Surgical Infection Research Articles

Characteristics and Clinical Features of Anorectal Malformations Without Fistula: A Systematic Literature Review

Anorectal malformation (MA) without fistula is a form of congenital abnormality that is often found in newborn babies. This study aims to identify the characteristics and clinical features of MA without fistula based on the latest scientific evidence. A systematic search was conducted on the PubMed, Scopus, and Web of Science databases using relevant keywords. Inclusion criteria included observational studies reporting the characteristics and clinical features of MA without fistula in humans. Two independent researchers conducted study selection, data extraction, and study quality assessment using the JBI Critical Appraisal Checklist tool. A total of 25 studies (2018-2024) involving 1548 MA patients without fistula met the inclusion criteria. The majority of patients were male (62%). The average age at diagnosis is 2 days. The most frequently reported clinical symptoms were absence of anus (100%), abdominal distension (78%), and vomiting (65%). The most common classification of MA without fistula was perineal (45%), followed by vestibular (30%) and cloacal (25%). The most frequently performed definitive surgery was perineal anoplasty (55%), followed by posterior sagittal anorectoplasty (PSARP) (35%) and laparoscopic-assisted anorectoplasty (10%). The most frequently reported postoperative complications were anal stenosis (15%), surgical wound infection (10%), and rectal prolapse (5%). MA without fistula is more common in male babies. The main clinical symptoms are absence of anus, abdominal distension, and vomiting. The perineal classification is the most common. Perineal anoplasty is the most frequently performed definitive surgery. Post-operative complications that need to be watched out for are anal stenosis, surgical wound infection, and rectal prolapse.

Tailorable copper-bearing titanium alloys with remarkable strength and ductility fabricated by spark plasma sintering for biomedical applications

Titanium and Ti-based alloys are widely used metallic biomaterials, however, the surgical infections related to bacteria always occur on the implants. Developing the antibacterial titanium alloys has been studied as one of the most effective methods to lower the inflammatory response. The addition of Cu element to Ti matrix can produce strong antibacterial properties. Here, the antibacterial Ti-xCu alloys (x = 3, 5, and 7 wt%) were fabricated by powder metallurgy (PM) technique using spark plasma sintering (SPS) route. The effects of Cu addition, SPS temperature, and post-heat treatment on microstructure and tensile properties of Ti–Cu alloys were investigated. The strengthening and deformation mechanisms were also discussed. The microstructures of PM Ti–Cu alloy consisting of α-Ti and Ti2Cu phases are fine and homogenous as well as free of porosity. With the increasing Cu addition, the yield and tensile strengths of Ti–Cu alloys increase, but the elongation decreases. The precipitation of Ti2Cu phases contributes the most increments of yield strength, and can also act as the barriers to pile up the dislocations during the plastic deformation, improving the work hardening rate and tensile strength. PM Ti–Cu alloys possess a good tensile strength of 575–810 MPa, and an excellent elongation of 11%–29%. The optimized tensile properties of PM Ti–5Cu alloys are comparable and even superior to those of Ti and other Ti-based alloys produced by traditional methods. Further, insights for the design and processing of PM Ti–Cu alloys with ample shaping freedom fabricated by SPS method are generalized and discussed.

Sampling for the diagnosis of orthopaedic surgical infections

Orthopaedic surgical infections, in Denmark, are managed heterogeneously, both within the orthopaedic surgical and the clinical microbiological specialty. More uniform guidelines for sampling and clinical microbiological diagnostics for suspected orthopedic surgical infections would be appropriate. The purpose of this review is therefore to initiate a process aiming for consensus on sampling methods of tissue materials and fluids and clinical microbiological sample handling.

Multi-arm multi-stage (MAMS) randomised selection designs: impact of treatment selection rules on the operating characteristics

BackgroundMulti-arm multi-stage (MAMS) randomised trial designs have been proposed to evaluate multiple research questions in the confirmatory setting. In designs with several interventions, such as the 8-arm 3-stage ROSSINI-2 trial for preventing surgical wound infection, there are likely to be strict limits on the number of individuals that can be recruited or the funds available to support the protocol. These limitations may mean that not all research treatments can continue to accrue the required sample size for the definitive analysis of the primary outcome measure at the final stage. In these cases, an additional treatment selection rule can be applied at the early stages of the trial to restrict the maximum number of research arms that can progress to the subsequent stage(s).This article provides guidelines on how to implement treatment selection within the MAMS framework. It explores the impact of treatment selection rules, interim lack-of-benefit stopping boundaries and the timing of treatment selection on the operating characteristics of the MAMS selection design.MethodsWe outline the steps to design a MAMS selection trial. Extensive simulation studies are used to explore the maximum/expected sample sizes, familywise type I error rate (FWER), and overall power of the design under both binding and non-binding interim stopping boundaries for lack-of-benefit.ResultsPre-specification of a treatment selection rule reduces the maximum sample size by approximately 25% in our simulations. The familywise type I error rate of a MAMS selection design is smaller than that of the standard MAMS design with similar design specifications without the additional treatment selection rule. In designs with strict selection rules - for example, when only one research arm is selected from 7 arms - the final stage significance levels can be relaxed for the primary analyses to ensure that the overall type I error for the trial is not underspent. When conducting treatment selection from several treatment arms, it is important to select a large enough subset of research arms (that is, more than one research arm) at early stages to maintain the overall power at the pre-specified level.ConclusionsMulti-arm multi-stage selection designs gain efficiency over the standard MAMS design by reducing the overall sample size. Diligent pre-specification of the treatment selection rule, final stage significance level and interim stopping boundaries for lack-of-benefit are key to controlling the operating characteristics of a MAMS selection design. We provide guidance on these design features to ensure control of the operating characteristics.

Prevalence of pre-operative anemia in elective surgical patients: A retrospective, observational study at a university hospital

BackgroundAnemia is the most hematological condition found in surgical patients. Pieces of empirical evidence shows that pre-operative anemia accounts for one- third of surgical patients. Yet, pre-operative anemia & blood transfusion for surgical patients has been associated with many complications such as lengthy hospital stay, post operation surgical wound infections, mortality and morbidity. PurposeThis Pilot preliminary study sought to determine the prevalence of pre-operative anemia in elective surgical patients and to assess health workers’ awareness and knowledge regarding patient blood management in Saudi Arabia. Material and methodsA questionnaire was used to collect data from the 129 healthcare workers in a selected hospital in Saudi Arabia. Additional data was obtained from the hospital electronic data records regarding the incidences of pre-operative anemia. Therefore, the study applied both retrospective and cross-sectional designs. The collected data was then analyzed using the Statistical Package for Social Services [SPSS]. ResultsThis study established the prevalence of pre-operative anemia in elective surgical patients to be 30 % (291 out of 970). In addition, 129 participants completed the questionnaires, from different hospital departments. From the questionnaire, it was noted that 74.2 % of the of physicians had the knowledge about patient blood management while 65 % (n = 50) were aware of the written protocol for the management of pre-operative anemia. This study also found out that 48.1 % of physicians rarely get to meet their patients assessed for possible anemia 4–8 weeks prior surgical operation. In addition, a relatively high number of physicians (42.6, n = 55 rarely investigate the cause of anemia after it has been established while 45.7 % confirm to rarely transfer their patient to pre-operative clinic for anemia management. Low intervention in correction of anemia of low iron origin by the physicians was established to be 44.2 %, and the most preferred hematology analyzer for point of care management was CBC Analyzer Sysmex (79.8 %). ConclusionThis study finds a significant lack of knowledge about pre-operative anemia management in line with the patient blood management protocol. Also, majority of physicians fail to follow the guidelines for anemia management despite the high incidence.

Hybrid treatment of recurrent venous mesenteric thrombosis with small intestinal necrosis

The article presents a clinical case of a 39-year-old patient with thrombosis and postoperative rethrombosis of the superior mesenteric vein. The disease was complicated by the small intestine necrosis and abdominal surgical infection. Successful thrombectomy and bowel resection made it possible to restore mesenteric blood supply, to stabilize the patient’s condition and to perform an enteroenteroanastomosis. Due to antithrombin III deficiency, rethrombosis in the early postoperative period was complicated by anastomotic leak, unformed intestinal fistula and peritonitis. A hybrid treatment (surgical, parasurgical and conservative) was performed, which included selective infusion of a thrombolysis activator at the superior mesenteric artery mouth. The patient recovered.Clinical and laboratory manifestations of superior mesenteric vein thrombosis, in contrast to acute circulatory disorders in the arteriomesenteric system, are nonspecific and do not always allow timely diagnosis of intestinal ischemia. MSCT angiography identifies venous mesenteric thrombosis in most cases. The ineffectiveness of anticoagulant therapy against the background of antithrombin III deficiency caused superior mesenteric vein thrombosis and rethrombosis. The treatment of the small intestine critical postoperative ischemia included an increase in the volume of antithrombin III and frozen plasma intravenous infusion and selective administration of a thrombolysis activator (actilyse) into the superior mesenteric artery, which made it possible to restore the arteriolovenular intramural blood flow of the small intestine and to prevent another stem rethrombosis of the superior mesenteric vein. Laparostomy using a silicone plate made it possible to constantly monitor the course of the abdominal infectious process and to make timely decisions about the next intervention if medically required. The vacuum assisted design provided permanent lavage of the abdominal cavity without trauma to the soft tissues of the abdominal wall and presenting intestinal loops.

Does the Surgical Approach Affect the Incidence of Post-Hepatectomy Liver Failure in Cirrhotic Patients? An Analysis of the NSQIP Database.

Background: The association between surgical approach and post-hepatectomy liver failure (PHLF) in cirrhotic patients is poorly understood. We hypothesize that patients will have similar rates of liver failure regardless of whether they undergo minimally invasive liver resection (MILR) or open liver resection (OLR) in major liver resections. In contrast, there will be lower rates of PHLF in patients undergoing minor hepatectomy via the MILR approach.Methods: Propensity score matching was used to analyze regression by matching the MILR to the OLR cohort. Patient demographics from the American College of Surgeons National Surgical Quality Improvement Program, including race, age, gender, and ethnicity, were matched. Chronic obstructive pulmonary disease, congestive heart failure, smoking, hypertension, diabetes, renal failure, dyspnea, dialysis dependence, body mass index, and American Society of Anesthesiologists (ASA) classification (>ASA III) were among the preoperative patient characteristics subject to matching. PHLF (Grade A vs B. vs C) was our primary outcome measure.Results: A total of 2129 cirrhotic patients were included in the study. In the minor hepatectomy group, patients undergoing an OLR were more likely to get discharged to a facility (7.0% vs 4.4%; P = .03), had greater hospital length of stay (5 vs 3 days; P = .02), and had a greater need for invasive postoperative interventions (10.7% vs 4.6%; P < .01). They were also noted to have higher rates of organ space superficial surgical infections (SSIs) (7.3% vs 3.7%; P = .003), Clostridium difficile infection (.9% vs .1%; P = .05), renal insufficiency (2.1% vs .1%; P < .01), unplanned intubations (3.1% vs 1.4%; P = .03), and Grade C liver failure (2.3% vs .9%; P = .03).Conclusion: A higher incidence of PHLF grade C was found in patients undergoing OLR in the minor hepatectomy group. Therefore, in cirrhotic patients who can tolerate minimally invasive approaches, MILR should be offered to prevent postoperative complications as part of their optimization plan.

Comparison of Conventional and Modern Wound Care in Post-Section Wounds at Cut Mutia Hospital, North Aceh Regency in 2023

The World Health Organization (WHO) sets the average cesarean sections (CS) standard at 5-15% per 1000 births. However, cesarean section rates in private hospitals exceed 30%, compared to 11% in government hospitals. This study investigates the prevalence and complications of surgical wound infections post-cesarean section and the effectiveness of modern wound dressing techniques in reducing these infections. Data analysis reveals cesarean wound infections occur during hospitalization (27%), re-admission (1%), and post-discharge (71%). Surgical wound infections (SWI) significantly increase morbidity, treatment duration, and healthcare costs, with a direct death rate ranging from 3% to 75% globally. The study evaluated modern wound dressings adhering to "moist wound healing" principles, such as hydrocolloids, alginate, and foam, which maintain a moist environment to enhance epithelial cell proliferation, accelerate wound healing, and reduce scarring. Findings indicate that moist wound dressings significantly improve healing outcomes, promoting epithelialization and collagen synthesis, with techniques showing a 30-50% increase in epithelialization and a 2-5 times faster re-epithelialization rate. These results highlight the need for adopting advanced wound care techniques to reduce surgical wound infections and improve patient recovery post-cesarean section. The study implies that healthcare providers should integrate modern wound care practices to enhance maternal health outcomes globally.

Fabrication of bioactive silk composite meshes for hernia repair and guided soft tissue remodeling: In silico, in vitro and in vivo models

ObjectivesPost-operative complications stemming from incompatible meshes often lead to delayed wound healing, seroma, infections, inappropriate tissue infiltration and pain. The present study was outlined to develop biocompatible composite hand-knitted silk meshes modified with polymers and natural extracts. Our study introduced hand-knitted B. mori silk fibroin as the primary mesh material, offering superior mechanical strength and biocompatibility. The spin-assisted dip coating achieved desirable morphology, internal structures, thickness, and surface roughness. Moreover, the application of biopolymeric composite coatings containing polymers and natural extracts introduced antimicrobial character, facilitated cell attachment, migration, proliferation, potentiating gene expression and accelerating the process of wound healing. These composite meshes are a viable solution for addressing post-op complications in hernia and soft tissue repair surgeries. MethodIn this study, 9 silk-based composite meshes (modified with polymeric-extract blends through spin-assisted dip coating) were successfully developed. Experimental variants were then subjected to various characterizations including SEM, DMA and chemical analysis (FTIR and GC-MS). Modified meshes were evaluated for their physiological characteristics and biological responses (the basic criterion for the selection of composite silk mesh). The biological testing included (antimicrobial susceptibility testing, in vitro cell viability assay, cell attachment assay (NIH3T3 and hUc-MSCs), in vitro cell migration, in vitro gene expression analysis with NIH3T3, in silico molecular docking with bioactive ligands of HE extract and in vivo analysis with PHBV-HE and PHBV-Control composite meshes in rat models. ResultsResults showed that all variants exhibited a multi-fiber morphology with significant surface coating, allowing for optimal drug release up to 72 h. This release facilitated antibacterial properties and biocompatibility, as evidenced by in vitro cell viability, migration assays and gene expression analysis. Among the variants, the PHBV-HE composite mesh demonstrated superior results. In the case of PHBV-coated polymeric controls, the SEM analysis concluded that the presence of coating reduced the pore size up to 39.62 % whereas, fiber diameter was increased by up to 19.89 % as compared to the control. The presence of a coating on the mesh improved the mechanical strength/modulus by 165.89 %, UTS by 185.38 % and reduced the % strain by 64.67 %. The fast release of HE from PHBV-HE composite mesh was 90.7% up to 72h, confirming that it can induce antibacterial activity against surgical infections. ConclusionPHBV-HE showed the highest cell viability, wound healing and gene expression. Based on appreciable biological evaluation results shown by PHBV-HE, in rat hernia models, only the PHBV-HE variant was tested for in-vivo analysis. Results confirmed its non-toxic nature and wound-healing abilities. Enhanced cell proliferation and wound healing observed both in vitro and in vivo indicated that PHBV-HE holds promise as a biomedical implant suggesting its potential for effective hernia and soft tissue repair and regeneration.

ENDOSCOPIC DRAINAGE FOR THE MANAGEMENT OF INFECTED SUBCUTANEOUS COLLECTIONS FOLLOWING DIEP FLAP RECONSTRUCTION TECHNIQUE: A CASE REPORT

Abstract Aim The deep inferior epigastric perforator (DIEP) flap procedure is a widely accepted method for immediate breast reconstruction following skin-sparing mastectomy in breast cancer patients. While complications are infrequent, challenges may arise, including surgical wound infection, skin necrosis, seroma, or hematoma. Methods We present the case of a 68-year-old woman with multifocal infiltrating carcinoma of the right breast (T1cN0M0) who underwent DIEP flap breast reconstruction one month before presenting to the emergency room. Her symptoms included a fever of 38°C, abdominal filling in the DIEP scar region, an elevated leukocyte count (23.01 × 10E3/microL), and a C-reactive protein level of 470 mg/L. Abdominal CT revealed a collection in the infraumbilical anterior abdominal wall extending through the subcutaneous cellular tissue of both iliac fossae. The patient underwent surgical intervention, including endoscopic drainage with lavage and drain placement under direct visualization. Results Following surgery, the patient responded positively to intravenous Meropenem, with the resolution of fever and improvement in local cellulitis. She was discharged on the 6th postoperative day with both drains, removed 10 and 15 days after surgery in an outpatient setting. Conclusions In cases where immediate percutaneous drainage is not feasible, endoscopic drainage emerges as an effective strategy for managing extensive infectious collections. This technique, involving lavage, debridement, and drain placement under direct vision, eliminates the need to reopen substantial surgical wounds. Notably, this approach aids early recovery in patients undergoing active chemotherapy, preventing delays in chemotherapy administration.

THE UK FOOT AND ANKLE COVID-19 NATIONAL (FALCON) AUDIT: RATE OF COVID-19 INFECTION AND 30-DAY MORTALITY IN FOOT AND ANKLE SURGERY IN THE UK

ObjectivesThe primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.DesignMulticentre retrospective national audit.SettingUK-based study on foot and ankle patients who underwent surgery between the 13th January to 31st July 2020 – examining time periods pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown.ParticipantsAll adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland.Main Outcome MeasuresVariables recorded included demographics, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates.Results6644 patients were included. In total 0.52% of operated patients contracted COVID-19 (n=35). The overall all cause 30-day mortality rate was 0.41%, however in patients who contracted COVID-19, the mortality rate was 25.71% (n=9); this was significantly higher for patients undergoing diabetic foot surgery (75%, n=3 deaths). Matching for age, ASA and comorbidities, the OR of mortality with COVID-19 infection was 11.71 (95% CI 1.55 to 88.74, p=0.017). There were no differences in surgical complications or infection rates prior to or after lockdown, and amongst patients with and without COVID-19 infection. After lockdown COVID-19 infection rate was 0.15% and no patient died of COVID-19 infection.ConclusionsCOVID-19 infection was rare in foot and ankle patients even at the peak of lockdown. However, there was a significant mortality rate in those who contracted COVID-19. Overall surgical complications and post-operative infection rates remained unchanged during the period of this audit. Patients and treating medical personnel should be aware of the risks to enable informed decisions.

#2559 “Remote software technology to assist clinical decision in vascular access surveillance: single UK centre experience”

Abstract Background and Aims Optimal arteriovenous access monitoring and surveillance aims for early detection of dysfunctional access, enabling pre-emptive referral for angioplasty or surgery to prevent access loss or thrombosis. Here we compared the addition of remote software surveillance to standard clinical care in our units. Method From January–December 2023 we conducted a 12-month prospective study of maintenance hemodialysis (HD) patients. We used Vasc-Alert software technology to assist clinical decision making for vascular access (VA) surveillance in 2 out of 5 HD units. In these units, vascular access risk score was calculated using Vasc-Alert software platform from routinely collected data from the dialysis procedure as previously described [1]. Patients with high Vasc-Alert access risk score (≥7) underwent clinical assessment and were referred for fistulogram if they met the relevant KDOQI criteria [2]. The following variables were collected from all 5 HD units: baseline permanent VA prevalence, subsequent VA events (stenosis or thrombosis), access abandonment (i.e. unsalvageable access loss), complication free days (CFD)-extended over one year (defined as days without serious vascular access events, radiological or surgical intervention, VA infection, hospitalisation or use of central venous catheter). Data was collected on patients who were pre-emptively referred for diagnostic fistulogram ± angioplasty but thrombosed while awaiting intervention. Median time interval from the date of fistulogram request till the date of confirmed thrombosed access was calculated. Comparison between HD units with Vasc-Alert use (Group 1) or without (Group 2) was performed using appropriate statistical tests depending on the type and distribution of the data. Survival analysis of post-intervention primary patency rate was conducted at 3 and 6 months defined as the time from the index procedure until the next access thrombosis or reintervention [3]. Results There were 81 (53.6%) patients with permanent VA in group 1and 201 (59.3%) patients in group 2at the start of the study. We recorded 23 (28.4%) episodes of stenosis and 6 (7.4%) episodes of thrombosis in Group 1 and 40 (19.9%) episodes of stenosis and 21 (10.4%) episodes of thrombosis in Group 2 (p value 0.121 and 0.432, respectively). In Group 2, 11 patients (5.5%) developed repeated stenosis and 2 patients (1%) repeated thrombosis. In Group 1, 5 /6 (83%) cases preemptively referred for diagnostic fistulogram ± angioplasty developed thrombosis whilst awaiting elective intervention, compared with 4/21 (19%) in group 2 (p value = 0.008) (Fig. 1). The median time interval from the date of fistulogram request till date of thrombosed VA was 26 days with Interquartile range (IQR 25-75%) of 21-34 days. Group 1 had better post-intervention primary patency rate of VA (Fig. 2) and longer CFD-extended compared to group 2 (p values &amp;lt; 0.001 and 0.002 respectively) (Table 1). Conclusion Our study shows that integrating Vasc-Alert technology into the VA surveillance program was associated with improved early detection of high-risk access, higher primary patency rates and CFD-extended. Additionally, our data emphasizes the need to enhance interventional radiology capacity for timely access intervention, to realise the true potential of Vasc-Alert technology in prevent access thrombosis.

Complications Rate and Related Factors After Laparoscopic Sphincter-Preserving Total Mesorectal Excision for Low Rectal Cancer: A Single-Center Study in Vietnam.

Colorectal cancer is a significant health concern. Surgery remains a critical component of the multimodal treatment strategy. The laparoscopic sphincter-preserving total mesorectal excision (TME) is increasingly utilized and effective, offering enhanced quality of life for patients compared to previous traditional methods. This study aims to determine the rate of complications and the related factors associated with complications following laparoscopic sphincter-preserving total mesorectal excision for low rectal cancer. This retrospective study was conducted at the University Medical Center of Ho Chi Minh City from March 2022 to March 2023. It included patients aged 18 years and older diagnosed with low rectal cancer who underwent laparoscopic sphincter-preserving total mesorectal excision. Data on patient demographics, surgical details, and postoperative complications were retrospectively collected and analyzed. Follow-ups were conducted up to six months after surgery. Of the 83 patients included, the postoperative complications rate was 14.5%. The complications observed included surgical wound infections (five cases), anastomotic leaks (five cases, including three recto-vaginal fistulas and two pelvic abscesses), urinary retention (one case), and pneumonia (one case). A significant finding was the higher rate of distant metastases in patients with complications compared to those without (p=0.033). Laparoscopic sphincter-preserving total mesorectal excision for low rectal cancer is safe and effective, with a high success rate and low complication rate during or after surgery. Anastomotic leakage remains the most significant complication. Despite advancements in surgery, modern suturing tools, and preoperative patient optimization, complications are avoidable. Therefore, understanding the related factors and implementing preventive interventions is crucial.

Current Knowledge and Perspectives of Phage Therapy for Combating Refractory Wound Infections

Wound infection is one of the most important factors affecting wound healing, so its effective control is critical to promote the process of wound healing. However, with the increasing prevalence of multi-drug-resistant (MDR) bacterial strains, the prevention and treatment of wound infections are now more challenging, imposing heavy medical and financial burdens on patients. Furthermore, the diminishing effectiveness of conventional antimicrobials and the declining research on new antibiotics necessitate the urgent exploration of alternative treatments for wound infections. Recently, phage therapy has been revitalized as a promising strategy to address the challenges posed by bacterial infections in the era of antibiotic resistance. The use of phage therapy in treating infectious diseases has demonstrated positive results. This review provides an overview of the mechanisms, characteristics, and delivery methods of phage therapy for combating pathogenic bacteria. Then, we focus on the clinical application of various phage therapies in managing refractory wound infections, such as diabetic foot infections, as well as traumatic, surgical, and burn wound infections. Additionally, an analysis of the potential obstacles and challenges of phage therapy in clinical practice is presented, along with corresponding strategies for addressing these issues. This review serves to enhance our understanding of phage therapy and provides innovative avenues for addressing refractory infections in wound healing.

Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome.

To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

Synthetic suture tape for medial patellofemoral ligament reconstruction is an effective treatment for complex paediatric patellofemoral instability.

To assess the outcomes of medial patellofemoral ligament (MPFL) reconstruction using synthetic suture tape in paediatric patients with patellofemoral instability (PFI). This ambispective comparative study, conducted from 2014 to 2022, included paediatric patients who underwent MPFL reconstruction with synthetic suture tape and had a minimum follow-up of 1 year. Pre- and postoperative clinical and functional outcomes, patient satisfactionand complications were assessed. The study comprised 22 patients (29 knees), with a median age at surgery of 14.4 years (interquartile range [IQR] 10.9-16.7) and a median follow-up of 46.5 months (24.7-66). Notably, 13 knees (44.8%) had open growth plates at the time of surgery. The cohort included patients with Down syndrome (3 patients), Ehlers-Danlos (2), arthrogryposis (1), generalized joint hypermobility (8)and previous unsuccessful PFI surgeries (8). Concomitant procedures were performed on 16 knees. Postoperatively, improvements were observed in all but one patient, who reported residual pain. There were two other complications: one suture-tape rupture and one surgical wound infection. Functional scores significantly improved: Kujala, +14 points (7-29) (p < 0.001); IKDC, +10.5 points (5.2-25.3) (p < 0.001); Tegner, +2 points (0-4) (p < 0.001);Lysholm, +15 points (0-37.5) (p < 0.001). Most patients achieved excellent outcomes by Crosby-Insall criteria (21 patients, 72.4%) and reported high satisfaction (23 patients, 79.3%). MPFL reconstruction using synthetic suture tape is a viable and effective treatment for paediatric patients with PFI, particularly for those with connective tissue disorders, generalized joint hypermobilityor past surgical failures, significantly enhancing clinical and functional outcomes with an acceptable complication rate. Level IV.

EVALUATING THE EFFECTIVENESS OF THE CRITICAL VIEW OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY AT BINH DAN HOSPITAL

Background: The aim of this study was to assess the safety of laparoscopic cholecystectomy using "The Critical View of Safety" (CVS) technique for the management of gallbladder stone disease. Subjects and methods: Prospective study, describing a series of cases of patients undergoing laparoscopic cholecystectomy with CVS applied to treat gallbladder stones at Binh Dan Hospital from January 2022 to October 2022. Results: We enrolled 89 patients and recorded the following outcomes: the success rate was high, at 97.8%. The failure cases were due to large stones blocking the gallbladder neck and severe adhesions in the hepatocystic triangle in necrotizing cholecystitis. There is a statistically significant difference in the success rate of achieving CVS between groups: gallbladder condition (p=0.02), degree of adhesion inflammation of the hepatocystic triangle (p=0.039). The overall bleeding complication rate was 10.3% (9 cases) and during CVS was 6.7% (6 cases). The overall gallbladder perforation complication rate was 8% (7 cases) and during CVS was 4.4% (4 cases), with no biliary tract injuries. The postoperative complications included fluid collection in the gallbladder bed in 10.3% of cases and surgical wound infection in 2.3% of cases. All were successfully treated with conservative measures. Conclusion: We concluded that CVS is a necessary, safe, and effective diagnostic method in laparoscopic cholecystectomy for gallbladder stone disease.

The impact of health care on outcomes of suspected testicular torsion: results from the GRAND study

BackgroundSuspicion of testicular torsion represents a urological emergency, necessitating immediate surgery. Comprehensive data on the current trends and perioperative outcomes regarding surgical exploration are sparse. Therefore, we utilized nationwide data on the prevalence and results of this surgery, aiming to provide evidence on this matter.MethodsWe assessed the GeRmAn Nationwide inpatient Data (GRAND) from 2005 to 2021, provided by the Research Data Center of the Federal Bureau of Statistics. We performed multiple regression analyses to evaluate the perioperative outcomes (length of hospital stay, transfusion, and surgical wound infection) after surgical exploration due to suspected testicular torsion based on both the outcome of surgery (orchiectomy, detorsion with preservation of the testicle, and no testicular torsion) and on the department of operation (urological versus non-urological).ResultsA total of 81,899 males underwent surgical exploration due to suspected testicular torsion in Germany from 2005 to 2021. Of them, 11,725 (14%) underwent orchiectomy, 30,765 (38%) detorsion with preservation of the testicle and subsequent orchidopexy, and 39,409 (48%) presented no testicular torsion. Orchiectomy was significantly associated with longer length of hospital stay (day difference of 1.4 days, 95%CI: 1.3–1.4, p < 0.001), higher odds of transfusion (1.8, 95% CI: 1.2–2.6, p = 0.002) and surgical wound infections (1.8, 95%CI: 1.4–2.3, p < 0.001) compared to no testicular torsion. The proportion of patients undergoing orchiectomy was significantly lower in urological departments (14%) versus non-urological departments (16%) and the proportion of patients undergoing preservation of testicle after detorsion was significantly higher in urological departments (38%) versus non-urological departments (37%), p < 0.001. Patients undergoing treatment in a urological department were discharged earlier and presented lower odds of transfusion and surgical wound infection (p < 0.001) compared to patients undergoing treatment in a non-urological department.ConclusionsNearly half of patients who underwent surgery for suspected testicular torsion did not have intraoperatively the condition confirmed. Patients treated in urological departments had significantly better perioperative outcomes compared to those treated in non-urological departments. Therefore, we advise to refer patients to urological treatment as early as possible.

Association Between Irrational Prophylactic Antibiotic Use and Post-Surgical Infections in Caesarean Section Patients at Indonesian Regional Hospitals

This study explores the link between irrational prophylactic antibiotic use and post-surgical infections in caesarean sections in Indonesia. A cross-sectional design was used, with medical data collected from patients who underwent caesarean section and received prophylactic antibiotics between 2018 and 2022 in a regional hospital in Indonesia. Antibiotic prescriptions were evaluated for appropriateness according to national guidelines. Medical record data was used to gather information regarding obstetric surgical wound infection (ICD-10 code: O86.1).

СОВРЕМЕННЫЕ ТЕНДЕНЦИИ АНТИБИОТИКОУСТОЙЧИВОСТИ ПАТОГЕННЫХ МИКРООРГАНИЗМОВ ПАЦИЕНТОВ ХИРУРГИЧЕСКОГО ПРОФИЛЯ

Background. To carry out adequate antibacterial therapy directed against pathogenic microflora in patients with surgical infection it is necessary to take into account indicators of antibiotic resistance of leading etiological agents. The aim of the work is to study the spectrum and current dynamics of changes in antibiotic resistance of purulent pathogens in soft tissues of surgical patients. Material and methods. An analysis of the results of antibiotic resistance of the seeded leading microflora in patients with purulent processes of soft tissues was made. Results. Isolates of Staphylococcus aureus from surgical patients are characterized by high resistance to all β-lactam antibiotics, the combination drug trimethoprim-sulfamethoxazole, and macrolides. The resistance of Klebsiella pneumoniae and Proteus mirabilis to all studied β-lactam antibiotics, as well as fluoroquinolones, aminoglycosides, tetracyclines, nitrofurans, and chloramphenicol ranges from 37 to 100%. Escherichia coli resistance to β-lactams, fluoroquinolones, carbapenems, and aminoglycosides reaches 50-73%. A high level of antibacterial resistance is also characteristic of other bacteria most often cultured in surgical patients. Conclusions. The most frequently cultured strains of both gram-positive and gram-negative groups of microorganisms from surgical patients are characterized by a high level of antibacterial resistance, reaching 100%. Currently, cases of polyantibiotic resistance and resistance even to reserve antibiotics are not uncommon. All this dictates the need to search for new classes of substances that have an antimicrobial effect, and metal nanoparticles may be one of them.