Time Of Surgery Research Articles

Cumulative dissipated energy during phacoemulsification is Associated with bleb failure in eyes with prior trabeculectomy

IntroductionTrabeculectomy is the most effective method of lowering the intraocular pressure (IOP) in patients with open-angle glaucoma refractory to pharmacological treatment or laser trabeculoplasty. Many phakic glaucoma patients later require cataract surgery after trabeculectomy. The purpose of this study is to determine factors that predict bleb failure after phacoemulsification. MethodsThis retrospective, observational study included 33 eyes from 30 patients with open-angle glaucoma who had successful trabeculectomy with mitomycin (MMC) and subsequently underwent uncomplicated cataract surgery by means of clear corneal phacoemulsification performed by a single surgeon between 2006 and 2018. Bleb failure was defined as an eye that required the addition of two or more glaucoma medications or had an IOP > 21 mmHg at any follow-up visit more than one month after surgery. Kaplan-Meier analysis was conducted to visualize bleb survival over the two-year study period. ResultsTen eyes (30.3%) experienced bleb failure, at an average of 325 ± 254 days after phacoemulsification surgery. A further six eyes (18.2%) partially failed over this period. Blebs that remained fully functional (51.5%) two years after phacoemulsification surgery received lower total cumulative dissipated energy (CDE; 12.6 ± 7.2 versus 19.0 ± 7.7, P = 0.027). ConclusionHigher levels of ultrasound energy at the time of cataract surgery, as reflected by CDE, are associated with bleb failure. Removing cataracts at a stage when the lens is less dense so that it will require less total ultrasound energy and allow shorter duration for surgery may benefit eyes with functioning filtering blebs.

Airway Management in Pediatric Patients Undergoing Microvascular Free Tissue Transfer Reconstruction After Mandibulectomy

Microvascular free tissue transfer (MVFTT) for head and neck reconstruction is infrequently performed in pediatric patients. There is a paucity of data on perioperative airway management in pediatric MVFTT, such as the need for tracheostomy, which can pose higher morbidity to young patients due to potential long-term effects on the softer, more pliable laryngotracheal cartilage. Our objective was to report airway outcomes on pediatric patients undergoing MVFTT after segmental mandibulectomy with or without tracheostomy. Retrospective chart review of pediatric patients who underwent MVFTT reconstruction after segmental mandibulectomy at a tertiary care center from 2014 to 2023. Demographic variables, surgical characteristics, and hospital clinical outcomes were recorded. Statistical analyses were performed with JMP Pro, Version 16.0.0 (2021) SAS Institute Inc., Cary, NC, 1989-2021. Ten patients (median age 11.5 years old, IQR: 9.0-13.3) underwent fibular free flap reconstruction. Mandibular pathologies included 3 ameloblastoma, 2 mesenchymal chondrosarcoma, 2 desmoplastic fibroma, 1 Ewing sarcoma, 1 chondroblastic osteosarcoma, and 1 desmoid tumor. Two patients received upfront tracheostomy at time of initial surgery for a subtotal mandibulectomy and a sub-hemimandibulectomy, respectively. Both patients were decannulated within 1 week after surgery and prior to discharge. The median ICU and hospital length of stay for patients who underwent tracheostomy was 3.5 days [IQR: 3.0-4.0] and 8.5 days [IQR: 8.0-9.0] respectively. Of the remaining 8 patients without tracheostomy, surgical defects were hemimandibulectomy and anterior subtotal mandibulectomy. Median intubation duration was 1.0 day [IQR: 1.0-2.5]. The median ICU and hospital length of stay for these patients were 3.0 days [IQR: 2.0-6.3] and 8.5 days [IQR: 7.3-13.0], respectively. No patient had to be reintubated for respiratory failure following extubation or had long-term airway complications during the follow-up period. Fibular free flap reconstruction without tracheostomy can be feasible in pediatric patients with mandibular defects, which can potentially reduce hospital resources required for fresh tracheostomy care needs and avoid additional surgical morbidity. Further studies in larger populations and prospective approaches are warranted.

Immunological impact of intraperitoneal and intravenous chemotherapy in ovarian cancer, translational analyses of the Phase 3 iPocc trial

BackgroundThe iPocc trial, a randomized, global phase 3 study that compared intraperitoneal (IP) and intravenous (IV) carboplatin with dose-dense paclitaxel chemotherapy in epithelial ovarian cancer (EOC) patients, demonstrated improved progression-free survival in patients who received IP chemotherapy. The present study aimed to investigate the role of preexisting tumor immunity in the clinical outcomes of patients receiving IP chemotherapy. MethodsThis study involved analyzing patient data from the iPocc trial, selectively of those whose tumor specimens were preserved at the time of primary surgery. A total of 116 cases ((IP; n = 59), (IV; n = 57)) were subjected to microarray analysis. Single-sample gene set enrichment analyses were performed to evaluate the tumor immune microenvironment. ResultsPatients with enhanced tumor infiltration of T cells, natural killer (NK) cells, and cytotoxic lymphocytes in the IP group had a longer overall survival (OS) than those in the IV group, but not in the group with low infiltration. IP therapy improved the OS of patients with high expression of immune-related genes such as CD8A and FOXP3. In patients' subdivided into “immune Hot” and “immune Cold” groups based on hierarchical clustering analysis using four parameters representing “Innate immunity,” “T cells,” “IFNG response” and “Inhibitory molecules,” IP therapy significantly improved prognosis in the “immune Hot” group, but not in the “immune Cold” group compared to that of IV therapy. ConclusionsIP chemotherapy enhances the survival rates of patients with EOC with an immune-Hot phenotype in the tumor microenvironment prior to treatment.(Japan Registry of Clinical Trials number, jRCTs031180141.)

Effect of surgical timing on postoperative outcomes in patients with acute cholecystitis after delayed percutaneous transhepatic gallbladder drainage

BACKGROUND To date, the optimal timing for percutaneous transhepatic gallbladder drainage (PTGBD), particularly for patients who have missed the optimal window for emergency laparoscopic cholecystectomy (LC) (within 72 hours of symptom onset) has not been determined. AIM To study the effects of LC timing on outcomes of grade II/III acute cholecystitis (AC) in patients with delayed PTGBD. METHODS Data of patients diagnosed with Tokyo Guidelines 2018 grade II or III AC who underwent delayed PTGBD followed by LC at a single hospital between 2018 and 2022 were retrospectively studied. According to the interval between gallbladder drainage and cholecystectomy, the patients were divided into early and delayed LC groups. Outcomes including surgery time, postoperative complications and hospital stay, and patient satisfaction were analyzed and compared between the two groups using t - and χ 2 tests. RESULTS There were no significant differences between the two groups in intraoperative blood loss, postoperative abdominal drainage tube placement time, pain index, or total disease duration (all P > 0.05). Compared with those of the early LC group, the delayed group showed significant decreases in the length of procedure (surgery time), conversion rate to open surgery, degree of adhesions, surgical complications, postoperative hospital stay, and total treatment costs, and increased patient satisfaction despite a longer interval before PTGBD (all P < 0.05). CONCLUSION For patients with grade II/III AC with delayed PTGBD, LC should be performed 2 weeks after PTGBD to decrease postoperative complications and hospital stays and improve patient satisfaction.

Lower trapezius transfer to infraspinatus in cases of sequelae of obstetric brachial plexus injury

Abstract Background Deficient shoulder function is a common and exhausting issue in children with obstetric brachial plexus injuries. Even with functioning elbow, wrist, and fingers, upper limb function is markedly disabled by limited shoulder abduction external rotation. Lower trapezius transfer carries many advantages; simple and safe technique, same line of pull as donor; reliable nerve supply (extraplexal from spinal accessory nerve), and not acting on rotation of the shoulder, mostly it will not adversely affect internal rotation range after the transfer. This study aims to evaluate the role of isolated lower trapezius transfer in reconstructing shoulder external rotation. Materials and methods This prospective case series study included 20 patients with sequelae of obstetric brachial plexus injury lacking shoulder external rotation who underwent lower trapezius transfer to infraspinatus. In all cases, the lower trapezius muscle was the donor, and the recipient tendon was the Infraspinatus muscle. Shoulder range of motion, Modified Gilbert grading, and Mallet Classification were used to evaluate results. Results The mean age at the time of surgery was 4.5 years. The average increase in shoulder external rotation and abduction was 40⁰ and 42.5⁰ respectively, the modified Gilbert grading improved from a mean of 3.85 to 4.85 postoperative. Mallet classification improved from a mean of 3.5 preoperative to 4.8 postoperative. Improvement (Mallet classification of ≥ 4) was obtained in 18 cases (90%). Conclusion Isolated lower trapezius transfer is considered an effective option with promising results in cases of sequelae of obstetric brachial plexus injury for restoration of shoulder external rotation as well as abduction.

Effects of morning versus afternoon surgery on peri‐operative disturbance of sleep–wake timing: An observational study

AbstractIntroductionThe circadian timing system regulates diurnal sleep–wake rhythm. Previously, we showed that, in patients undergoing elective surgery, sleep–wake timing is altered and post‐operative sleep quality is reduced. However, how the timing of the surgical procedure affects the disturbance and what other factors affect this disturbance remain unknown.MethodsSingle‐centre prospective observational study investigating the influence of surgery timing on post‐operative sleep in adult patients (≥18 years) undergoing elective surgery. Sleep–wake timing was measured from three nights before until seven nights after surgery with a daily sleeping log. Primary outcome was post‐operative midpoint of sleep shift between patients undergoing morning and afternoon surgeries. Secondary outcomes included factors affecting sleep timing disturbance and changes in subjective sleep quality.ResultsWe included 259 patients: 144 patients underwent morning procedures (08:00 h–12:00 h) and 115 underwent afternoon procedures (12:00 h–17:00 h). Both groups had significant phase advance of midpoint of sleep on the night after surgery when compared with three nights before surgery (mean − 00:41 h, 95% CI −00:27 h to −00:54 h, p < .001, for morning surgery and mean − 00:28 h, 95% CI −00:09 h to −00:46 h, p = .003, for afternoon surgery). However, there was no between‐group difference (mean − 00:13 h, 95% CI −00:35 h–00:09 h, p = .25). Reduction of sleep quality was also similar. Phase advance was larger for patients with an evening chronotype or with lower pre‐operative sleep quality. Decline of sleep quality after surgery was larger for patients with an evening chronotype, longer procedures or better pre‐operative sleep quality.ConclusionOur results suggest that the timing of surgery between 08:00 h and 17:00 h does not modulate the effect of anaesthesia and surgery on phase of the sleep–wake rhythm in patients undergoing elective surgery with a low pre‐operative risk of delirium.Editorial CommentTiming of surgery may impact post‐operative sleep. However, in this prospective cohort study of elective surgical patients, sleep–wake timing and post‐operative sleep quality did not differ between those undergoing morning versus afternoon surgery.

Abstract C040: Spatial transcriptomics unveils disparities in tumor microenvironment dynamics between breast cancer responders and non-responders

Abstract Spatial transcriptomics is revolutionizing our understanding of cellular dynamics and interactions in the tumor microenvironment (TME). By mapping distinct cellular populations and their interactions, we can gain valuable insights into tumor behavior. To investigate these dynamics in breast cancer, we conducted Xenium In-situ spatial transcriptomics on twenty formalin-fixed paraffin-embedded (FFPE) samples taken from eight patients undergoing neoadjuvant chemotherapy. These samples have been taken pre-treatment, mid-treatment and post-treatment from four cases with pathological complete response (pCR), and four cases with residual disease (RD) at time of surgery. Our analyses have found distinct cellular composition changes between pCR and RD cases. Patients with RD demonstrated an increase in endothelial, perivascular-like (PVL) and epithelial cells from pre- to post-treatment. This was accompanied by a decrease in myeloid and malignant epithelial cells at mid-treatment. In contrast, patients with pCR demonstrated increases in cancer-associated fibroblasts (CAFs) and myeloid cells, with reductions in plasmablasts and cancer epithelial cells at mid-treatment. This suggests that an increase in CAF and myeloid cells observed between pre-treatment and mid-treatment samples may be predictive of response. We performed ligand-receptor (LR) analyses, which demonstrated diverse myeloid interactions in RD cases and diverse CAF interactions in pCR cases in pre-treatment samples. Mid-treatment samples exhibited a decrease in interactions for CAFs, myeloid and T cells in pCR and RD cases. The most frequently identified CAF LR interactions, as senders, were between TGFB1/TGFB3 and TGFBR1/TGFBR2, while the most frequently identified myeloid LR interactions were between PDCD1LG2 - PDCD1 (encoding PDL2 & PD1), CCL8 - ACKR1 (encoding Atypical Chemokine Receptor 1) and CCL2 - ACKR1. Our findings indicate that the dynamic changes in cellular composition and interactions within the TME differs between responders and non-responders. To further explore these differences, we plan to perform spatially constrained analyses to identify unique cellular niches that may serve as potential biomarkers for informing novel therapeutic strategies. Citation Format: Jeremy Mo, Hanyun Zhang, Kate Harvey, Alexander Swarbrick. Spatial transcriptomics unveils disparities in tumor microenvironment dynamics between breast cancer responders and non-responders [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C040.

Serous Tubal Intraepithelial Carcinoma (STIC): A Review of the Literature on the Incidence at the Time of Prophylactic Surgery

Background: Serous tubal intraepithelial carcinoma (STIC) is an early-stage cancerous lesion found in the fallopian tubes, often at the fimbrial end. It is strongly associated with high-grade serous carcinoma (HGSC), a highly aggressive type of ovarian cancer. STIC is considered a precursor to many HGSC cases, originating in the fallopian tubes. Its development is frequently linked to mutations in the TP53 gene, leading to the formation of a p53 signature, an early abnormality that may progress to HGSC. This signature is more common in BRCA mutation carriers, explaining the higher incidence of STIC in this group. The aim of this review is to evaluate the literature on the incidence of serous tubal intraepithelial carcinoma in patients (both BRCA-positive and BRCA-negative) undergoing preventive salpingo-oophorectomy, analysing the available data and identifying associations between specific characteristics and the onset of STIC. Methods: A comprehensive review of the literature from 2016 to 2023 was conducted using PubMed, focusing on studies analysing the incidence of STIC in BRCA-positive patients undergoing preventive salpingo-oophorectomy. Data on patient characteristics, interventions, outcomes, and incidence of STIC were extracted and analysed. Results: Nine international studies were included in the review, reporting varying incidences of STIC among patients undergoing salpingo-oophorectomy. The overall incidence of STIC in all the women included in the studies was 7.31%, while that in the BRCA-mutated women was approximately 6.08%. Notably, the presence of the TP53 signature was significantly associated with the occurrence of STIC. Conclusions: The etiopathogenesis of STIC involves complex interactions between genetic, environmental, and molecular factors. Further research is needed to fully understand its mechanisms and identify additional risk factors beyond BRCA mutations. Establishing a national database of STIC cases could facilitate future research and improve patient outcomes.

Influence of surgical timing on the visual prognosis of patients suffering from a pituitary apoplexy with visual impairment.

Pituitary apoplexy is a clinical syndrome that can cause vision loss and oculomotor (OM) deficits. Neurosurgical decompression is still considered the treatment of choice for those with visual impairment. We aim to explore the influence of timing of neurosurgical decompression on visual outcome. Multicentre retrospective study of patients presenting with pituitary adenoma and pituitary apoplexy who were operated in three Spanish tertiary hospitals between 2008 and 2022. We identified 49 patients with pituitary apoplexy with visual symptoms and were operated. Among the visual symptoms, 35 patients (73%) had visual acuity (VA) impairment and 33 (67%) had an OM nerve paresis. Twenty-three of the 35 patients improved their VA, and 24 of the 33 improved their OM nerve paresis after surgery. The median time between apoplexy to surgery was 10 days (range 0-164). Regarding visual acuity, 50% (3 out of 6) of those operated within 3 days of apoplexy showed improvement, compared to 69% (20 out of 29) of those operated beyond (p = 0.37).Regarding OM paresis, 62.5% (5 out of 8) of those operated within 3 days of apoplexy improved, compared to 76% (19 out of 25) of those operated beyond (p = 0.56).Mean apoplexy to surgery time was 18 ± 19 days in those whose VA improved (vs. 32 ± 51; p = 0.46); and mean apoplexy to surgery time for those whose OM symptoms improved was 21+/- 35 days (vs. 24 +/- 37; p = 0.86). Our results suggest that timing of neurosurgical decompression does not affect the visual outcome of patients with pituitary apoplexy.

The Punch Graft Technique: A Simplified Protocol for Three-Dimensional Peri-Implant Soft and/or Hard Tissue Augmentation in a Single Step.

This article describes a clinical protocol utilizing soft tissue augmentation alone or in combination with guided bone regeneration (GBR), introducing simultaneous application of the one abutment one time concept for three-dimensional reconstruction of the deficient ridge. Soft and hard tissue quality and dimensions are fundamental elements for long lasting results in implant dentistry. Different techniques have been described for soft and hard tissue augmentation at time of implant placement presenting favorable results. However, multiple abutment disconnections during the prosthetic phase of treatment can compromise the results achieved during surgery. The purpose of this article is to present a surgical protocol that allows three-dimensional ridge reconstruction involving soft tissue augmentation alone, or in combination with hard tissue augmentation in one single step with the use of an one-time intermediate abutment as an anchorage device for the regenerative materials. Two clinical cases utilizing the proposed protocol are also presented, demonstrating favorable results. The application of the proposed protocol simplifies the surgical phase of treatment, protects the achieved result and enables a favorable outcome in decreased time. Utilising an intermediate abutment as an anchorage device at time of surgery can be proven an easy to apply and biologically favorable alternative way to other methods of soft tissue graft stabilization proposed in the past.

Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study.

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures. The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications. The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%. In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.

Conversion of a muco-supported complete prosthesis into fixed implant-supported prosthesis using the NeoConvert™ solution in a maxillary rehabilitation with guided surgery and immediate loading

Modern dentistry has seen the development of different techniques aimed at improving patient satisfaction. Immediate loading and delivering a fixed implant-supported prosthesis at surgery time has become an option. This case report describes the clinical results of the immediate loading of a conventional complete denture converted into a fixed prosthesis on six implants placed under a guided surgery protocol. A male patient, systemically healthy, with total upper edentulism, attended the ILAPEO College to begin treatment with implants in the upper jaw. Six implants were placed under a guided surgery protocol, and then immediate loading was performed by converting the patient’s complete denture into a fixed prosthesis using the NeoConvert™ system. Immediate loading using the NeoConvert™ technique is a functional and predictable alternative, reducing clinical time and achieving great patient and clinician satisfaction.

The effective duration of systemic therapy and the neutrophil-to-lymphocyte ratio predict the surgical advantage of primary tumor resection in patients with de novo stage IV breast cancer: a retrospective study.

The primary tumor resection (PTR) of de novo stage IV breast cancer (DnIV BC) is controversial, and previous studies have suggested that the neutrophil-to-lymphocyte ratio (NLR) could be a poor-prognosis factor for BC. We investigated PTR's surgical advantage related to clinical outcomes, the surgery timing in responders to systemic therapy, and whether the NLR can predict the benefit of surgery for DnIV BC. We retrospectively analyzed the cases of the DnIV BC patients who received systemic therapies and/or underwent PTR at our institution between January 2004 and December 2022. Blood tests and NLR measurement were performed before and after each systematic therapy and/or surgery. Sixty patients had undergone PTR local surgery (Surgery group); 81 patients had not undergone surgical treatment (Non-surgery group). In both groups, systemic treatment was performed as chemotherapy (95%) and/or endocrine therapy (92.5%) (p < 0.0001). The groups' respective median progression-free survival (PFS) durations were 88 and 30.3 months (p = 0.004); their overall survival (OS) durations were 100.1 and 31.8 months (p = 0.0002). The Surgery-group responders to systemic therapy lasting > 8.1-months showed significantly longer OS (p = 0.044). The PFS and OS were significantly associated with the use of postoperative systemic therapy (p = 0.0012) and the NLR (p = 0.018). A low NLR (≤ 3) was associated with significantly better prognoses (PFS and OS; p < 0.0001). A longer effective duration of systemic therapy (> 8.1 months) and a low pre-surgery NLR (≤ 3.0) could predict PTR's surgical advantage for DnIV BC. These variables may help guide decisions regarding the timing of surgery for DnIV BC.

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up.

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Case series; Level of evidence, 4. Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Treatment of Pink Pulseless Hand Following Supracondylar Fractures of the Humerus in Children.

Background: Supracondylar humerus fractures (SCHF) in children are common and can lead to serious complications, including neurovascular injury. The optimal management of children with a 'pink pulseless' hand following such a fracture is unclear. This study aimed to ascertain an appropriate therapeutic approach for children with SCHF and a pink pulseless hand. Methods: A retrospective analysis of medical records from paediatric patients under 16 years old with SCHF and clinically perfused but pulseless hands between 1 January 2016 and 30 June 2021 was conducted. Clinical characteristics, imaging, treatment processes and follow-up results were analysed to predict arterial injuries requiring vascular repair and determine the optimal timing for exploratory surgery. Results: The study included 88 patients, predominantly male (58%) with an average age of 6 years. Most fractures resulted from falls onto outstretched arms. Satisfactory outcomes, indicated by the return of the pulse following closed reduction and percutaneous pinning (CRPP) alone, were seen in 66% of patients, negating the necessity for vascular exploration. Amongst patients with a persistently absent radial pulse 72 hours after CRPP, 83% were diagnosed with brachial artery injuries, with all such patients experiencing recurrent pulse loss after surgery. Conclusions: Urgent reduction and CRPP are effective initial treatments for children with SCHF and a pink pulseless hand. Immediate vascular exploration is generally not necessary in these patients. Further research is needed to determine the optimal management for persistent pulselessness and recurrent pulse loss. Level of Evidence: Level IV (Therapeutic).

The Influence of Timing of Surgery on Postoperative Length of Hospital Stay in Closed Ankle Fractures

The Influence of Timing of Surgery on Postoperative Length of Hospital Stay in Closed Ankle Fractures

Virtual surgical plan with custom surgical guide for orthognathic surgery: systematic review and meta-analysis.

The shift from traditional two-dimensional (2D) planning to three-dimensional (3D) virtual surgical planning (VSP) has revolutionized orthognathic surgery, offering new levels of precision and control. VSP, combined with computer-aided design/computer-aided manufacturing (CAD/CAM) technology, enables the creation of patient-specific surgical guides and implants that translate preoperative plans into more precise surgical outcomes. This review examines the comparative accuracy and operative efficiency of VSP, especially when used with custom surgical guides, against conventional 2D planning in orthognathic surgery. The study systematically reviewed and analyzed published literature comparing the accuracy and operative time between VSP and conventional planning methods. The meta-analysis included clinical trials, controlled trials, and observational studies on patients undergoing orthognathic surgery, focusing on the degree of alignment between planned and postoperative bone positions and total surgery time. Results indicate that VSP consistently reduces discrepancies between planned and actual surgical outcomes, particularly when integrated with custom surgical guides. Additionally, while VSP demonstrated potential time-saving advantages over conventional planning, these differences were not statistically significant across studies, likely due to high variability among study protocols and designs. VSP with custom surgical guides enhances surgical accuracy in orthognathic procedures, marking a significant advancement over traditional methods. However, the reduction in operative time was not conclusively significant, underscoring the need for further studies to evaluate time efficiency. These findings emphasize VSP's role in improving surgical precision, which holds substantial implications for future orthognathic surgical practices.

BS SO14 - Is there a correlation between preoperative HbA1c changes and long-term weight loss plus glycemic control in patients with type 2 diabetes undergoing metabolic surgery?

Abstract Background Optimization of patients with type 2 diabetes mellitus (T2DM) prior to metabolic surgery aims to achieve tight glycemic control by the time of surgery. Little is known about the influence of altering preoperative HbA1c on postoperative weight loss and glycemic control. The aim of this study was to determine whether a change in HbA1c during the preoperative period correlated with long term weight maintenance and HbA1c in patients undergoing metabolic surgery. The proportion of glucose-lowering medication used following surgery was also examined. Method Retrospective analysis was conducted of patients with T2DM who underwent metabolic surgery between 2013 – 2017. Preoperative HbA1c change was measured as change in glycemic control during the 1-year pre-surgery. Primary outcomes were % excess weight loss (EWL) and HbA1c at 5 years post-surgery. Secondary outcomes were % EWL and HbA1c at 1-year post-surgery and the use of glucose-lowering medications post-surgery. The Pearson correlation coefficient (r) was used to determine the relationship between the pre-surgery HbA1c change and postoperative % EWL and HbA1c. Chi-squared test was used to calculate the statistical impact of change in medication use post-surgery Results Sixty-nine patients with complete data were included in the study. The mean change in HbA1c in the 1-year pre-surgery, the 1-year post-surgery and 5-years post-surgery was -0.9% (± 1.5), -0.7% (± 1.2) and 0% (± 1.8), respectively. The change in HbA1c in the 1-year pre-surgery did not correlate with % EWL at 1-year and 5-years post-surgery or with HbA1c at 1-year and 5-years post-surgery. There was a significant decrease in the proportion of patients requiring glucose-lowering medications at 1-year and 5 years post-surgery (p&amp;lt;0.05). Conclusion This study demonstrated a significant reduction in the proportion of glucose-lowering medication required long-term following metabolic surgery. Altering pre-operative glycemic control was not associated with long term weight maintenance or glycemic control.

Dorsolateral Transdural Surgical Management of Spontaneous Intracranial Hypotension From Ventral Dural Cerebrospinal Fluid Leaks: Case Series and Technical Report

BACKGROUND and OBJECTIVES: Spontaneous intracranial hypotension is an uncommon but debilitating condition that commonly involves positional headaches and vertigo. One cause is cerebrospinal fluid (CSF) leakage from ventral dural defects from calcified spinal discs. Patients can undergo epidural blood or fibrin glue patches as treatment; however, in cases where the leak does not resolve, surgical repair of the dural tear may be warranted. We aim to describe a case series and technical notes for these patients. METHODS: Patients with spontaneous intracranial hypotension because of myelography-confirmed ventral dural defect from calcified thoracic disc, who were treated surgically between June 2020 and March 2024, were included in the study cohort. Demographic information, clinical course, and postoperative outcomes were collected. The surgical technique was also described based on an illustrative case. RESULTS: Twelve consecutive patients underwent surgery between June 2020 and March 2024 with postoperative records. The median age at the time of surgery was 41.5 years (range: 28-58 years). Male patients comprised 50% of the cohort. Dural defects were spread throughout the thoracic spine in the cohort. While all patients reported positional headaches, other symptoms included vertigo, pulsatile tinnitus, and neck pain. Median length of follow-up time was 6.5 weeks. There were no surgical complications or permanent neurologic deficits. All patients had radiologic cure of their leaks with absence of extradural CSF on postoperative MR imaging. Ten patients (83.3%) had complete resolution of spontaneous intracranial hypotension-related symptoms. Two patients did suffer from rebound headaches postoperatively. CONCLUSION: The dorsolateral transdural surgical approach is a safe and effective method to repair type 1 CSF leaks caused by ventral dural defects. Our case series of 12 patients did not involve any surgical or immediate postoperative complications, and all patients had radiologic resolution of their leaks with relief of positional headaches. Two patients experienced continued headaches after treatment.

A02 - BS Ethnic and Social Deprivation Influence Weight Regain Following Roux En-Y Gastric Bypass

Abstract Background Weight regain is a prevalent issue following Roux-En-Y Gastric Bypass (RYGB) surgery for obesity. This study aims to assess the impact of ethnicity and social deprivation on the likelihood of weight regain post-RYGB. Method We analysed data from Luton &amp; Dunstable Hospital. Key variables included patient demographics such as sex, age, ethnicity, social deprivation (Indices of Multiple Deprivation – IMD), American Society of Anesthesiologists (ASA) classification, and weight and Body Mass Index (BMI) at the time of surgery. Weight regain was defined as the regaining of more than 25% of the Total Body Weight Loss (TBWL) achieved after RYGB. Results Out of 1,346 patients who underwent RYGB, 80% were female. The median age was 48 years (IQR: 39-55), and the median BMI was 44.7 kg/m^2 (IQR: 40.6-50.1). At a median follow-up of 39 months, 20.7% experienced weight regain. Multivariable analysis showed that patients from Black (HR: 1.63, 95% CI: 1.33-1.81, p=0.009) and Asian (HR: 1.40, 95% CI: 1.23-1.71, p=0.011) ethnic groups, as well as those from more socially deprived backgrounds (HR: 2.39, 95% CI: 1.99 – 3.13, p&amp;lt;0.001), were more likely to experience weight regain compared to their White and more affluent counterparts. Conclusion Ethnicity and social deprivation significantly influence the likelihood of weight regain following RYGB. The factors contributing to these disparities are likely multifaceted, encompassing genetic, social, and educational elements. Early identification of patients at increased risk of weight regain and the provision of tailored resources can help mitigate this risk and enhance surgical outcomes.