Surgery Research Articles

EGS SO32 - Management of Spontaneous Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how these should be optimally managed. Endoscopic Vacuum Therapy (EVT) has emerged as safe and effective option particularly in cases where major invasive surgery would otherwise be deferred. Herein, we sought to explore the effectiveness, patient benefit and related morbidity/mortality by exploring the strategy outcomes in SOPs prior to and during periods where EVT was available. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=72) presented or transferred to our tertiary oesophagogastric unit for SOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or perforation secondary to malignancy, iatrogenic, traumatic or food bolus were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day, 1-year mortality. Results In 2009-2017 pre-EVT period, 25/72 patients were managed a) 18/25 surgically with thoracotomy and T-tube, b) non-surgical 7/25, four were palliated. 30-day, 90-day mortality were 4/25 and 2/25, 90-day morbidity Clavien-Dindo >IIIa 14/25 (56%), 90-day reintervention 8/25 (32%), median LOS 27 days. In 2018-2023 EVT period , 47/72 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 18/47, b) non-surgical 15/47, c) endoscopy 6/47, d) EVT in 14/47. 30-day mortality was 6/47, 90-day mortality 2/47, 90-day morbidity Clavien-Dindo >IIIa 32/47 (68%), 90-day reintervention 26/47 (55.3%), median LOS 34 days. 1-year mortality was 5/25 and 3/47 respectively. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of spontaneous oesophageal perforations. Optimal patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is recommended as soon as such a diagnosis is confirmed.

EGS SO30 - Management of Iatrogenic Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass non-operative for early perforation without sepsis, endoscopic with endoclip/stent and surgical including primary repair, exclusion and diversion or oesophagectomy. Recently, Endoscopic Vacuum Therapy (EVT) has been introduced as safe and effective alternative approach. We sought to assess treatment outcomes in patients with IOPs prior to and during periods where EVT was available as treatment option. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=30) presented or transferred to our tertiary oesophagogastric unit for IOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or spontaneous perforation secondary to malignancy or benign pathology were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day and 1-year mortality. Results In 2009-2017 pre-EVT period, 11/30 patients were managed a) non-surgically 7/11, b) endoclip 3/11 and stenting 1/11. 30-day and 90-day mortality were 1/11, 90-day morbidity Clavien-Dindo >IIIa 3/11 (27.3%), 90-day reintervention 8/11 (72.7%), median LOS 27 days. In 2018-2023 EVT period, 19/30 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 5/19, b) non-surgical 7/19, c) IR NJT, stent or PEG in 6/19 d) EVT in 4/19. 30-day mortality was 0/19, 90-day mortality 1/19 (5.2%), 90-day morbidity Clavien-Dindo >IIIa 7/19 (36.8%), 90-day reintervention 9/19 (47.4%), median LOS 61 days. 1-year mortality was 0/19 for both. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of iatrogenic oesophageal perforations. Careful patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is a sine qua non.

REGULARITIES OF DEVELOPMENT AND FORMATION OF EMBRYOTOPOGRAPHY OF THE THYROID AND PARATHYROID GLANDS IN HUMAN EMBRYOS OF 7-9 WEEKS OF GESTATION

The article describes the peculiarities of development and formation of variants of external shape and localization of thyroid and parathyroid glands in human embryos of 7-9 weeks of gestation.Aim of the study. The objective of the study was to fi nd the regularities of development and formation of embryotopographic relations between the thyroid and parathyroid glands during 7-9 weeks of the human intrauterine development. Material and methods. The study was carried out using a complex of morphological methods on 42 samples of human embryos without external signs of anatomical deviations or developmental defects. The specimens were taken from the museums of the Department of Human Anatomy of M. H. Turkevytch and the Department of Anatomy, Clinical Anatomy and Operative Surgery of the Bukovinian State Medical University.Results and discussion. In embryos with parietococcygeal length (PCL) of 14,0-17,0 mm intensive organogenesis processes of thyroid gland occur: separation of gland lobes, loss of connection with aortic arch and establishment of close correlations with laryngeal rudiment and vagus nerves. Therefore, the thyroid gland becomes semicircular. In embryos with 18,0-24,0 mm PCL there is a separation of the isthmus from the lateral lobes of the thyroid. Initially it is caused by intensive growth of the cricoid arch. Gradually the gland becomes H-shaped and fragmentation of the caudal part of the thyroglossal duct occurs. When the PCL reaches 29.5-31.0 mm, folliculogenesis begins and the thyroid gland becomes horseshoe- shaped. 9-week embryos show clear individual variations in the external shape of the thyroid gland: semicircular, H-shaped, and horseshoe. Areas of undiff erentiated epithelial tissue are found in the thyroid parenchyma, especially in its center.Conclusions. The conducted study has shown that during the 7-9 weeks of intrauterine development the structural organization of the thyroid and parathyroid rudiments becomes more complicated. Tight embryotopographic relations are established between them. Vascularization intensifi es and the connective tissue capsules of the thyroid and parathyroid glands are formed. At the same time their linear dimensions increase rapidly.

Abstract 4120469: Racial and ethnic disparities in catheter based interventions vs. open heart surgery in congenital heart disease

Introduction: Transcatheter cardiac interventions have emerged as a viable alternative to open heart surgery for specific congenital heart disease lesions. There is literature to support racial and ethnic disparities in medicine, indicating that patients from racially and ethnically marginalized populations are less likely to receive advanced less invasive procedures. This study seeks to delve into the existence of such inequities between transcatheter and surgical interventions, shedding light on potential inequalities in access and outcomes. Methods: We analyzed California and Florida's State Inpatient and Ambulatory Surgery Databases from 2005 to 2017 to study patients under 18 admitted with diagnosis of atrial septal defect, pulmonary stenosis, aortic stenosis, and ventricular septal defects. Multivariable logistic regression, adjusted for patient characteristics, assessed race and ethnicity's influence on procedure type and in-hospital mortality. We also used log-transformed linear regression to examine associations with length of stay, hospitalization cost, and cost per day. Results: We identified 13,771 records who had open surgeries, and 2,045 records who had CBI. Compared to non-Hispanic White patients, Black patients were significantly more likely to undergo open surgical procedures (adjusted Odds Ratio [aOR] 1.49, p < .001). Additionally, Black, Hispanic, and other race patients had higher risks of in-hospital death (aOR 1.92, p = 0.016 for Black; aOR 1.93, p < 0.01 for Hispanic; aOR 2.37, p < 0.01 for other races). Black and Hispanic patients also experienced longer lengths of stay (Adjusted Means Ratio [aMR] 1.34, p < 0.01 for Black; aMR 1.16, p < 0.01 for Hispanic), and higher costs (aMR 1.12, p = .01 for Black; aMR 1.11, p = .01 for Hispanic), but Black patients had a lower cost per day (aMR 0.96, p = .02). Conclusion: Racial and ethnic gaps persist in pediatric cardiac care, with Black patients facing reduced access to less invasive procedures, higher mortality rates, longer hospital stays, and increased costs compared to non-Hispanic whites. However, the higher costs are likely attributed to longer hospital stays rather than expensive interventions. It is imperative to tackle these disparities to prioritize patient-centered care and streamline resource allocation in healthcare.

PREVENÇÃO E TRATAMENTO DA COMUNICAÇÃO BUCO-SINUSAL EM PROCEDIMENTOS ODONTOLÓGICOS: REVISÃO DE TÉCNICAS CIRÚRGICAS E BIOMATERIAIS

Oroantral communication (OAC) is a frequent complication in dental procedures, especially in extractions of upper posterior teeth due to the anatomical proximity to the maxillary sinus. This review addresses the main surgical techniques and the use of biomaterials in the treatment of OAC, based on articles published between 2010 and 2024, found in databases such as PubMed and Scielo. Risk factors like the proximity of dental roots to the floor of the maxillary sinus and advanced age increase the likelihood of OAC, with cone-beam computed tomography (CBCT) being an effective tool in preoperative evaluation. Minimally invasive surgical techniques, such as controlled osteotomy and piezosurgery, have been effective in preventing perforations, while biomaterials like collagen membranes and bone grafts are widely used in treating larger perforations, promoting bone regeneration and healing. The combination of appropriate sutures and biomaterials is essential to avoid postoperative complications such as chronic sinusitis and fistulas. The review concludes that despite advances in surgical techniques and the use of biomaterials, gaps remain in the literature regarding the management of complex perforations, highlighting the need for more comparative studies to optimize OAC treatment. An integrated approach—including preoperative evaluation, appropriate surgical techniques, and postoperative follow-up—is crucial for treatment success and the reduction of long-term complications.

Factors contributing to severe scoliosis after open chest surgery for congenital heart disease: a case-control analysis.

Previous reports have identified factors associated with open chest surgery for congenital heart disease (CHD) and scoliosis. However, these reports included conditions such as Down syndrome and Marfan syndrome, which involve both cardiac disease and scoliosis. The relationships between these factors and open chest surgery remain unclear. This study aimed to identify factors contributing to severe scoliosis in CHD patients who have undergone open chest surgery. Seventy-four post-CHD surgery patients with severe scoliosis (Scoliosis group) and 30 post-CHD surgery patients without scoliosis (NS group), excluding those with any syndrome or intellectual disability, were retrospectively analyzed. Patient background characteristics and radiographic parameters were compared between the NS and Scoliosis groups. Furthermore, the patients in the Scoliosis group were classified into three categories, namely, mild scoliosis, moderate scoliosis, and severe scoliosis, and the results were compared among the four groups. Eighteen patients in the NS group and 63 in the Scoliosis group met the inclusion criteria. Compared with the NS group, the Scoliosis group included significantly more girls and patients who had younger ages at first CHD surgery and multiple open chest surgeries. Severe scoliosis progression was observed in patients who underwent multiple surgeries for severe CHD with cardiomegaly. Progression to severe scoliosis was noted in patients with younger ages at first CHD surgery and those who underwent multiple surgeries for severe CHD. Assessing spinal deformities should be a key aspect of postoperative care for CHD, particularly in patients with severe CHD who are undergoing multiple chest surgeries. III.

Clinical Presentations and Treatment Approaches in a Retrospective Analysis of 128 Intracranial Arteriovenous Malformation Cases

Background: Intracranial AVMs are a highly heterogeneous group of lesions that, while not very common, can pose significant risks. The therapeutic management of AVMs is complicated by ambiguous guidelines, particularly regarding which Spetzler–Martin grades should dictate specific treatment options. This study analyzed the clinical presentations and treatment approaches of 128 brain AVM cases managed between 2014 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. Methods: A retrospective analysis was conducted on patient demographics, clinical symptoms, Spetzler–Martin categorization, nidus localization, therapeutic management, and outcomes. Statistical analysis was performed using Python 3.10. Results: In our cohort of patients, the median age was 45 years, with a slight male predominance (67 males, 61 females). At admission, 51.5% presented with elevated blood pressure. The majority of patients had a Spetzler–Martin score of 2 (37.5%), followed by scores of 3 (31.3%) and 1 (20.3%). Treatment strategies included microsurgical resection in 32% of cases, conservative management in 31.2%, Gamma Knife radiosurgery in 22.6%, and endovascular embolization in 13.3%. Notably, open surgery was predominantly chosen for Grade II AVMs. The functional outcomes were favorable, with 69.5% achieving a good recovery score on the Glasgow Outcome Scale. Only four in-hospital deaths occurred, all in patients who underwent open surgery, and no deaths were recorded during the two-year follow-up. Conclusions: AVMs within the same Spetzler–Martin grade display considerable complexity, necessitating personalized treatment strategies. Our findings highlight the limitations of open surgery for Grade I cases but affirm its effectiveness for Grade II AVMs.

Do Antibacterial Skin Sutures Reduce Surgical Site Infections After Elective Open Abdominal Surgery?—A Prospective, Randomized Controlled Single-Center Trial

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified.

Results of a German nationwide survey on perioperative cardiac management in vascular surgery.

This article is based on a survey from 2018 of heads of German vascular surgical departments or units regarding their experience with perioperative cardiac management. The questionnaire asked about the experience with preoperative cardiac evaluation and its extension, awareness of perioperative myocardial ischemia, the art of postoperative monitoring and the routine use of the best medical treatment. In total, 62% of responders agreed that perioperative myocardial ischemia is a relevant postoperative problem in their clinic after open abdominal aortic surgery, while 47% stated the same after vascular surgery (VS) like carotid endarterectomy, peripheral arterial surgery or EVAR. Preoperative cardiological evaluations are performed routinely by 87% of responders before open abdominal aortic surgery and by 42% before VS. Preoperative cardiac evaluation included cardiac echography in 92% and stress diagnostics (stress echography, stress ECG) in 38%. Routine preoperative cardiac catheterisation is performed in 4% before OAS and only 0.5% before VS. In addition, 79% of participants initiate acetylsalicylic acid routinely and 68% use statins preoperatively. The serum troponin diagnostic test in asymptomatic patients was routinely applied by 19% of responders after OAS and by 6% after VS. Perioperative myocardial ischemia is considered a relevant problem, primarily after aortic surgery. The preoperative cardiac stress diagnostics among vascular surgeons does not seem to be sufficiently widespread. The preoperative initiation of acetylsalicylic acid and statins is not routine in 30% of hospitals.

Staged dissection reduces blood loss in surgery for metopic synostosis.

Fronto-orbital remodelling for metopic synostosis is an extensive operation with substantial blood loss, particularly from emissary veins in the glabellar region. One possibility to reduce blood loss may be to stage dissection and cauterise anomalous emissary veins before dissecting in the subperiostal plane. OBJECTIVE: The aim of the present study was to compare perioperative bleeding using a staged dissection in the glabellar region with the traditional subperiostal dissection technique during surgery for metopic synostosis. All consecutive patients operated for metopic synostosis with the new staged dissection technique (T2) were included. For comparison, the most recent equal number of cases operated with the traditional dissection technique (T1) were included. Age, sex, weight, surgical technique (spring or bone graft), perioperative blood loss, perioperative blood pressure, per- and postoperative blood transfusion, operation time and length of hospital stay were registered. RESULTS: A total of 80 patients were included; 40 T1 and 40 T2, respectively. Perioperative blood loss was significantly reduced with the new staged dissection technique. Blood loss in absolute numbers was reduced from 160.0 (120-240) (median and (interquartile range)) ml to 150 (102.5-170.0) ml, p=0.028. Blood loss in relation to patient weight was reduced from 24.2 ml/kg (15.3-33.3) to 18.7 (16.6-23.1) ml/kg, p=0.024. As percentage of total blood volume, blood loss was reduced from 32.3 (20.3-32.3) % to 29.9 (18.4-30.8) %, p=0.024. No other variables differed significantly between the techniques. CONCLUSION: In summary, staged dissection technique in the glabellar region, allowing control of the emissary veins, reduces perioperative blood loss during surgery for metopic synostosis.

Abstract 4140138: Coronary Artery Vasculopathy in a Cohort of 321 Heart Transplant Recipients: A Single Center Experience

Introduction: Despite advances in surgical techniques, organ preservation methods and immunosuppressant medications, the ten-year survival for orthotropic heart transplantation (OHT) remains around 50%. Coronary artery vasculopathy (CAV), among other factors, seems to have an important role in accelerated organ injury and failure. Aim: To determine the rate of survival and CAV development along with associated factors in a cohort of OHT recipients. Methods: Patients who underwent OHT at Virginia Commonwealth University (VCU) between October 2008 and September 2021 were retrospectively reviewed until June 2024. According to the VCU protocol, right heart biopsies were done weekly for the first month, every other week for the second month and at the first year mark post transplant. Left heart catheterizations were done one year after OHT and then at 2 year intervals. Survival, CAV development and need for percutaneous coronary interventions (PCI) as well as organ rejection rates in CAV patients were surveyed. Results: A total of 321 patients received OHT during that period with a median follow up time of 8.15 years from the date of transplant. Of these, 122 patients had 10-year follow up or more post OHT (53.27% survived) and 240 patients had 5-year follow up or more (66.25% survived). All patients had greater than 2.75 years of follow up. The overall mortality was 29.5%. CAV occurred in 55 patients out of 321 (17%) with median time of 2.82 years for CAV development. Mortality in the CAV group was 40% compared to 27% in the non-CAV group. Out of 55 patients with CAV, 19 required at least 1 PCI with 3 requiring interventions on chronic total occlusions. Evidence of rejection on right ventricle biopsy was observed in 51% of patients with CAV Conclusion: Our cohort had above average 10-year survival rate compared to the national data. Results revealed CAV is common post OHT and has implications on long term survival. Given CAV may develop in the absence of organ rejection, further studies are needed to identify factors associated with CAV and explore optimal treatment options that would potentially improve long-term survival post OHT.

Clinical Outcome and Quality of Life after Modular Reverse Total Shoulder Arthroplasty in Comparison with Joint-Preserving Locking Plate Osteosynthesis in Aged Patients: A Retrospective Comparison Study.

Proximal humeral fractures (PHFs) show a high incidence in aged patients. While nondisplaced fractures achieve good results by conservative treatment, surgical procedures are discussed controversially. Next to open reduction and internal fixation (ORIF), the primary use of reverse shoulder arthroplasty (RSA) has become increasingly important. The aim of this study was to investigate the clinical function, activities of daily living (ADL), as well as pain assessment in patients with PHFs, treated by ORIF or RSA. A retrospective comparison study was assessed. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF or RSA of the proximal humerus, were included in this study. Pain was measured by numeric rating scale (NRS). ADL were obtained by Katz-Index and SF-12. Moreover, shoulder function was assessed using the Oxford Shoulder Score (OSS). The maximum range of motion (ROM) was also recorded. From November 2011 to March 2016, 34 patients (17 matched pairs) that had undergone either ORIF (Figure or RSA of the proximal humerus) were included in this study. For statistical analyses, Student's t-test, Wilcoxon test, and Chi-Quadrat test were used. Statistical significance was indicated with p < 0.05. Totally 34 patients with an average age of 76.6 years were included. Surgical treatment was performed on average 5.2 days after diagnosis, differing significantly between the two groups (RSA/ORIF: 6.9/3.5 days) The operation time of RSA (97 min) was significantly longer than for ORIF (78 min). Pain assessment, as well as the Katz-Index and the SF-12, showed no significant differences. Moreover, clinical shoulder function showed no significant discrepancies between the two surgical techniques. Aged patients with PHFs treated with RSA display similar results regarding clinical function, ADL as well as pain perception compared with ORIF. However, revision surgery rate was lower in patients who underwent RSA. Thus, the surgical treatment of PHFs by RSA represents an excellent alternative, especially with regard to an aging patient population.

Possibly more favorable short‐term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high‐volume center study

AbstractBackgroundMinimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short‐term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated.MethodsWe retrospectively compared short‐term outcomes between MTG and OTG for locally advanced gastric and esophago‐gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders.ResultsIn total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien–Dindo classification (C‐D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra‐abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C‐D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C‐D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C‐D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen.ConclusionsMTG for locally advanced gastric cancer may provide improved short‐term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.

Abstract 4119303: The New Strait-Jacket Designed for Endovascular Therapy Reduces the First Reperfusion Time of Emergency Thrombectomy for Stroke

Introduction: Conscious sedation during cerebrovascular interventional surgery can shorten the time of vascular recanalization and bring significant benefits to patients, but patients are often difficult to cooperate, which affects the operation of interventional surgery. This study aims to develop a novel cerebral vascular intervention strait-jacket and explore its safety and effectiveness in emergency cerebral vascular intervention surgery. Methods: Using the convenient sampling method, patients with acute large artery occlusion stroke who underwent emergency mechanical thrombectomy in Zhongnan Hospital of Wuhan University from September 2018 to March 2021 were selected as the research objects. The control group was treated with conventional restraint belt, and the experimental group was treated with new cerebrovascular interventional surgery strait-jacket. The first reperfusion time, total operation time, modified Rankin score (mRS) at 30 days, intraoperative limb prolapse rate, average surgical cost, and safety indicators were compared between the two groups. The t test, Mann-Whitney U test or Fisher exact test were used for comparison between groups according to the data type. A p&lt;0.05 indicated statistical significance. Results: The new type of cerebrovascular interventional surgical strait-jacket developed in this study are shown in Figure 1, which have been patented and transformed into products. A total of 140 patients were included for mechanical thrombectomy, randomly divided into an experimental group (n=69) and a control group (n=71). Using the new strait-jacket significantly shortened the first reperfusion time (43.5±13.7 vs 50.7±15.7, P=0.039) and the total operation time (81.1±12.6 vs 93.2±21.1, P=0.027). There was a significant decrease in limb dislodgement rate (0% vs 35.2%, P&lt;0.001) and a noticeable reduction in average surgical cost (76315±12400 vs 81462±14142 P=0.040) by using the strait-jacket. In terms of safety performance, using the strait-jacket significantly lower rates of skin redness than the control group (8.7% vs 42.3%, P&lt;0.001). Conclusion: The new type of cerebrovascular interventional surgical strait-jacket is safe, which can effectively shorten the operation time, reduce the rate of intraoperative limb prolapse and the average operation cost, and can bring good social benefits.

Abstract 4136085: The Prognostic Impact of Thrombocytopenia at 6 months after Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Study

Background: Transient thrombocytopenia after transcatheter aortic valve replacement (TAVR) is a common phenomenon. Thrombocytopenia after TAVR during the perioperative period has been reported to impact prognosis. However, the impact of thrombocytopenia in the mid-term post-TAVR period is currently unknown. Methods: A retrospective observational study was conducted on 1405 patients who underwent TAVR from May 2016 to February 2023 at four institutions. Of these, 850 patients were analyzed. Patients who underwent dialysis (67), converted to an open chest surgery (8), had a Valve-in-Valve procedure (30), underwent a direct aortic approach (16), had a malignant tumor (66), and patients whose platelet levels could not be measured at 6 months after TAVR due to death or dropout were excluded from the analysis. The clinical follow-up occurred at 1, 6, and 12 months after the procedure. Laboratory testing was conducted before TAVR, during the perioperative period, 1 month post-procedure, and 6 months later. The decrease in platelet count (DPC) 6 months after TAVR was calculated by the following formula: [(Baseline platelet – 6 months platelet)/baseline platelet *100]. A receiver operating characteristics curve was plotted for all-cause mortality at 1 year and DPC at 6 months. The calculated cutoff value for the DPC at 6 months (28.68%) was utilized to classify and compare the two groups. Multivariate logistic regression models were also used to examine the association between the DPC at 6 months and all-cause mortality at 1 year. Adjusted for propensity score matching, the DPC was compared at 6 months in self-expandable and balloon-expandable prosthetic valves. Result: Of the 850 eligible patients (age: 85.5 ± 4.9 years), 31 (3.4%) died between 6 months and 1 year after TAVR. The DPC at 6 months after TAVR was 11.9 ± 22.5%. Multivariate logistic regression analysis including the DPC at 6 months, age, gender, and STS score showed that the DPC at 6 months was independently associated with all-cause mortality at 1 year (odds ratio: 1.03, 95% confidence interval: 1.005-1.046, p=0.01). After adjustment for propensity score matching, the balloon-expandable prosthetic valve had a higher rate of thrombocytopenia at 6 months (15.0% vs. 9.6%, p=0.04). Conclusion: The DPC at 6 months after TAVR may predict all-cause mortality at 1 year.

Integrated surgical intervention for intradural extramedullary hemangioblastoma of the cervical spine: a case report and literature review

IntroductionThe incidence of hemangioblastoma is low, constituting only 1-5% of all spinal cord tumors. Specifically, intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome represents an exceedingly rare condition.MethodsWe report the first documented case of cervical intradural extramedullary hemangioblastoma in China. A 53-year-old male patient presented with a 3-year history of mild right hemiplegia, segmental muscle strength and sensation impairment, and a positive pyramidal tract sign. MRI showed an abnormal oval signal focus in the intradural and extramedullary region at the C6-C7 vertebral level. Before surgery, angiography was performed to identify the supplying arteries and draining veins. Subsequent interventional therapy achieved over 90% occlusion of blood vessels, creating optimal conditions for complete resection of the spinal tumor.ResultsThe patient demonstrated satisfactory postoperative recovery with significant restoration of sensory and motor functions. Pathological examination showed a significant upregulation of CD31 in tumor cells and a substantial presence of the neuro-specific marker S100 in the tumor stroma, consistent with the diagnostic criteria for spinal hemangioblastoma.ConclusionThe rarity of cervical intradural extramedullary hemangioblastoma without Von Hippel-Lindau syndrome was reaffirmed by a comprehensive review of the existing literature. Complete tumor resection remains the optimal approach for managing this uncommon condition, generally resulting in a favorable prognosis. Traditional open fenestration surgery is linked to elevated risks of bleeding and trauma. Meanwhile, endovascular injection of embolic agents may lead to residual lesions and an increased risk of recurrence. Therefore, we recommend a one-time combined treatment conducted in a hybrid operating room to achieve complete resection and effectively reduce intraoperative bleeding risk. Despite presenting challenges and requiring high proficiency, we still recommend this type of combined surgery as a suitable therapeutic option for such diseases.

Comparing the Effect of Topical Lignocaine and Bupivacaine in Nasal Packs for Pain Relief in Post Operative Nasal Surgery Patients

This randomized controlled trial compared the analgesic efficacy of lignocaine, bupivacaine, and placebo nasal packs in patients undergoing nasal surgeries, including septoplasty and functional endoscopic sinus surgery (FESS). A total of 100 patients, aged 18–60 years, were randomly assigned into three groups: lignocaine (n=34), bupivacaine (n=33), and placebo (n=33). Postoperative pain was assessed using the Visual Analog Scale (VAS) over 24 hours. Additional analgesic requirements, side effects, recovery time, and length of hospital stay were recorded. Bupivacaine provided significantly lower pain scores at all intervals compared to lignocaine and placebo (p &lt; 0.05). The bupivacaine group had a lower need for additional analgesics (39.4%) compared to lignocaine (76.5%) and placebo (81.8%) (p = 0.041). Side effects such as nausea and vomiting were similar across all groups. The bupivacaine group experienced a shorter hospital stay (2.0 days) compared to the lignocaine (2.5 days) and placebo (3.0 days) groups (p = 0.038). In conclusion, bupivacaine-soaked nasal packs offer superior pain relief, reduce the need for additional analgesics, and shorten hospital stays, making it a preferable option for postoperative pain management in nasal surgeries.

A Novel Preoperative Classification System for Selecting Suitable Surgeries in Liver Transplant Patients with Portal Vein Cavernous Transformation

Background To evaluate the new preoperative Changgung classification (CC) system of portal vein thrombosis (PVT) in choosing suitable operative procedures to reconstruct portal veins during liver transplantation (LT) in patients with portal vein cavernous transformation (PVCT). Methods This retrospective observational study analyzed data from allograft LTs performed for various liver diseases Results The study included 22 males and 4 females with LT indications comprising cirrhosis (n = 9), hepatocellular carcinoma (n = 12), PVCT (n = 2), liver failure from fulminant hepatitis B (n = 1), dysfunction of transplanted liver (n = 1), and chronic rejection of transplanted liver (n = 1). Patients were classified according to Yerdel (21 Yerdel II and 5 Yerdel III) and CC (C1–C5). In total 16 simple operations were performed on C1–C3 cases and 9 complex operations on C4–C5 cases, with one additional simple operation. The distribution according to the Yerdel classification was 16 simple and 5 complex operations in Yerdel II cases and 1 simple and 4 complex operations in Yerdel III cases. The median follow-up time was 27.5 months with overall one-year and three-year OS rates of 88.1% and 83.9% for the cohort. Specifically, the one-year OS rates for patients classified as C1-3 vs. C4-5 were 93.3% and 80.0%, while the three-year OS rates were 86.7% and 80.0%, respectively (p = 0.526). Conclusion The CC proposed in this study shows comparable potential to the Yerdel classification in preoperatively identifying the need for complex surgical techniques in LT patients with PVCT and may also have predictive power for the survival benefits following LT.

Subretinal tissue plasminogen activator without vitrectomy for submacular hemorrhage displacement using Nano-vitreoretinal gateway device: A pilot report

Purpose: To evaluate the surgical outcome of subretinal tissue plasminogen activator (tPA) delivered without vitrectomy for the displacement of submacular hemorrhage (SMH). Method: A retrospective interventional cases series of consecutive patients who underwent subretinal tPA and intravitreal expansile gas without vitrectomy for SMH displacement. Concomitant injection of subretinal air and intravitreal ranibizumab and expansile gas was performed per surgeon’s discretion. Results: Seven eyes from 7 patients were included. 6 eyes (85.7%) had polypoidal choroidal vasculopathy (PCV) and 1 (14.3%) had wet age-related macular degeneration (wAMD). The median baseline visual acuity (VA) was 0.014 (range 0.005-50.1) ETDRS letters, which improved to 35 (range 26.3-65.1), 35 (range 31.0-73.9), 35 (range 35-77.3) and 35 (range 5-80.2) ETDRS letters at 1 week, 1 month, 3 months and 6 months, respectively. Visual gain of ≥5 letters was achieved in majority of patients through 6 months. Successful displacement of blood away from fovea was achieved in 100% of eyes. The rate of postoperative vitreous hemorrhage, retinal pigment epithelium tear and macular hole were 14.3% (1 patient) each. Conclusion: This novel, minimally invasive surgical technique is effective in displacing SMH and preserving vision.

Implementation of Robotic-Assisted Sacrocervicopexy for Apical Organ Prolapse Using the Semitendinosus Tendon-Pilot Study and Analysis of Clinical Outcome.

This video demonstrates a robotic-assisted sacrocervicopexy using the semitendinosus tendon. Between June 2022 and February 2023, we performed the worldwide first Da Vinci robotic-assisted sacrocervicopexies (SCP) for apical organ prolapse using the semitendinosus tendon of the left knee. Analysis of safety, feasibility, and clinical outcome of the first ten patients operated on using this new surgical technique included the German pelvic floor questionnaire (GPFQ) as well as a clinical examination. Ten patients with a follow-up of 12months were included. There was a significant reduction of the patient's symptoms according to the GPFQ regarding the domain bladder (preoperatively versus 3 months postoperatively, mean 3.85 vs 1.61, p = 0.034), total score (preoperatively versus 3 months postoperatively, mean 12.79 vs 3.28, p = 0.034), and descensus symptoms (preoperatively versus 12months postoperatively, mean 4.74 vs 0.67, p = 0.022). POP-Q stage (point C) was significantly reduced between the preoperative period and at the time of discharge (mean 2.2 vs 0, p = 0.004). No serious intra- and postoperative complications occurred. This pilot study showed satisfying clinical outcomes after a follow-up of 12months, with a low mid-term complication rate.