Surgery In Asia Research Articles

Chronic kidney disease and metabolic surgery in Asia

Chronic kidney disease and metabolic surgery in Asia

Revision Surgery for Zygoma Reduction: Causes, Indications, Solutions, and Results from a 5-Year Review of 341 Cases

Many patients undergo a revision surgery after malar reduction, which is one of the most popular aesthetic surgeries in Asia. We reviewed the leading causes of revision for malar reduction surgery to establish proper indications for revision, seek adequate surgical strategies, and share the results from revision surgical cases. A retrospective review was conducted involving 341 patients who underwent malar reduction reoperation between March 2010 and June 2015. Surgical strategies were decided based upon specific problems and complaints from the previous surgery. Facial photographs, cephalography, and computed tomography images were analyzed, and a patient satisfaction survey was conducted before and after the surgery. A total of 341 patients (321 women, 20 men; average age, 26.6years, range 18-40years) were included. The main causes of reoperations were subjective dissatisfaction and nonunion-related symptoms. Undercorrection of the zygomatic body and arch (n=175, 51.3%) was the most frequent reason for dissatisfaction. The patients underwent revision surgeries via different techniques and strategies based on previous problems from primary surgery, and postoperative patient satisfaction was high. Complications occurred in 35 patients (10.3%) after revision. Based on the results of this study, patient dissatisfaction with the procedure can be minimized beforehand through accurate goal identification and careful planning. Bone nonunion is usually due to excessive bone resection during zygoma reduction surgery. Careful selection of the reposition site and appropriate fixation based on a thorough understanding of masseter action are essential in ensuring satisfactory outcomes without adverse side effects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Oncoplastic breast surgery in asia

Oncoplastic breast conservation surgery has given a new light to the options of performing breast conserving surgery by combining oncological principles of breast cancer surgery with plastic surgery techniques. The ultimate oncoplastic achievement would be the conversion of what normally would be considered as an oncologic and/or cosmetic failure when using standard techniques of breast conserving surgery into both oncological and cosmetic success and to avoid mastectomy where possible. Most Techniques are fairly well established. However surgical techniques may also need to be adjusted based on the cohorts that the treatment is offered to. For example, for larger breasts, the technique is more forgiving. However for smaller breast, there is still a limitation of the cosmetic outcome when a high percentage of breast volume has been excised no matter how good the technique or the surgeon is. Various aspects of oncoplastic breast surgery technique will be discussed and its applicability to Asian Cohorts.

A modified mini-incisional technique for double-eyelid blepharoplasty

Background Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. Objective To introduce a modified mini-incisional technique to form a double eyelid. Methods A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. Results The follow-up period was three to 12 months (mean nine months). Most of the double eyelids were natural. During the follow-up period, 92% (342 of 372) patients were satisfied with the blepharoplasty. The most common complications were swelling within first week after the operation, which subsided spontaneously. Asymmetries occurred in 17 patients; six patients had multiple eyelids and seven patients experienced shifting of the fold. These were corrected six months after the operation. Disappearance of the fold was not observed. The scars of the stab incision became invisible after one full year of recovery. No other severe complications were found. Conclusion The four mini-incisional blepharoplasty technique was successful for the formation of a natural-appearing and long-lasting double eyelid. Except for individuals with obvious skin redundancy, patients with a single eyelid are suitable candidates for the technique.

Combined Intraoral and Endoscopic Approach for Malar Reduction.

Malar reduction is one of the most solicited aesthetic surgeries in Asia,1,2 where wide broad cheek bones and/or prominent anterior malar projection are considered masculine causing an aged appearance from illusory temporal and buccal hollowing. Most Asian women prefer a slim oval face with smooth malar-to-cheek transitioning.3,4 Increasingly, these patients desire minimally invasive malarplasty with short downtime to create the ideal profile. When evaluating for malar reduction it is vital to determine which specific areas of the zygoma are causing concern.5 Patients may specify the exact area of malar prominence that they want corrected. Some have facial widening due to an excessively curved zygomatic arch and many techniques can correct this.6-19 Conversely, if the malar body is anteriorly prominent, correction should entail re-positioning of the entire zygoma complex . Thus a technique versatile enough to correct any part of the malar anatomy is desirable. The earliest described reduction malarplasty was bone-shaving,3 and subsequent techniques entailed zygomatic arch resection, arch infracture,4 or osteotomy and repositioning of the entire zygomatic segment.20 Several effective malarplasty procedures – each with their pros and cons - can be categorized into intraoral approaches, external approaches, and a combination of both (Table 1). The technique we present avoids problems associated with previous methods2,9,21-23 through the major advantages of using a combined intraoral and external-endoscopic approach. View this table: Table 1. Pros and Cons of Different Malarplasty Approaches Any facial asymmetry, deviation or deformity was fully documented and communicated to the patient using preoperative photographs, since these may be corrected during the procedure or postoperatively become more obvious. Posterior-anterior and inverted Towne’s view cranial radiographs and 3D facial computed tomographic (CT) scanning were done - the latter particularly important for analyzing asymmetrical malar …

Aesthetic Plastic Surgery in Asians: Principles and Techniques

Lee L.Q. Pu, Yu-Ray Chen, Qing-Feng Li, Woffles Wu, Dae-Hwan Park, Susumu Takayanagi, Fu-Chan Wei, eds. Aesthetic Plastic Surgery in Asians: Principles and Techniques . Boca Raton, FL: CRC Press, Taylor and Francis Group, 2015. ISBN-13: 978-1482240870, ISBN-10: 1482240874. $450.00. ![Graphic][1] Aesthetic Plastic Surgery in Asians : Principles and Techniques is the culmination of a monumental effort by well-known experts in the field, Dr Lee L.Q. Pu and his six coeditors. The magnitude of this undertaking is astounding since it involves 90 contributors from multiple Asian countries. This beautiful two-volume set is very timely since the popularity of aesthetic plastic surgery in Asia is skyrocketing with no limit in sight. The two volumes consist of 74 chapters under 10 major sections and also include four chapters on breast reconstruction. In Asia, breast reconstruction is usually considered cosmetic in nature. The set also includes three DVDs and a complimentary eBook version. The quality of writing and editing is excellent. This by itself is a testament to Dr Pu and his coeditors since many of the authors come from countries where English is not their first language. Many chapters include remarks on pertinent differences between Asian and Caucasian anatomy. High quality artwork and images run throughout the book along with clear tables and algorithms. Each … Corresponding Author: Dr Clyde H. Ishii, 1329 Lusitana Street, Suite 304, Honolulu, HI 96813, USA. E-mail: cishii{at}ishiiplasticsurgery.com [1]: /embed/inline-graphic-1.gif

Is Elective Gastroscopy Prior to Bariatric Surgery in an Asian Cohort Worthwhile?

The preoperative use of gastroscopy for patients undergoing bariatric surgery remains controversial. We aim to evaluate the diagnostic yield of gastroscopy and the clinical significance in asymptomatic individuals undergoing bariatric surgery in Asia. We retrospectively reviewed the medical records of all patients undergoing gastroscopy prior to bariatric surgery at the National University Hospital and Khoo Teck Puat Hospital, Singapore, between Jan 2006 and June 2013. Gastroscopy findings were classified into four groups: group1 (normal study), group2 (abnormal findings that do not modify surgical approach), group3 (abnormal findings that modify surgical approach) and group4 (absolute contraindications to immediate surgery). During the study period, 208 asymptomatic individuals were evaluated by gastroscopy prior to bariatric surgery. Gastroscopy was normal in 70 (33.6%). Group2 comprised 67 (32.2%) patients with mild gastritis or oesophagitis. Group3 included 69 (33.2%) patients diagnosed with erosive gastritis or oesophagitis, peptic ulcer disease, hiatal hernia or mass lesions. There were 2 patients (1.0%) in group4. One patient had a gastro-oesophageal junction adenocarcinoma, and 1 had a gastrointestinal stroma tumour. In group3, modification of surgical approach included concurrent hiatal hernia repair, institution of medical therapy with delay in surgery, further evaluation of mass lesions and change in choice of surgical procedures. Routine gastroscopy for asymptomatic bariatric patients has a high diagnostic yield. Given the high percentage of patients with clinically important lesions, our current experience supports the use of routine preoperative gastroscopy prior to bariatric surgery in Singapore.

A modified mini-incisional technique for double-eyelid blepharoplasty.

Double-eyelid blepharoplasty is one of the most popular cosmetic surgeries in Asia. To introduce a modified mini-incisional technique to form a double eyelid. A total of 372 patients (325 women, 47 men) were involved in the study between July 2008 and August 2014. Their age ranged from 16 to 34 years, with a mean age of 24 years. All patients underwent the modified mini-incisional upper blepharoplasty. In the technique, four 2 mm incisions were made along the designed fold. The orbicularis muscle overlying the levator aponeurosis was removed. The removal of the lateral fat pad was completed accordingly. The medial fat pad was also removed if necessary. Suture was used to fix the skin to pretarsal fascia along the double-eyelid line. The double-eyelid crease was formed after the operation. The follow-up period was three to 12 months (mean nine months). Most of the double eyelids were natural. During the follow-up period, 92% (342 of 372) patients were satisfied with the blepharoplasty. The most common complications were swelling within first week after the operation, which subsided spontaneously. Asymmetries occurred in 17 patients; six patients had multiple eyelids and seven patients experienced shifting of the fold. These were corrected six months after the operation. Disappearance of the fold was not observed. The scars of the stab incision became invisible after one full year of recovery. No other severe complications were found. The four mini-incisional blepharoplasty technique was successful for the formation of a natural-appearing and long-lasting double eyelid. Except for individuals with obvious skin redundancy, patients with a single eyelid are suitable candidates for the technique.

Early Course of Inflammatory Bowel Disease in a Population-Based Inception Cohort Study From 8 Countries in Asia and Australia

The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study. We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis. The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%. In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.

Investigation of Nasal Mobility in Asians and its Change After Alloplastic Augmentation

Augmentation rhinoplasty is one of the most popular cosmetic surgeries in Asia, and both dorsal augmentation and mobile nose modifications are emphasized for the characters of the Asian nose and for Asians who are fond of the Western nasal shape. The goal in rhinoplasty is to create a balanced and natural appearance. Therefore, the cosmetic aspects, postoperative complications, and functional aspects should be regarded as a whole. In fact, the first 2 aspects had been widely reported in a large number of literatures. However, the functional aspects about mobility have been ignored by most surgeons. A sample method was used in this article to investigate the range of mobility of normal nasal tip in Asians and analyze the correlations of the nasal mobility and alloplastic materials. A total of 170 healthy adult subjects aged from 18 to 35 were included and were classified into 3 groups standing for normal nose and rhinoplasty with L-shaped silicon implants with e-PTFE implants. A 3D raster surface scanner was used to capture the images of the subjects accurately and rapidly in this detailed anatomical study. The range of nasal mobility (to right or left) in Asian normal women was 35.53 ± 4.84 degrees, and the length of mobile part was 16.62 ± 1.94 mm, which accounts for 40% ± 5% of nasal length. The L-shaped alloplastic implants would reduce the nasal mobility, and there had been differences among the changes caused by different implants, which might cause unsatisfactory outcomes in patients. Results of the study indicated that augmentation rhinoplasty should be performed as well as augmented mammaplasty which attaches importance not only to the static and dynamic appearance of the nasal tip but also to the feeling when it is touched.

Keys to the successful indexing of the archives of plastic surgery in science citation index expanded.

Recently, we were invited to attend the workshop for members of the Editorial Board of the Archives of Plastic Surgery (APS) to share our experience of the Science Citation Index Expanded (SCIE) indexing of the Journal of Neurogastroenterology and Motility (impact factor [IF] of 2013, 2.698). The Editor-in-Chief wanted us to review two issues of APS and to comment on them. Through this experience, we assessed the strengths and weaknesses of APS and how to compensate for the weaknesses. APS, the official journal of the Korean Society of Plastic and Reconstructive Surgeons, is published six times a year, every other month. This journal is a peer reviewed and open access journal, the full text of each article is available online, and the articles are required to be written in English. The self-analyzed IF has been estimated at 0.6-0.9 points [1,2]. To our understanding, APS has major strengths. Among the parts of a paper, the abstract part looks very good; it is framed by a colored box, which allows readers to identify it with ease. Likewise, the figures are arranged with appropriate size and with high resolution, drawing readers into the articles. Thanks to the editor's effort, the majority of articles in the past two years of publication were submitted by non-Korean authors. In 2012, only 10 papers were published from 7 countries excluding Korea, while 49 papers were published from 23 countries in 2013 [3]. In addition, open access online has increased the accessibility of this journal. However, some parts of the journal require correction in order to continue to build APS to a higher level academic journal. First of all, APS includes case reports and images. Although the impact factor is an absolute standard for assessing the quality of a journal, many academic journals use the impact factor as an indicator for evaluating the impact of articles. Since case reports and images are less likely to be cited in other journals than original articles and reviews, they play a role in undermining the impact factor of the articles overall. Therefore, APS needs to place greater emphasis on reviews and original articles than case reports and images. Secondly, the fact that the records on research approval have been omitted from many articles of APS is also a matter of general concern. Many academic journals recently have begun to emphasize strict research ethics and require Institutional Review Board (IRB) approval only for prospective but also retrospective research. For example, all of the original articles published in Plastic and Reconstructive Surgery Journal in August 2014 specify research approval, whereas 9 of 16 original articles recently published in APS in July 2014 have neither research approval nor IRB approval. Thirdly, the fact that the regulations for submission have been complied with well and the fact that the format has been standardized is also problematic. Although the submission rules for the figure title of APS say to use a short tile with 5-7 words, 3 out of 16 articles published in July 2014 did comply with the rules. In addition, 4 out of 16 articles did exactly indicate the roles of authors, and 4 articles reported P-values in ways that were incompatible with the rules. Many articles have used various expressions, such as X, not significant, NS, to indicate that there is no statistical significance, and the phone numbers of authors have several formats. The fact that the way to express the decimal places in tables varies in different articles also needs to be corrected. In summary, to increase its IF, APS needs to increase the proportion of original articles relative to case reports, and to endeavor to publish review articles on recent problems or issues in order for the journal to move toward publishing articles with a stronger impact. In addition, APS needs to indicate IRB or research approval in the methods part of all articles and maintain uniformity among articles by locating the research approval or statistical methods in the same place. In addition, assigning someone other than the editors to uniformly define the format and content of the role of authors and phone numbers may take the journal one step further toward excellence. APS is the only plastic surgery clinical journal in English published in Korea, and its influence is expanding throughout Asia and beyond. We expect that APS can develop into an academic journal that leads plastic surgery in Asia in the near future through the improvements mentioned above.

Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database

Data on the incidence of venous thromboembolism (VTE) following major surgery in Asian populations are limited. Using the Korean Health Insurance Review and Assessment Service database, we performed a nationwide population-based epidemiologic study to estimate the incidence of VTE after major orthopedic, cancer, and benign surgeries. VTE cases were identified from all patients undergoing major surgery between 2007 and 2011 using both diagnostic and drug codes as treatment evidence of VTE within 5weeks of surgery. We also calculated the relative risk of VTE in major orthopedic and cancer surgery compared to benign surgery. The overall rates of postoperative VTE were 1.24%, 0.67%, and 0.05% for major orthopedic, cancer, and benign surgeries, respectively. Hip fracture (1.60%) and colorectal cancer surgeries (1.67%) were associated with the highest rates of VTE, and the rates steadily increased during the study period. Advanced age, female sex, and general anesthesia were independent risk factors for VTE. Patients undergoing surgery for colorectal, pancreatic, ovarian, and esophageal cancer, and major orthopedic surgery had a > 20-fold higher risk of VTE than those undergoing benign surgery. This is the largest epidemiologic study to investigate the incidence of VTE after major surgery in Asia, demonstrating that the rates of postoperative VTE are lower than in Caucasian populations. This study contributes to a better understanding of the differences in postoperative VTE development between Korean and Caucasian populations; the data also suggest that perioperative prophylactic strategies in Asians should be based on studies of such populations.

The Rate and Mortality of Postoperative Venous Thromboembolism of Moderate Risk Surgery in Asian Patients without Thrombo‐prophylaxis: Systematic Review with Meta‐analysis

The general gynecologic and neurologic surgeries are regard as carrying moderate risk for postoperative venous thromboembolism (VTE). This review analyzed the postoperative VTE rate of these surgeries in Asia. Inclusion criteria were: prospective study; deep vein thrombosis (DVT) diagnosed by venography, ultrasonography, or radionucleotide scan; and no thromboprophylaxis. The pooled proportion was back calculated from Freeman-Tukey variant transformation, using a random effect model. Medline, EMBASE, Cochrane Library, and KoreaMed were searched. Fourteen studies (total population of 1,625) published from 1974 to 2008 were included. In general surgery, the pooled rate of all-sites proximal, isolated distal DVT was 13.4, 2.1, and 11.8 % (radionucleotide scan). The cancer patients carried a higher all-sites DVT rate (19.7 % radionucleotide scan and 17.4 % ultrasound). Gynecologic and neurologic surgery had 3.1 % (ultrasound) and 3.8 % (radionucleotide scan) all-sites DVT rate. For general, gynecologic, and neurologic patients, the pooled rates of symptomatic DVT were 1.5, 0.2, and 1.0 % respectively. The pooled rate of symptomatic pulmonary embolism (PE) was 0.4 % for general surgery. No patients died from PE (pooled rate 0.2 %); however, a single PE death was reported in the excluded study. Postoperative symptomatic VTE was relatively low in Asia. Further study is required to stratify VTE risk and the need for thromboprophylaxis in individual patients.

Practical Outcome of Adjuvant FOLFOX4 Chemotherapy in Elderly Patients with Stage III Colon Cancer: Single-center Study in Korea

Elderly patients derive similar benefits from 5-fluorouracil-based adjuvant chemotherapy in Stage III colon cancer; however, conflicting data exist regarding additional benefit from oxaliplatin, fluorouracil and leucovorin (FOLFOX) chemotherapy. Single-center, retrospective analysis was performed to compare the safety and efficacy of adjuvant oxaliplatin, fluorouracil and leucovorin-4 chemotherapy in older patients (age ≥65 years) with younger patients with Stage III colon cancer after surgical resection. Among 391 patients with Stage III colon cancer, 229 patients received adjuvant oxaliplatin, fluorouracil and leucovorin chemotherapy (87 (43.5%) ≥65 years old versus 142 (74.3%) <65 years old). Older patients had similar clinico-pathological characteristics as younger patients except for higher Charlson-Age comorbidity score (median 3.44 versus 2.85, P < 0.01). The estimated 3-year disease-free survival (76.5 versus 80.0%, P = 0.88) and 3-year overall survival (90.9 versus 92.7%, P = 0.98) were similar. Grade 3-4 neutropenia was the only toxicity with higher frequency in the elderly patients (62.1 versus 46.5%, P = 0.02). Elderly patients received a lower relative dose intensity of oxaliplatin (0.76 versus 0.79) and 5-fluorouracil (0.75 versus 0.80, P = 0.009). Adjuvant oxaliplatin, fluorouracil and leucovorin chemotherapy resulted in similar efficacy without significant increase in toxicity in older patients aged ≥65 when compared with younger patients with curatively resected Stage III colon cancer. Therefore, for colon cancer patients aged ≥65, oxaliplatin, fluorouracil and leucovorin chemotherapy can be recommended as safe and effective adjuvant chemotherapy after curative surgery in Asia.

Lateral facial contouring via a single preauricular incision

Many Asians have faces with prominent zygomas, and therefore reduction malarplasty is one of the most frequently undergone surgeries in Asia, including South Korea. It is performed using various surgical approaches (external, intraoral, bicoronal or their combination). The reduction technique that is the most effective, safest and with the lowest morbidity needs to be determined. From December 2005 to January 2010, 1652 patients who wanted to undergo zygoma reduction for purely aesthetic reasons were operated on using a novel technique that we have developed (the 3S technique), which is a simple and safe surgical technique that results in only a short scar. First, under local anaesthesia, a 13- to 15-mm-long skin incision is made at each sideburn. The subperiosteal dissection is continued anteriorly all the way to the body of the zygoma. Zygoma reduction is then performed in three steps: (1) malar shaving (lateral area of the zygoma body), (2) lateral corticotomy (zygomatic arch) and (3) full-thickness osteotomy (pretubercular area of the temporomandibular joint). Next, the zygomatic arch is displaced medially with digital pressure (infracture). Finally, a Silastic drain is inserted through the incision site, skin repair is completed and a gentle compressive dressing is applied. Most of the patients were satisfied with the results of the operation. This technique provides the following advantages: (1) it is simple and safe because it is performed under only local anaesthesia; (2) only one scar is created at the sideburn; (3) no foreign bodies, such as wires or miniplates, are used; and (4) it is minimally invasive, and as such there are fewer potential complications (e.g., no cheek drooping due to a wide muscle incision or dissection, less oedema and bleeding and a short hospitalisation time). The presented technique is simplerand more effective than previously described surgical techniques for reduction malarplasty.

Predictors of diabetes remission after bariatric surgery in Asia

Obesity and type II diabetes mellitus (T2DM) are closely related and difficult to control by current medical treatment. Bariatric surgery has been proposed for inadequately controlled T2DM in association with obesity. However, prediction of successful T2DM remission after surgery has not been clearly studied in Asian patients. This information might be helpful for applying gastrointestinal surgery as metabolic surgery for T2DM. This was a retrospective clinical study. From January 2002 to December 2008, 88 consecutive patients with morbid obesity, who were enrolled into a surgically supervised weight loss program, and who had T2DM before surgery with at least 1 year complete follow-up data were included. Sixty-eight (77.2%) patients received gastric bypass procedures, and the remaining 20 (22.8%) received restrictive procedures. We analyzed the available information during the initial evaluation of patients who were referred for bariatric surgery, by logistic regression analysis and data mining methods for predictors of successful diabetes remission after surgery. Overall, 68 (77.2%) of the 88 patients had remission of their T2DM 1 year after surgery. Patients in the bypass group had a higher remission rate than those in the restrictive group [59/68 (86.7%) vs. 9/20 (45.0%), p=0.000]. In univariate analysis, patients who had T2DM remission after surgery were younger, heavier, had a wider waist, less severe disease, shorter duration, and higher C-peptide levels than those without remission. Type of operation and T2DM duration remained independent predictors of success after multivariate logistical regression analysis (p<0.000). Data mining analysis confirmed that T2DM duration was the most important predictor. Bariatric surgery is a treatment option for T2DM. Duration of diabetes is the most predictor of success after surgery.

IFSO-APC Consensus Statements 2011

Associations of BMI with body composition and health outcomes may differ between Asian and European populations. Asian populations have also been shown to have an elevated risk of type 2 diabetes, hypertension, and hyperlipidemia at a relatively low level of BMI. New surgical indication for Asian patients should be discussed by the expert of this field. Forty-four bariatric experts in Asia-Pacific and other regions were chosen to have a voting privilege for IFSO-APC Consensus at the 2nd IFSO-APC Congress. A computerized audience-response voting system was used to analyze the agreement with the sentence of the consensus. Of all delegates, 95% agreed with the necessity of the establishment of IFSO-APC consensus statements, and 98% agreed with the necessity of a new indication for Asian patients. IFSO-APC Consensus statements 2011. Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities. Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30. The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5. Other eight sentences are agreed with by majority of the voting delegates to form IFSO-APC consensus statements. This will help to make safe and wholesome the progress of bariatric and metabolic surgery in Asia.

Ocular surface area changes after double eyelidplasty

Double eyelidplasty is one of the most common cosmetic surgeries in Asia. Subjective enlargement of the ocular surface area (OSA) after double eyelidplasty was appreciated by patients. Objective measurement of the OSA provides a more scientific result. We introduce a relatively precise method, using iris as a scale combined with the digital photography and software calculation, to measure the OSA before and after double eyelidplasty. One hundred and nineteen patients (108 females and 11 males) were enrolled in this study. Ninety-two patients received minimally invasive double eyelidplasty without other procedures and 27 patients received medial epicanthoplasty with modified Z-plasty besides double eyelidplasty. Digital photographs of the operative eyes in all patients were obtained preoperatively and postoperatively. The image processing software we used was ImageJ (v1.43, National Institutes of Health, United States). Preoperative and postoperative OSAs were measured. The percentage of difference of the OSA between two eyes in same patient before and after the operation was calculated and compared. The average increase of the OSA among 238 operative eyes was 12.5±8.2%. Preoperative and postoperative OSA differences between two eyes in same patients were significantly decreased after surgery. Digital photography using iris as a scale combined with software calculation is an easy and convenient method to measure the OSA; it provides quantitative information for both preoperative and postoperative evaluation. Our study revealed that double eyelidplasty not only increased OSA but also improved ocular asymmetry after surgery.

Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low‐risk populations: a nationwide study in Taiwan

Thromboprophylaxis should be universally administered in major orthopedic surgery. However, epidemiology of venous thromboembolism (VTE) following major knee surgery in Asia is scarce. To describe the use of thromboprophylaxis and calculate the incidence and risk factors of symptomatic VTE following major knee surgery in Taiwan. We used Taiwan's National Health Insurance Research Database to retrospectively identify patients (≥45 years) who underwent major knee surgery from 1998 to 2007 and collected the medical records within 3 months after the discharge. Logistic regression analysis was used to determine the risk factors of symptomatic VTE after the surgery. We identified 113 844 patients (mean age, 69.0 ± 7.7 years; female, 75.2%) receiving major knee arthroplasties. The mean length of stay was 9.1 ± 3.3 days. The overall pharmacological thromboprophylaxis rate was 2.2%. The 3-month cumulative incidence of procedure-related symptomatic VTE was 0.46% (95% CI, 0.42–0.50%). The median time to the first post-operation VTE was 7 days, with 85.4% occurring within 2 weeks after the discharge.Logistic regression analysis showed that previous VTE, malignancy, heart failure and neurologic disorder with extremity paralysis or pararesis were independent risk factors (P < 0.05) for symptomatic VTE following major knee arthroplasties. The thromboprophylaxis rate is low, which may be due to the very low incidence of symptomatic VTE after the surgery in Taiwan. Most symptomatic VTE occurred within 2 weeks after the surgery. Universal thromboprophylaxis for knee arthroplasties may not be necessary in Taiwan, but it should be considered in some high-risk populations.

Postoperative Endophthalmitis following Cataract Surgery in Asia

Postoperative endophthalmitis is a rare clinical occurrence. However, it remains one of the most serious complications following cataract surgery because of its poor prognosis. We investigated the epidemiologic trends in postoperative endophthalmitis following cataract surgery, particularly in Asian populations. The incidence of postcataract endophthalmitis was generally consistent with epidemiologic data reported from Caucasian populations. The most frequently occurring causative organism was coagulase-negative Staphylococci in most studies of Asian populations. However, Pseudomonas aeruginosa and Nocardia were found to be the most common microorganisms in several studies. The rates of culture positivity were slightly lower than in Caucasian studies. In the evaluation of risk factors of poor visual outcomes, initial visual acuity and virulence of the causative microorganisms were generally found to be the most important risk factors. A history of pars plana vitrectomy was found to be the major risk factors for developing endophthalmitis in several studies.