Surgical Charts Research Articles

Reductive rhinoplasty principles applied to the curative treatment of different nasal diseases.

Reductive rhinoplasty is generally intended as a facial plastic procedure aiming for functional and aesthetic outcomes in patients affected by nasal dysmorphism and/or obstruction. However, when applied to different pathologies of the nasal pyramid it holds great potentialities, beyond the solo cosmetic and functional objectives. We retrospectively analyzed preoperative conditions, surgical charts, and postoperative results of patients who underwent reductive rhinoplasty for different nasal diseases at our Institution. Principles and techniques of reductive rhinoplasty were described in the different possible applications to the treatment of nasal disease, from nasal septal perforation to benign and malignant diseases of the nose. Reductive rhinoplasty showed to play a crucial role in the curative purpose of different nasal diseases, representing a versatile tool in the expert hand of rhinoplasty surgeons who approach them. N/A.

Impact of liberal intraoperative allogeneic blood transfusion on postoperative morbidity and mortality in major thoracic and lumbar posterior spine instrumentation surgeries.

To investigate the impact of intraoperative blood transfusion on outcomes in patients who had major thoracic and lumber posterior spine instrumentation surgery. Retrospective study included patients who underwent major spine surgery between 2013 and 2017. Patients' demographics, surgical charts, anesthesia charts, discharge charts and follow-up outpatient charts were reviewed. Data collection included: age, gender, BMI, Charlson Co-morbidity Index (CCI) scores, American Society of Anesthesiologists (ASA) scores, amount of estimated blood loss [% estimated blood volume (%EBV)], amount of blood transfused during surgery and post-surgery before discharge, number of fusion levels, pre- and postoperative hemoglobin (Hb) levels, and length of hospital stay. Also collected in-hospital postoperative complications (cardiovascular, pulmonary, infections and deaths). Patients' postoperative intubation status data documented. Reviewed follow-up charts to document any complications. Sample size = 289; No transfusion = 92; transfusion = 197. Transfused patients were significantly older, p < 0.001, higher average BMIs (p < 0.001); ASA scores (p < 0.001); CCI scores (p < 0.001), mean postoperative Hb level (p = 0.004), average intraoperative %EBV loss (p < 0.001), longer hospital stays (p = 0.003). Non-transfusion cohort had significantly higher proportion of patients (p < 0.001) extubated immediately after surgery. Seventeen patients had at least one in-hospital complication, p = 0.05. Complications were not significant among groups. Intraoperative blood transfusions and high volume intraoperative allogeneic blood transfusions did not increase risk for in-hospital complications or surgical site infections. Delayed extubations noticed in patients who received higher volumes of intraoperative allogeneic blood transfusions. High-volume intraoperative blood transfusions increased length of hospital stays. High post-hospital surgical infections associated with high volume intraoperative blood transfusions. Results should be interpreted cautiously due to small sample size.

Improving Completeness of Surgical Inpatient Medical Records in Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

Introduction One of the most essential steps in improving the quality of service delivery in the health service is the improvement of patients’ medical record completeness. The aim of this study is to assess patient medical record completeness in the Saint Paul hospital department of surgery and assess the pattern of improvement in record completeness after intervention. Methods surgical Patient charts were randomly reviewed with a standard patient chart completeness evaluation checklist prepared by the Federal Ministry of Health. Baseline data was collected in June 2019 and post intervention data was collected in November 2019. The schedule for intervention was carried out between July and October 2019. Interventions include modification of formats, continuous monitoring, and inclusion of chart completeness in the monthly morbidity and mortality conference, and establishment of a recognition system for best performing wards. Result A total of 253 and 273 medical charts were evaluated during baseline and post intervention. The Post intervention assessment showed 206 (75.5%) of records had admission notes completed, 205 (75%), the order sheet was completed in 218 (79.7%) and the discharge summary was completed in 217 (79.5%) of medical records. From nursing parameters, the medication sheet was completed in 177 (64.8%) and the nursing care plan was completed in 155 (56.8%) of medical records. When all six indicators were seen in aggregate, total medical record completeness showed a statistically significant improvement from 41% during base line to 72% post intervention (p < 0.05). Conclusion and recommendation Study has shown that small and persistent quality improvement interventions that focus on continuous evaluation, leadership engagement, and innovative strategies bring significant improvement in record completeness.

Retrospective Comparison of Intraoperative Parameters, Efficacy and Safety in Cataract Surgery Between Halogen and Light-Emitting Diode (LED) Illuminated Surgical Microscope.

PurposeThe objective was to compare the operative time, ultrasound time, efficacy and safety of phacoemulsification with IOL insertion between using halogen and light-emitting diode (LED) illuminated microscope.Patients and MethodsTwo hundred and twenty-seven surgical charts of cataract patients who underwent phacoemulsification with IOL insertion between June 2018 and October 2020 were reviewed. There were 113 cases operated on under halogen-illuminated microscope (Carl Zeiss OPMI LUMERA S7®) and 114 cases operated on under light-emitting diode (LED)-illuminated microscope (Leica PROVEO 8®). All cases were operated on by the same surgeon (S.T.). The difference in operative time and ultrasound time between two groups was compared by independent samples t-test. The proportion of cases with 3-months BCVA that was better than 20/30 and the proportion of cases with intraoperative complications from the operation between two groups were compared by Pearson’s Chi-squared test.ResultsThe mean ultrasound time was 121.29±53.60 seconds in halogen group and 123.98±61.53 seconds in LED group. The mean difference was −2.69±8.44 seconds which was not statistically significant (95% CI, −19.35 to 13.97; p=0.573). The mean operative time was 19.83±4.77 minutes in the halogen group and 17.20±3.02 minutes in the LED group. The mean difference was 2.63±0.53 minutes (95% CI, 1.59 to 3.67; p < 0.001). The cases with BCVA better than 20/30 was 93.69% in halogen group and 95.49% in LED group. The proportion of cases with intraoperative complications was 3.53% in halogen group and 2.63% in LED group. The difference of both proportions was not statistically significant (p=0.553 and p=0.692, respectively).ConclusionThis study shows statistically significant operative time reduction with LED microscope. This evidence could be used for making the decision to switch from halogen microscope to LED microscope. Upgrading to LED-illuminated microscope might be beneficial for productivity improvement if there were at least six to seven cases operated on per day. The ultrasound time, efficacy, and safety showed no significant difference.

MSF Hospital in Tabarre, Haiti: Why a Field General Surgery Fellowship Is Necessary

Recently, the Hospital at Tabarre in Port-au-Prince Haiti was reopened by the Operational Center of Paris—Médecins Sans Frontières (MSF). This hospital is now purely a Trauma Center staffed by five national general surgeons and five orthopedic surgeons. MSF hopes that the new trauma focus of Tabarre Hospital and the presence of a full complement of experienced national surgeons can enable this site to become one of the training sites for exptriate surgeons on their first humanitarian mission with MSF. The general surgical case charts from the first 3 months after the reopening of the hospital were retrospectively reviewed. All procedures done by the general surgical department in the operating room theatre were registered and short and long-term results analyzed. The Hospital at Tabarre has a very high rate of penetrating traumas compared to other MSF hospitals, and seems ideally suited to train expatriate surgeons during their first missions in the field with MSF because of the experience of the National surgical staff. Additionally, it is felt that a longer Field General Surgery fellowship can and should be developed within MSF to ensure that the next generation of general surgeons can continue to provide the type of surgical care that is still needed in the field.

Congenital laryngeal webs: from diagnosis to surgical outcomes

IntroductionCongenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is imperative when deciding which surgical technique to use. The choice of appropriate stenting may be decisive to avoid persistent anterior commissure synechia and poor voice results. ObjectiveTo report outcomes for endoscopic and open surgical approaches in the treatment of congenital laryngeal webs and the challenges one may encounter while applying the current classification and deciding for the best treatment option. MethodsRetrospective review of medical and surgical charts for congenital laryngeal webs treated in two tertiary university centers. ResultsSeven patients were included; following Cohen’s classification there were: three type II webs, one of them with an atypical posterior synechia, two type III webs and two type IV webs. Six patients were submitted to laryngotracheal reconstruction and one was treated with an endoscopic approach. Description of precise glottic and subglottic involvement and tailored surgical options are presented. The LT mold® stent was used for long-term stenting that varied between 40 to 60 days. All patients were successfully decannulated with good voice quality and after follow-up of over one year, there were no complications associated with the surgeries. ConclusionCongenital laryngeal webs should be suspected and thoroughly evaluated in the presence of neonatal dysphonia and early onset of laryngitis. Otolaryngologists must be familiar with associated lesions and genetic conditions that may be associated to congenital laryngeal webs. Congenital laryngeal webs may be successfully treated at an early age. The correct choice of surgical technique after meticulous evaluation of glottic and subglottic components of the web, presence of concomitant lesions and appropriate stenting, is imperative to avoid persistent scarring and poor voice quality.

Surgical Admissions Testing Center Chart Preparation Process

In the Pre-anesthesia testing and evaluation center for surgical outpatient/same day admit patients’ surgical charts were not being prepared greater than three days prior to scheduled surgery, even when the surgery was posted several weeks in advance. There was repetition of work and unclear roles between nurses and medical office assistants (MOA). Patients needing anesthesia and medical clearance were not being identified until a day prior to scheduled surgery resulting in delayed scheduling of pre-anesthesia testing appointments. This lead to dissatisfaction of patients, surgeons and Admissions Testing Center (ATC) staff, and potential cancellation of surgery on evening prior to the scheduled surgery date.

Comparison of Two Different Ophthalmic Operating Microscopes on Speed, Consistency and Time Savings in the Operating Room: A Mini Review

Purpose: To evaluate the operating times and surgical efficiencies of to two different operating microscopes Leica Stativ S3B, Leica Microsystems, Wetzlar, Germany of OPMI Lumera T with Callisto software (Carl Zeiss Meditec, Inc., Dublin, CA) for uncomplicated cataract surgery at a single center. Both systems contain apochromatic optics, Schott-style glass and focused beams aligned with the microscope oculars. Lumera provides a xenon illumination source while Leica utilizes halogen as its illumination source. Xenon illumination sources generally provide greater brightness of illumination. Clinical method and review: This was a prospective review of surgical charts by two experienced high-volume surgeons looking at total surgical times recorded in the chart. Previously identified traumatic and complicated cataract cases were excluded. Two focused beam microscopes were assessed. Discussion: Fifty cases for each microscope were reported. Mean surgery time with the Leica microscope was 14.18 minutes (standard deviation 8.672) and 11.15 minutes (standard deviation of 2.421) with the OPMI Lumera T Zeiss microscope. ANOVA analysis revealed that the difference in surgery time between the two groups was significant at a level of p=0.16. Conclusion: The newer model microscope with xenon lighting consistently produced significantly shorter operating room times with a time savings of 3.03 minutes per case with cataracts of similar density and complexity. Additionally, more variability within the surgical times was noted in the Leica groups compared with the Zeiss group (standard deviation 8672 versus 2.421, respectively). Enhanced illumination produced sharper imaging, easier visualization of structures that appears to provide an efficiency advantage in the operating room when performing routine cataract surgery. Translational relevance: As baby boomers age, more and more strain is being put on the healthcare system including declining reimbursements. Surgical and clinical efficiencies are essential to meet growing healthcare needs in the safest, most efficient methods possible.

Stoma-related symptoms in patients operated for rectal cancer with abdominoperineal excision.

The primary aim of this study was to characterize the frequency, severity, and distress of symptoms from the colostomy and colostomy acceptance in rectal cancer patients. The secondary aims were to study the symptomatic parastomal herniation, its relationship to stoma-related symptoms, and potential risk factors for the development of symptomatic parastomal herniation. Data was collected from the Swedish Colorectal Cancer Registry and from surgical charts. Patients operated for rectal cancer with an abdominoperineal excision in Sweden between 2007 and 2009 and alive 3 years postoperatively were contacted (n = 852). Patients who consented to participate, had a colostomy constructed during the abdominoperineal excision, and who answered a questionnaire 3 years postoperative were included (n = 495). Answers were analyzed with emphasis on stoma-related symptoms and their intensity as well as the level of distress associated with the symptoms. Almost 90% of patients did not feel limited in their daily life by their colostomy. Patients with symptomatic parastomal hernia had a 53% higher risk of flatulence. Fifty-six patients developed symptomatic parastomal hernia (11%). The only risk factor associated with the development of symptomatic parastomal hernia was high body mass index (BMI). This study shows that most patients do not feel limited by their stoma 3 years after surgery for rectal cancer. Symptomatic parastomal hernia was associated with high BMI but not with the surgical technique.

Transumbilical laparoscopic-assisted appendectomy in children: Clinical and surgical outcomes.

The aim of this paper is to present and describe transumbilical laparoscopic-assisted appendectomy in children, focusing on its technical aspects and clinical and surgical outcomes. The surgical charts of all patients aged between 0 and 14 years treated with transumbilical laparoscopic-assisted appendectomy admitted to the authors' institution from January 2009 to September 2013 with a diagnosis of suspected appendicitis following clinical, laboratory and ultrasound findings were reviewed. Operating time, intraoperative findings, need for conversion or for additional trocars, and surgical complications were reported. During the study period, 120 patients aged between 6 and 14 years (mean age: 9.9 years), 73 females (61%) and 47 males (39%), were treated with transumbilical laparoscopic-assisted appendectomy. There were 37 cases of hyperemic appendicitis (subserosal and retrocecal), 74 cases of phlegmonous appendicitis and 9 cases of perforated gangrenous appendicitis. It was not possible to establish a correlation between grade of appendicitis and mean operating time (P > 0.05). Eleven cases (9%) needed the use of one additional trocar, while 8 patients (6%) required conversion to the standard laparoscopic technique with the use of two additional trocars. No patient was converted to the open technique. Transumbilical laparoscopic-assisted appendectomy is a safe technique in children and it could be used by surgeons who want to approach other minimally invasive techniques.

Características y evolución de la transposición de grandes vasos en el periodo neonatal

Introduction and objectivesTransposition of the great arteries is a prevalent congenital heart defect with a high survival rate and a good long-term outcome, especially if managed with early surgical intervention during the neonatal period. In this study, our main objective was to describe patient characteristics and outcomes and to identify possible predictors of early and long-term morbidity and mortality. MethodsRetrospective analysis through review of clinical and surgical charts of patients with transposition of the great arteries admitted to the service of neonatology during 2000-2011. ResultsThe study included 136 patients; 119 of them had undergone corrective surgery during the neonatal period. Patients were divided into 3 groups: group I, 81 cases of isolated transposition; group II, 24 cases with ventricular septal defect, and group III, 31 with “complex” transposition of the great arteries. The overall postoperative survival was 96.7% (115 of 119 patients); no patients from group I died after surgery. Duration of surgery, intubation, inotropic treatment, and length of stay were higher in patients in groups II and III. The overall survival rate after an average of 6 years of follow-up was 90.4% (123 of 136 patients), with no deaths after discharge in group I. The most frequent residual defect during cardiac follow-up was supravalvular pulmonary stenosis, in 33 of 113 patients that had follow-up data. ConclusionsIn our study, the survival rate was high in patients with transposition of great arteries and especially in those undergoing arterial switch. The number of subsequent residual heart defects was low.Full English text available from:www.revespcardiol.org/en

Characteristics and Outcomes of Transposition of Great Arteries in the Neonatal Period

Introduction and objectivesTransposition of the great arteries is a prevalent congenital heart defect with a high survival rate and a good long-term outcome, especially if managed with early surgical intervention during the neonatal period. In this study, our main objective was to describe patient characteristics and outcomes and to identify possible predictors of early and long-term morbidity and mortality. MethodsRetrospective analysis through review of clinical and surgical charts of patients with transposition of the great arteries admitted to the service of neonatology during 2000-2011. ResultsThe study included 136 patients; 119 of them had undergone corrective surgery during the neonatal period. Patients were divided into 3 groups: group I, 81 cases of isolated transposition; group II, 24 cases with ventricular septal defect; and group III, 31 with “complex” transposition of the great arteries. The overall postoperative survival was 96.7% (115 of 119 patients); no patients from group I died after surgery. Duration of surgery, intubation, inotropic treatment, and length of stay were higher in patients in groups II and III. The overall survival rate after an average of 6 years of follow-up was 90.4% 123 of 136 patients, with no deaths after discharge in group I. The most frequent residual defect during cardiac follow-up was supravalvular pulmonary stenosis, in 33 of 113 patients that had follow-up data. ConclusionsIn our study, the survival rate was high in patients with transposition of great arteries and especially in those undergoing arterial switch. The number of subsequent residual heart defects was low.

Laparoscopic percutaneous extraperitoneal closure for inguinal hernia: learning curve for attending surgeons and residents

Laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric inguinal hernia is a simple technique in which a purse-string suture made of nonabsorbable material is placed extraperitoneally around the hernia orifice by a special suture needle (Lapaherclosure™). Concerns have been raised about the extensive learning curve for both attending surgeons and residents to master this technique. This study assesses the difference in learning curves for the safe performance of LPEC by attending surgeons and residents. A retrospective analysis was performed on the surgical charts of 409 consecutive patients (175 girls, 234 boys) who had undergone LPEC for inguinal hernia repair from December 2005 to December 2011 at Jikei University Hospital. The number of operation needed by attending surgeons and residents to reach the appropriate operation time was analyzed by the Mann-Whitney U test. LPEC was performed by three attending surgeons and four residents who had not previously performed LPEC. The standard operation time for LPEC by attending surgeons who have performed more than 100 LPEC cases safely is 30 min. In our study, the attending surgeons needed a mean of 12 operations (range, 10-16) to reach 30 min for LPEC. Three residents needed a mean of 31 operations (range, 27-33) to reach 30 min for LPEC. The fourth resident could not perform LPEC in 30 min or less. The difference between the number of operations needed by the attending surgeons and the residents to perform LPEC safely was statistically significant (P < 0.05). The overall incidence of contralateral patent processus vaginalis was 47.9 %. Our learning curve analysis showed that whereas attending surgeons needed a mean of 12 operations to perform LPEC repairs safely in 30 min or less, residents needed more than 30 operations to safely perform LPEC repairs without supervision.

Combined S-1 and S-2 sacral alar-iliac screws as a salvage technique for pelvic fixation after pseudarthrosis and lumbosacropelvic instability

Lumbosacropelvic pseudarthrosis after long spinal fusions for treatment of adult degenerative scoliosis remains a challenging condition. Moreover, although pelvic fixation with iliac screws is widely used in deformity surgery to provide a biomechanically strong distal anchor for long thoracolumbar constructs, there are very few options available after failed pelvic fixation with iliac screws. The authors conducted a retrospective review of the surgical charts and imaging findings of patients subjected to revision surgery for lumbosacropelvic pseudarthrosis from August 2011 to August 2012. This review identified 5 patients in whom a salvage technique combining both S-1 and S-2 sacral alar-iliac (SAI) screws had been performed. In this technical note, the authors present a detailed anatomical discussion and an appraisal of the sequential intraoperative steps of this new technique involving a combination of S-1 and S-2 SAI screws. The discussion is illustrated with a surgical case in which this technique was used to treat a patient with pseudarthrosis that had developed after fixation with classic iliac screws. In conclusion, although S-2 SAI screws have previously been reported as an interesting alternative to classic iliac wing screws, this report is the first on the use of combined S-1 and S-2 SAI screws for pelvic fixation as a salvage technique for lumbosacropelvic instability. According to the reported experience, this technique provides a biomechanically robust construct for definitive pelvic fixation during revision surgeries in the challenging scenarios of pseudarthrosis and instability of the lumbosacropelvic region.

An audit of generic prescribing in a general surgical department

The Health Service Executive introduced a generic prescription policy to reduce costs. Despite this, generic prescription rates remain low. To audit in-patient prescription practice in a single surgical department and identify potential savings which could be realised by adherence to the generic prescribing policy. Surgical in-patient charts were obtained at the point of discharge and their drug prescription information was recorded. 51% of prescriptions involved a trade-name prescription where an appropriate generic equivalent existed. The cost implications for hospital and community patients were found to be greatly affected by substitution policies that exist at hospital pharmacy level. There is a need to promote greater adherence to generic prescribing amongst hospital doctors in line with international best practice. It can have a positive impact in terms of safe prescribing and can have cost implications at both hospital and community level.

Trans-Mastoid Management of Temporal Bone Tegmen Defects, Encephaloceles and CSF Leaks

Trans-Mastoid Management of Temporal Bone Tegmen Defects, Encephaloceles and CSF Leaks A review of records revealed fifteen post-surgical patients who underwent tegmen defect repair from 2009-2012. We reviewed patients’ surgical logs, pre- and postoperative charts, imaging, and billing records. At six to nine months postoperatively, all patients underwent MRI with appropriate sequencing to evaluate the repair site and evidence of residual tegmen defect, encephalocele, or CSF leaks.

Laparoscopic inguinal hernia repair in premature babies weighing 3 kg or less

This retrospective study aims to evaluate the feasibility, safety and complication rate of laparoscopic inguinal hernia repair for small babies weighing 3 kg or less. A retrospective analysis was performed on the surgical charts of 67 infants (47 boys and 20 girls) weighing 3 kg or less who underwent laparoscopic hernia repair in a 3-year period. A regular 5-mm scope was used for visualization, and 2 or 3-mm instruments were used for the closure of the inner inguinal ring using 3/0 non-absorbable suture. The median weight at surgery was 2,600 g (range 1,450-3,000 g). All except three were premature. Of the 67 infants, 15 (22.3 %) presented with an irreducible hernia. In three cases of irreducible hernias, we also performed a transumbilical appendectomy at the end of the hernia repair. Minor problems related with anesthesia were noted in four cases. Hernia recurrence was observed in three patients (4.4 %). No cases of testicular atrophy occurred. In 10 boys, we observed 12 cases of high testes, only 4 testes requiring subsequent orchiopexy. Laparoscopic inguinal hernia repair for babies weighing 3 kg or less is feasible, safe and perhaps even less technically demanding than open inguinal herniotomy.

Use of Administrative Data in Efficient Auditing of Hospital-Acquired Surgical Site Infections, New York State 2009–2010

To efficiently validate the accuracy of surgical site infection (SSI) data reported to the National Healthcare Safety Network (NHSN) by New York State (NYS) hospitals. Validation study. 176 NYS hospitals. NYS Department of Health staff validated the data reported to NHSN by review of a stratified sample of medical records from each hospital. The four strata were (1) SSIs reported to NHSN; (2) records with an indication of infection from diagnosis codes in administrative data but not reported to NHSN as SSIs; (3) records with discordant procedure codes in NHSN and state data sets; (4) records not in the other three strata. A total of 7,059 surgical charts (6% of the procedures reported by hospitals) were reviewed. In stratum 1, 7% of reported SSIs did not meet the criteria for inclusion in NHSN and were subsequently removed. In stratum 2, 24% of records indicated missed SSIs not reported to NHSN, whereas in strata 3 and 4, only 1% of records indicated missed SSIs; these SSIs were subsequently added to NHSN. Also, in stratum 3, 75% of records were not coded for the correct NHSN procedure. Errors were highest for colon data; the NYS colon SSI rate increased by 7.5% as a result of hospital audits. Audits are vital for ensuring the accuracy of hospital-acquired infection (HAI) data so that hospital HAI rates can be fairly compared. Use of administrative data increased the efficiency of identifying problems in hospitals' SSI surveillance that caused SSIs to be unreported and caused errors in denominator data.

Infections ostéo-articulaires en période néonatale

Congenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is imperative when deciding which surgical technique to use. The choice of appropriate stenting may be decisive to avoid persistent anterior commissure synechia and poor voice results.To report outcomes for endoscopic and open surgical approaches in the treatment of congenital laryngeal webs and the challenges one may encounter while applying the current classification and deciding for the best treatment option.Retrospective review of medical and surgical charts for congenital laryngeal webs treated in two tertiary university centers.Seven patients were included; following Cohen’s classification there were: three type II webs, one of them with an atypical posterior synechia, two type III webs and two type IV webs. Six patients were submitted to laryngotracheal reconstruction and one was treated with an endoscopic approach. Description of precise glottic and subglottic involvement and tailored surgical options are presented. The LT mold® stent was used for long-term stenting that varied between 40 to 60 days. All patients were successfully decannulated with good voice quality and after follow-up of over one year, there were no complications associated with the surgeries.Congenital laryngeal webs should be suspected and thoroughly evaluated in the presence of neonatal dysphonia and early onset of laryngitis. Otolaryngologists must be familiar with associated lesions and genetic conditions that may be associated to congenital laryngeal webs. Congenital laryngeal webs may be successfully treated at an early age. The correct choice of surgical technique after meticulous evaluation of glottic and subglottic components of the web, presence of concomitant lesions and appropriate stenting, is imperative to avoid persistent scarring and poor voice quality.

Comparison of a Novel Technique of the Microlaparoscopic Pyloromyotomy to Circumbilical and Weber–Ramstedt Approaches

IntroductionThe aim of this retrospective comparative study was to compare the surgical results and outcomes of the newly inaugurated approach of microlaparoscopic pyloromyotomy with open techniques. MethodsThe surgical charts of 110 infants (85 boys and 25 girls, ages ranging from 10 to 98 (average 28) days) undergoing pyloromyotomy microlaparoscopically (28), through the circumbilical approach (56), or via the right upper quadrant access (26) were reviewed. The variables were compared between the three surgical approach groups, and the statistical analysis was performed. ResultsThere was a significant difference between Bianchi and microlaparoscopy in terms of operation time (average 38.5 vs. 20.5 min, p < 0.0001) and time to full enteral feed (average 48 vs. 32 h, p = 0.001). There was no significant difference in postoperative length of stay (75 vs. 82 h, p = 0.12). The operative time for the surgeons experienced in microlaparoscopy was in average of 14 min (range, from 9 to 18 min). When comparing the Weber–Ramstedt procedure and microlaparoscopy, microlaparoscopy required significantly less operative time (50 vs. 20 min, p < 0.0001), a shorter time to full enteral feed (70 vs. 32 h, p < 0.001), and a shorter postoperative length of stay (90 vs. 82 h, p = 0.04). There were no cases of mucosal perforation or incomplete pyloromyotomy. ConclusionDespite the small sample size included in the present study, it seems that microlaparoscopic pyloromyotomy is safe and feasible with the lowest rate of complications and the shortest operative time. The Bianchi approach is a good alternative to achieve a small scar without laparoscopy.