogastric junction cancer (EGJC). Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a simple technique for transmediastinal radical esophagectomy (TMr) without thoracic approach (258 cases). Forty patients with EGJC were also treated by TMr. Methods Left single-port mediastinoscopic cervical approach was performed with pneumomediastinum. Mainly for advanced SCC, upper mediastinal lymph node dissection including recurrent laryngeal nerve LNs was performed with intraoperative monitoring using NIM system. Next, LTHA was performed for en bloc mediastinal lymph node dissection. The esophageal hiatus was opened, and working space was secured by Long Retractors. The posterior plane of the pericardium was extended. The posterior side of LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura. Reconstruction with narrow gastric conduit was performed through substernal tract. Results Patients with EGJC performed TMr were analyzed (n = 40, SCC/Adeno/Others = 21/17/2). Upper mediastinal lymph node metastasis was found in 6 cases (SCC/Adeno = 3/3), middle mediastinal lymph node metastasis was found in 2 cases (SCC/Adeno = 1/1), and all of them had advanced tumors. Their perioperative outcome were compared with those performed the right thoracotomy (n = 41). The operative time and bleeding were decreased by TMr. The number of resected mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in the two groups were not different. In 95.0% of patients treated by TMr, extubation was performed at 0 POD. Postoperative respiratory complications was decreased by TMr (TMr:7.5%, thoracotomy:17.1%). Conclusion This procedure, TMr, resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications in patients with EGJC.

A Retrospective Study on the Feasibility of Completely Laparoscopic Transabdominal Approach Partial Intersphincteric Resection.

Background: With the development of surgical techniques, gastrointestinal surgeons seek ways to improve the quality of life (QOL) for postoperative patients, while ensuring the tumor radical effect, such as reducing trauma, alleviating pain, and preserving the anus. This article discusses the postoperative outcomes of completely laparoscopic transabdominal approach partial intersphincteric resection (CLTPISR). Materials and Methods: The clinical data of 68 patients who underwent CLTPISR at the Affiliated Hospital of Chengde Medical College between May 2017 and June 2020, including procedure-related data, general postoperative conditions, and postoperative anal function data, were retrospectively analyzed to investigate the feasibility and safety of CLTPISR. Results: All 68 rectal cancer patients completed the CLTPISR. The average age was (60.47 ± 7.08) years, the average operative time was (196.22 ± 8.15) minutes, the mean operative bleeding was (49.12 ± 29.61) mL, and the average postoperative hospital stay was (13.46 ± 4.78) days. The postoperative pathology showed that the circumferential margins and distal margins were all negative, the maximum tumor diameter was (3.26 ± 1.11) cm, the distance from the anal verge was (3.92 ± 0.89) cm, and the average number of lymph nodes cleared was (11.06 ± 3.67). There were 28 stage I patients (41.18%), 21 stage II patients (30.88%), and 19 stage III patients (27.94%). The median follow-up time after surgery was 28 months, and the rates of distant metastasis, disease-free survival, and overall survival of the patients were 8.82%, 91.18%, and 95.59%, respectively. The patient's postoperative anal function gradually recovered as time increased. Conclusions: Under the premise of strictly grasping the indications, the CLTPISR is a safe and feasible surgery. It could achieve maximum anal preservation and improve patients' QOL, while maintaining the tumor radical effect, and had the advantages of the short operation time, low intraoperative bleeding, and quick recovery. The Clinical Trial Registration number is LL2020397.

Application Value Analysis of Minimally Invasive Surgery for Hypertensive Intracerebral Hemorrhage

Application Value Analysis of Minimally Invasive Surgery for Hypertensive Intracerebral Hemorrhage

MP06-15 POST OPERATIVE BLEEDING AND THOMBOTIC RISK FOR PATIENTS ON NOVEL ORAL ANTICOAGULANTS (NOAC) THERAPY UNDERGOING UROLOGICAL SURGERY

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-15 POST OPERATIVE BLEEDING AND THOMBOTIC RISK FOR PATIENTS ON NOVEL ORAL ANTICOAGULANTS (NOAC) THERAPY UNDERGOING UROLOGICAL SURGERY Modassar Awan, Eloise Merriott, Sybghat Rahim, Ibrahim Khawaja, Sam Datta, Khalid Saja, and Zafar Maan Modassar AwanModassar Awan More articles by this author , Eloise MerriottEloise Merriott More articles by this author , Sybghat RahimSybghat Rahim More articles by this author , Ibrahim KhawajaIbrahim Khawaja More articles by this author , Sam DattaSam Datta More articles by this author , Khalid SajaKhalid Saja More articles by this author , and Zafar MaanZafar Maan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a paucity of urological published data on the risks of post-operative bleeding and thrombosis for patients that discontinue NOAC treatment perioperatively. The aim of this review was to establish the incidence of post operative bleeding and thrombotic complications for patients undergoing common, predominantly endourological procedures with a moderate or high risk of post-operative bleeding. METHODS: A review was undertaken for 109 successive patients on NOAC therapy undergoing urological surgery (99 males, 10 females, median age 75.7 years with the range of 48-92 years). Data from 58 patients was reviewed retrospectively, 51 patients prospectively. In all cases NOAC therapy was stopped and re-started peri-operatively on the basis of our local guidelines (Rahim et al, EAU 2017) or individualised haematological advice given to the pre assessment clinical team.Bleeding complications were noted and categorised accordingly: requiring blood transfusion, > 30 g/L Hb drop from baseline; haematuria requiring readmission; requirement for bladder washouts or a return to theatre. Electronic discharge summaries and patient notes linked to their respective primary care practices were used to search for any thrombotic events occurring within 30 days of NOAC therapy interruption. RESULTS: Of the 109 patients; 75 (68.8%) were on Apixaban, 22 (20.2%) on Rivaroxaban, 10 (9.2%) on Dabigatran, and 2 patients (1.8%) on Edoxaban. Procedures included TURBT (30), prostate biopsies (18), TURP (9), HoLEP (12), Ureteroscopy (15), prostate biopsies (18), other (25). The NOAC was stopped on average 49.7 hours prior to surgery. The NOAC was most commonly reinitiated 72 hours after surgery (median 72 hrs, mean 110 hrs, range 24-672 hrs). There was incomplete documentation for 37 patients on the timing of NOAC restart after surgery. Bleeding complications were noted in 4 patients (3.66%). Three of the 4 patients were on Apixaban (2.75%) and one patient was on Rivaroxaban (0.92%). One patient (0.92%) was taken back to theatre for bladder washout/cystodiathermy and the other three were managed satisfactorily with catheter irrigation. One patient (0.92%) required transfusion and two patients (1.84%) had a drop in haemoglobin (>30 g/L). It was noted that the NOAC was restarted later than recommended in two of the four patients with bleeding complications, as per the surgeon’s discretion. There were no thrombotic complications within 30 days of stopping NOACs in either the prospective or retrospective groups. CONCLUSIONS: Bleeding complications, after stopping and restarting NAOCs for patients undergoing predominantly endourological procedures appear to be uncommon (<4%). The bleeding rate is in keeping with established bleeding rates for TURP in publishes series. The risk of blood transfusion or return to theatre in our reviewed series was <1%. There were no thrombotic complications in the 109 patients reviewed within one month of surgery. Source of Funding: Nothing to declare © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e95-e95 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Modassar Awan More articles by this author Eloise Merriott More articles by this author Sybghat Rahim More articles by this author Ibrahim Khawaja More articles by this author Sam Datta More articles by this author Khalid Saja More articles by this author Zafar Maan More articles by this author Expand All Advertisement Loading ...

Analysis of risk factors for delayed bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm

Objective: To determine the potential risk factors of delayed hemorrhage after endoscopic submucosal dissection (ESD) in patients with early gastric carcinomas or precancerous lesions. Methods: The clinical data of 637 patients with early gastric carcinomas (EGC) who treated with ESD in Department of Endoscopy at Cancer Hospital, Chinese Academy of Medical Sciences, from August 2013 to August 2019, were retrospectively analyzed. Univariate analysis and multivariate logistic analysis were conducted to evaluate the risk factors associated with delayed bleeding. Results: A total of 699 lesions in 637 patients, of which 696 lesions were resected enbloc, the curative resection rate was 92.1% (644/699). The pathological diagnosis after ESD showed that 46 cases were low-grade intraepithelial neoplasia, 71 were high-grade intraepithelial neoplasia, and 582 were cancer. Delayed bleeding occurred in 74 lesions, while other 625 lesions without postoperative bleeding. The incidence was 10.6%. Compared with the non-bleeding group, there were statistically significant differences in the maximum length of the lesion, the gross shape of the lesion, the control of intra operative bleeding, and the operation time in the delayed bleeding group (P<0.05). Multivariate logistic regression analysis showed that the maximum length of the lesion and the gross shape of the lesion were independent factors of delayed bleeding after ESD. Delayed bleeding was inclined to occur in patients with lesion size ≥3.0 cm (OR=1.958, 95% CI: 1.162-3.299) and the superficial and flat lesion (OR=10.598, 95% CI: 1.313-85.532) after ESD. Conclusions: The maximum length of the lesion and the gross shape of the lesion are independent impact factors of delayed bleeding occurring in patients with EGC and precancerous lesions after ESD. Patients with lesion size≥3 cm, or superficial flat lesion should be paid attention after ESD operation. It needs to take timely measures to prevent the very likely bleeding in order to ensure postoperative recovery and improve the quality of life for postoperative patients.

The Endoscopic Submucosal Dissection Surgery in the Whole-Course Antegrade Endoscopic Approach: A More Effective Treatment Strategy for the Siewert II/III Type Mucosal Lesions of Esophagogastric Junction.

Objective: The purpose of this study was to investigate the safety and efficacy of endoscopic submucosal dissection (ESD) for treating cardiac mucosal lesions. Methods: A total of 86 patients with cardiac mucosal lesions were treated with ESD in retrograde endoscopic approach or antegrade endoscopic approach. The relationship between the two methods was analyzed according to the size, location, depth of pathological infiltration, classification, and examination results. The main evaluation indexes of intraoperative complications were operation time, bleeding, perforation, and complete resection (R0 resection). Results: Total R0 excision was performed in 85 patients and curative excision in 77 patients. When the diameter of lesion was 2-4 cm or >4 cm, the median treatment time in the antegrade endoscopic approach group was shorter than that in the retrograde group (P < .001, respectively). When the lesion was confined to the mucosa, the median treatment time in the antegrade endoscopic approach group was shorter than that in the retrograde group (P < .001). When the lesion was located in the posterior wall of the cardia, the average treatment time in the antegrade endoscopic approach group was shorter than that in the retrograde group (P < .05). When the lesion was located in the lesser curvature of the cardia, the average treatment time in the antegrade endoscopic approach group was shorter than that in the retrograde group (P < .001). Conclusion: The ESD surgery in the antegrade endoscopic approach is effective and safe for the treatment of cardiac mucosal lesions.

Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned

ObjectiveWe hypothesize that procedure deployment rates and technical performance with minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) can be enhanced in post-trial clinical practice, per Phase III trial results and lessons learned. Materials and MethodsWe identified ICH patients and those who underwent MISTIE procedure between 2017–2021 at a single site, after completed enrollments in the Phase III trial. Deployment rates, complications and technical outcomes were compared to those observed in the trial. Initial and final hematoma volume were compared between site measurements using ABC/2, MISTIE trial reading center utilizing manual segmentation, and a novel Artificial Intelligence (AI) based volume assessment. ResultsNineteen of 286 patients were eligible for MISTIE. All 19 received the procedure (6.6% enrollment to screening rate 6.6% compared to 1.6% at our center in the trial; p=0.0018). Sixteen patients (84%) achieved evaculation target < 15 mL residual ICH or > 70% removal, compared to 59.7% in the trial surgical cohort (p=0.034). No poor catheter placement occurred and no surgical protocol deviations. Limitations of ICH volume assessments using the ABC/2 method were shown, while AI based methodology of ICH volume assessments had excellent correlation with manual segmentation by experienced reading centers. ConclusionsGreater procedure deployment and higher technical success rates can be achieved in post-trial clinical practice than in the MISTIE III trial. AI based measurements can be deployed to enhance clinician estimated ICH volume. Clinical outcome implications of this enhanced technical performance cannot be surmised, and will need assessment in future trials.

Recent Updates in Neurosurgical Interventions for Spontaneous Intracerebral Hemorrhage: Minimally Invasive Surgery to Improve Surgical Performance.

The efficacy and safety of surgical treatment for intracerebral hemorrhage (ICH) have long been subjects of investigation and debate. The recent results of the minimally invasive surgery plus alteplase for intracerebral hemorrhage evacuation (MISTIE) III trial demonstrated the safety of the procedure and a reduction in mortality compared to medical treatment. Although no improvement in functional outcomes was shown, the trial elucidated that benefits of intervention depend on surgical performance: a greater ICH reduction, defined as ≤ 15 mL end of treatment ICH volume or ≥70% volume reduction, correlated with significant functional improvement. Recent meta-analyses suggested the benefits of neurosurgical hematoma evacuation, especially when performed earlier and done using minimally invasive procedures. In MISTIE III, to confirm hemostasis and reduce the risk of rebleeding, the mean time from onset to surgery and treatment completion took 47 and 123 h, respectively. Theoretically, the earlier the hematoma is removed, the better the outcome. Therefore, a higher rate of hematoma reduction within an earlier time course may be beneficial. Neuroendoscopic surgery enables less invasive removal of ICH under direct visualization. Minimally invasive procedures have continued to evolve with the support of advanced guidance systems and devices in favor of better surgical performance. Ongoing randomized controlled trials utilizing emerging minimally invasive techniques, such as the Early Minimally Invasive Removal of Intra Cerebral Hemorrhage (ENRICH) trial, Minimally Invasive Endoscopic Surgical Treatment with Apollo/Artemis in Patients with Brain Hemorrhage (INVEST) trial, and the Dutch Intracerebral Hemorrhage Surgery Trial (DIST), may provide significant information on the optimal treatment for ICH.

Laparoscopic vs open portoenterostomy in biliary atresia: a systematic review and meta-analysis.

Hepatoportoenterostomy remains the cornerstone of treatment for biliary atresia. Current employed techniques include laparoscopy and open surgery. This study aims to determine if either method provides an advantage. Following PRISMA guidelines, a systematic review was conducted. Nineteen studies were included. Mean operative time 34.98 (95% CI 20.10, 49.85; p ≤ 0.00001) was longer in laparoscopic while bleeding volumes -16.63 (95% CI -23.39, -9.86; p ≤ 0.00001) as well as the time to normal diet -2.42 (95% CI -4.51, -0.32; p = 0.02) were lower in the laparoscopic group. No differences were observed in mean length of stay -0.83. Similar complication, transfusions, postoperative cholangitis 0.97, and transplant free survival rates 1.00 (0.63, 1.60; p = 0.99) were seen between groups. Laparoscopic portoenterostomy provides advantages on operative time and bleeding as well as to normal diet when compared to open procedures. Both procedures showed no differences in length of stay, complications, cholangitis, and importantly, native liver survival. Level of evidence: III.

Acute traumatic abdominal wall hernia—value of the physical examination: case report

Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object with few cases reported. Perforations of the hollow viscera commonly follow abdominal trauma and likely require surgery for hemorrhage and sepsis source control. We report a case where a high velocity impact of the abdominal wall against the stump of a felled tree caused a TAWH with concomitant gastric perforation in a 20-year-old male patient who required exploratory laparotomy with primary repair of the stomach and fascia. The physical examination findings without previous history of abdominal hernia and pneumoperitoneum in the chest X-ray made suspect our diagnosis and it was confirmed intraoperatively. At 3 months postoperatively the patient has a strong abdominal wall. It is imperative to emphasize the importance of the physical examination goal of not losing diagnosis of TAWH.

Early experience of pure minimally invasive donor hepatectomy by junior surgeon

Although the pure minimally invasive donor hepatectomy (PMIDH) has been increasingly performed, it is still reported by experienced surgeons. Here we reported the early experience of PMIDM by junior surgeon. From April 2019 to November 2020, PMIDHs were performed for 19 patients by single novice surgeon (H.D.H) at Yonsei University College of Medicine. Clinical characteristics, perioperative outcomes of donors and clinical features of recipients were analyzed. Eighteen of 19 donors had pure laparoscopic liver resection. Right, left hemihepatectomies and left lateral sectionectomies were performed for 15, 1 and 3 donors, respectively. Mean total operation time was 460.63 ± 70.89 minutes and median operative bleeding was 200 mL (50-1,600 mL). Median hospital stay was 8 (7-11) days. In terms of laparoscopic donor right hemihepatectomy, mean total operation time was 464.21 ± 43.52 minutes. Median amount of bleeding during operation was 225 mL (50-1,600 mL). Mean estimated total liver volume was 1,228.26 ± 217.01 (935.80-1,584.90) and mean real graft weight was 764.86 ± 153.46 (529.00-1,077.00). The robotic donor right hemihepatectomy was performed for one donor. Total operation time was 663 minutes with 550 mL of operative bleeding. There was no conversion to open surgery. Only the first donor had transfusion during operation. There was no severe perioperative complication more than grade III according to classification of Clavien-Dindo surgical complication. Although the PMIDH may need high level of surgical skill, it appears to be a safe and feasible procedure by junior surgeon in properly selected donors.

Methods of Haemostasis and Restore of Bladder-urethral Segment During Retropubic Prostatectomy in Patients with Benign Prostatic Hyperplasia

The objective: to estimate methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia. Materials and methods. Analysis of methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia was performed. Results. Open retropubic prostatectomy (like transbladder prostatectomy) was recommended by European Association of Urology (EAU, 2020) as operation of first choice for surgical treatment big size prostatic hyperplasias. The authors gave such prevalences of retropubic prostatectomy over trans-bladder: operation is performed under visual control that gives haemostatic control of prostatic cavity and removing all parts of nodules; the bladder is not drainaged that avoids disuria in postoperative period, decreases postoperative bed-time and increases comfort for patients; urethra is cut by scissor in apical part of prostate that is prophylaxis tearing of urethra, trauma of exernal sphincter, stricture of memranaceas urethra and urine incontinence after operation; reconstruction of bladder-urethral segment is performed that is prophylaxis of stricture of bladder neck; surgeon can performed simultaneous hernioplasty and retropubic prostatectomy in case of inquinal hernia and benign prostatic hyperplasia. Arterial and venous blood supplying of bladder and enlarged prostate were wrote. Places of arterial and venous bleeding after cutting of prostatic capsule and removing nodules, prophylaxis suturing of arterial and venous bleeding places were noted. Original own methods of restoring of bladder-urethral segment and haemostasis of prostatic cavity by using two or three П-like catgut sutures were shown. For simplifying operation and decreasing time of performing operation and increasing haemostasis of prostatic cavity authors recommended performing passing haemostatic sutures throught prostatic capsule only once and linking of sutures on muscle peaces from rectus muscle (or pyramidal muscle). In case of absent bleeding from prostatic cavity the simplify method of bladder neck trigonisation by using two П-like catgut sutures or two V-like catgut sutures on bladder neck for prophylaxis of bladder neck stenosis was recommended (proximal trigonisation of bladder neck in prostatic cavity). Review of haemostatic merhods of prostatic cavity during retropubic prostatectomy was shown. Conclusion. Analysis of methods of haemostasis and restore of bladder-urethral segment and own original methods during retropubic prostatectomy in patients with benign prostatic hyperplasia allow improve haemostasis of prostatic cavity, prophylaxis of bladder neck and urethra stenosis, decrease intraoperative bleeding and period of operation.

Effects of intraoperative blood loss during liver resection on patients’ outcome: a single- center experience

Background/aim Operative bleeding is one of the major determinants of outcome in liver surgery. This study aimed to describe the impact of intraoperative blood loss on the postoperative course of liver resection (LR). Materials and methods The data of 257 patients who were treated with LR between January 2007 and October 2018 were retrospectively analyzed. LRs were performed via intermittent portal triad clamping (PTC) under low central venous pressure. Results LRs were performed for 67.7% of patients with a malignant disease and 32.3% of patients with a benign disease. Major LR was performed in 89 patients (34.6%). The mean PTC period was 20.32 min (±13.7). The median intraoperative bleeding amount was 200 mL (5–3500 mL), the 30-day mortality rate was 4.3%, and the morbidity rate was 31.9%. The hospital stay (p = 0.002), morbidity (p = 0.009), and 30-day mortality (p = 0.041) of patients with a bleeding amount of more than 500 mL significantly increased. Conclusion Surgeons should consider the adverse effects of intraoperative bleeding during liver resection on patients’ outcome. Favorable outcomes would be obtained with diligent postoperative care.

Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery.

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

Effect of pFNA internal fixation of senile fracture in maxillofacial injuries

To investigate the effect of proximal intramedullary nail (pFNA) internal fixation and hip replacement. Methods: 100 patients with rough fractures were selected from December 2012 to December 2015, fixed group with 50 patients in fixed group, hip replacement, incision length, intra operative bleeding, surgery, postoperative implantation, hospitalization, weight exercise time, complications and preoperative hip Harris scores. Results: incision length, intra operative bleeding, surgical time, complications were significantlylower than the replacement group, P &lt;0.05, and Harris scores were significantly higher than 3,6 months, P &lt;0.05), but the same (P&gt; 0.05). Conclusion: Hip replacement and pFNA internal fixation have good treatment effect, the former is conducive to the early activity of elderly patients, the latter has small trauma and less complication, which should be selected according to clinical needs. To sum up, hip replacement and pFNA internal fixation have good efficacy in the treatment of crude Cologne fractures in the elderly, the former is conducive to the early activity of the elderly patients, but the latter has small trauma and few complications, which should be selected according to clinical needs.

Comparative study between conventional adenoidectomy and adenoidectomy using micro-debrider

BackgroundAdenoidectomy is a common ENT procedure. This article aims to evaluate micro-debrider-assisted adenoidectomy as a substitute for the conventional curettage method.ResultsThe study aimed to compare between two study groups: micro-debrider-assisted adenoidectomy (group A) and conventional adenoidectomy (group B). The average time needed in group A was 34.1 min while it was 22.83 min in group B (p<0.001). The average amount of blood lost in group A was 29.57 ml and 16.67 ml in group B (p<0.001). The resection was nearly complete in group A, while in group B, five (16.66%) cases had more than 50% of the adenoid tissue left behind. Four cases in group B had damage to collaterals while in group A no major injuries were noted. Postoperative pain has only been studied in cases where adenoidectomy solely was done. Candidates in group A (n=8) reported a pain score of 3.5-3.09 whereas candidates in group B (n=11) reported a pain score of 2.75-2.55. The mean recovery time was 2.8 days in group A and 8.23 days in group B (p<0.001).ConclusionsEndoscopic adenoidectomy using micro-debrider is both an effective and safe adenoidectomy tool. The strengths of this technique include resection completeness, precise resection under vision, minor damage to collaterals, and a more rapid recovery period. Conventional adenoidectomy, however, scored better regarding lesser operative time and bleeding intraoperatively.

Association of Satellite Sign with Postoperative Rebleeding in Patients Undergoing Stereotactic Minimally Invasive Surgery for Hypertensive Intracerebral Haemorrhage.

There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery (MIS) for hypertensive intracerebral haemorrhage (ICH), and little is known about the relationship between satellite sign on computed tomography (CT) scans and postoperative rebleeding after MIS. This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS. We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission. Postoperative rebleeding occurred in 14 of 65 (21.5%) patients with the satellite sign on baseline CT, and in 5 of the 40 (12.5%) patients without the satellite sign. This difference was statistically significant. Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5% and 87.5%, respectively. Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding. In conclusion, the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.