Surgical Approach For Management Research Articles

Evaluation and Surgical Outcomes of Primary Closure for Breast Abscess- 3 Year Experience in Rangpur Zone

Background: Breast abscesses are a common medical concern, often associated with pain, cost implications, and dressing-related complications. Managing breast abscesses presents an opportunity to optimize patient outcomes while streamlining healthcare resource utilization. This study aimed to evaluate the effectiveness of primary closure as a surgical approach for breast abscess management in a private practice setting, focusing on reducing hospital stays and associated costs, particularly improving patient compliance. Methods: This prospective study was conducted in private practice settings over three years, from July 2020 to June 2023. A total of 119 patients, comprising both acute (n=72) and chronic (n=47) breast abscess cases, were included in the study. The surgical procedures included incision, drainage, curettage, and primary closure using 16 FR/18 FR drains. Special measures included iodine irrigation, keeping drains for at least 7 days, suture removal on 10th-14th postoperative days, and administering antibiotics for up to 14 days. Follow-up appointments occurred after 3 weeks. Results: Among the 119 patients, 72 (60.5%) presented with acute breast abscesses, while 47 (39.5%) had chronic abscesses. All patients were discharged on the 2nd postoperative day. In cases of chronic breast abscess, drains were removed between 5-7 postoperative days, while in acute cases, drains were removed at the 10th postoperative day or upon suture removal. No suction drains were used. Over 95% of patients resumed breastfeeding shortly after surgery. Suture removal on the 10-12th postoperative days showed healthy wounds in 88 patients, minor wound gaps in 13 patients (requiring no further intervention), and secondary stitching in 10 patients. Ten patients experienced delayed abscess formations under the scar, necessitating drainage under local anesthesia and oral antibiotics. The most frequently isolated causative organism from pus was Staphylococcus aureus. .........

Surgical vs. Non-Surgical Management of Temporomandibular Joint Disorders: Clinical Outcomes

ABSTRACT Background: Temporomandibular joint disorders (TMDs) encompass a range of clinical conditions affecting the temporomandibular joint (TMJ) and associated structures. Management approaches for TMDs vary and include both surgical and non-surgical interventions. Materials and Methods: In this retrospective cohort study, medical records of 150 patients diagnosed with TMDs were reviewed. Patients were categorized into two groups: surgical intervention and non-surgical intervention. The surgical group underwent various surgical procedures, including arthroscopy, arthroplasty, and joint replacement, while the non-surgical group received conservative treatments such as physical therapy, pharmacotherapy, and occlusal splints. Pain levels, TMJ function, quality of life (QoL), and patient satisfaction were assessed at baseline and post-treatment (6 months and 1 year). Results: At the 6-month follow-up, both groups experienced a significant reduction in pain scores (surgical group: 6.3 ± 1.2 to 2.4 ± 0.9, non-surgical group: 6.1 ± 1.1 to 3.2 ± 1.0). TMJ function improved in both groups (surgical group: 2.5 ± 0.8 to 4.8 ± 0.6, non-surgical group: 2.6 ± 0.7 to 4.2 ± 0.9). QoL scores increased (surgical group: 35.2 ± 4.6 to 50.3 ± 5.1, non-surgical group: 35.5 ± 4.2 to 45.7 ± 4.8), and patient satisfaction rates were high (surgical group: 92%, non-surgical group: 87%) at the 1-year follow-up. Conclusion: Both surgical and non-surgical management approaches demonstrated significant improvements in pain relief, TMJ function, QoL, and patient satisfaction for individuals with TMDs.

Surgeons' Roles and Responsibilities in Disaster and Public Health Emergency Management-A Transition from Multitasking Surgeons to a Collaborative Surgical Approach.

Surgeons have historically played critical roles in disaster management, particularly as military and trauma specialists. However, the role of surgeons in disasters has changed over time, with advancements in medical knowledge and disaster response capabilities. Recent public health emergencies and global events have signaled a paradigm shift, emphasizing the necessity of cross-disciplinary, transdisciplinary, and multidisciplinary approaches. This shift calls for revisiting and reevaluating surgeons' roles and responsibilities. In this narrative review, the literature concerning the roles and responsibilities of surgeons during disasters and public health emergencies was systematically searched and mapped. This streamlined process aimed to gather high-quality information typically found in a systematic review but within a shorter timeframe. The goal was to expedite the discovery of insights that could inform policy decisions or address urgent matters related to the study's topic. Furthermore, action research was performed to strengthen the paper's methodology, capture essential literature, and avoid missing important data. The results indicate a change in surgical specialty and a shift in the paradigm from multitasking surgeons to a multidisciplinary approach in surgical disaster management. Current educational initiatives are insufficient, and training opportunities are lacking, indicating the need for novel educational initiatives, simulation training, a collaborative surgical approach, and a reevaluation of the current curriculum. The study outcomes aim to guide future policy development and facilitate the creation of practical guidelines for disaster and public health emergency planners at local, regional, national, and international levels. Surgeons' future roles in disaster and public health emergency management will be characterized by innovation, collaboration, and a commitment to improving outcomes for affected populations, addressing the unique challenges of disasters, and strengthening healthcare systems globally.

Delayed surgical step-up approach for management of infected pancreatic necrosis – is it Worth or Vain?

Delayed surgical step-up approach for management of infected pancreatic necrosis – is it Worth or Vain?

Review of various surgical approaches for varicocele management

Varicocele is one of the most common correctable causes of male infertility. Varicocele can also cause scrotal pain or discomfort. Treatment of varicocele is proved to have benefits in terms of fertility and pain. There are many treatment options for varicocele. This review aims to describe the treatment procedures and determine the outcomes, advantages and disadvantages for each treatment option.

How we can reduce the environmental impact of our operating theatres: a narrative review.

Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re-use and re-processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service.

Submerged vs Nonsubmerged Reconstructive Approach for Surgical Treatment of Peri-implantitis: Reanalysis of Two Prospective Clinical Studies.

To complete a reanalysis study of two similarly designed prospective controlled studies exploring prognostic factors associated with the surgical outcomes of reconstructive treatment of peri-implantitis. Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant suprastructure removal and complete coverage of grafted sites. The second study employed a nonsubmerged healing protocol in which healing abutments were kept in place and the implants were not fully submerged. Both studies measured all prognostic factors at similar time points throughout 1 year and included clinical defect fill (DF) and radiographic defect fill (RDF), reduction of pocket depth (PDR), and bleeding on probing (BoP). Multilevel regression was used for statistical assessment of outcomes relative to the impact of site, local, surgical, and patient-related variables. Overall, 59 implants (30 submerged and 29 nonsubmerged) were treated. Statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm), and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BoP reduction was similar. After controlling for treatment (submerged/ nonsubmerged), there were no other significant associations with patient-related (age, sex, smoking, prior periodontitis etc), or implant-related (previous prosthesis type, arch, keratinized tissue width [KTW], etc) factors. Within the study's limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a nonsubmerged approach.

Abstract 14607: Management of Inappropriate Sinus Tachycardia: A Promising Breakthrough

Introduction: Inappropriate Sinus Tachycardia (IST) is a cardiac dysautonomia with limited treatment options. This case highlights the effectiveness of a novel sinus node-sparing hybrid surgical ablation (SNSHA) for IST. Objective: To describe a novel hybrid surgical approach for management of IST. Case Description: A 43 y/o female presented with history of palpitations/tachycardia for 5 years. A comprehensive evaluation directed towards the diagnosis of IST with resting heart rates (HR) above 100 bpm and HR changes greater than 30% with minimal exertion. A trial of ivabradine & beta blockers along with lifestyle modifications offered limited relief. Patient was offered the novel SNSHA after a shared decision-making process. Methods: The SNSHA is a minimally invasive procedure performed by a CT surgeon in conjunction with an electrophysiologist involving thoracoscopic epicardial ablation of the sympathetic connections from the SVC to the IVC. The thoracoscopic approach allows for safeguarding of the phrenic nerve and sinus node followed by endocardial ablation along the lateral wall. Results: Intraprocedural pre and post ablation electroanatomic map (EAM) and electrogram (EGM) demonstrated an immediate drop in HR as shown in the Figure 1(a-d). An ILR was implanted during the procedure. On 45-day post-op visit, the patient experienced significant symptom relief and improvement in her HR as well as HR variability on ILR as shown in Figure 1(e). Conclusion: SNSHA offers a reasonable treatment option for patients with drug resistant IST. This procedure provided symptom alleviation and improvement in HR without increasing the risk of complications in comparison to sinus node modification ablation, which has previously been shown to be associated with higher incidence of pacemaker implantation.

Pattern A endocervical adenocarcinomas with ovarian metastasis are indolent and molecularly distinct from destructively invasive adenocarcinomas.

The invasive pattern in HPV-associated endocervical adenocarcinoma (HPVA) has prognostic value. Non-destructive (pattern A) HPVA has excellent prognosis mirroring adenocarcinoma in-situ (AIS). However, the rare occurrence of ovarian spread in these tumours suggests aggressiveness in a subset of patients with these otherwise indolent lesions. We hypothesise that AIS/pattern A HPVA with ovarian metastases are biologically different than metastatic destructively invasive HPVA. Samples from patients with HPVA and synchronous or metachronous metastases were retrieved and reviewed to confirm diagnosis and determine the Silva pattern in the primary lesion. For each case, normal tissue, cervical tumour and at least one metastasis underwent comprehensive sequencing using a 447-gene panel. Pathogenic single-nucleotide variants and segmental copy-number alterations (CNA), tumour mutational burden and molecular signatures were evaluated and compared between primary and metastases and among invasive pattern categories. We identified 13 patients: four had AIS/pattern A primaries, while nine had pattern B/C tumours. All AIS/pattern A lesions had metastasis only to ovary; 50% of patients with ovarian involvement, regardless of invasive pattern, also had involvement of the endometrium and/or fallopian tube mucosa by HPVA. In the ovary, AIS/pattern A HPVA showed deceptive well-differentiated glands, often with adenofibroma-like appearance. Conversely, pattern C HPVAs consistently showed overt infiltrative features in the ovary. Sequencing confirmed the genetic relationship between primary and metastatic tumours in each case. PIK3CA alterations were identified in three of four AIS/pattern A HPVAs and three of eight pattern B/C tumours with sequenced metastases. Pattern C tumours showed a notably higher number of CNA in primary tumours compared to pattern A/B tumours. Only one metastatic AIS/pattern A HPVA had a novel pathogenic variant compared to the primary. Conversely, five of eight pattern B/C tumours with sequenced metastases developed novel pathogenic variants in the metastasis not seen in the primary. All four AIS/pattern A patients were alive and free of disease at 31, 47, 58 and 212 months after initial diagnosis. Conversely, cancer-related death was documented in five of nine pattern B/C patients with follow-up at 7, 20, 20, 43 and 87 months. Morphologically and genomically, AIS/pattern A HPVA with secondary ovarian involvement appears distinct from destructively invasive tumours. In at least a subset of these cases, ovarian spread appears to occur via trans-Mullerian superficial extension, different from the stromal and lymphatic vascular spread typical of more aggressive tumours (pattern C). These differences may explain the indolent outcome observed in the rare subset of patients with AIS/pattern A HPVA and ovarian metastasis. Our data underscore the potential for conservative surgical management approaches to pattern A HPVA.

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

Patient-Reported Outcomes of Surgically Treated Lisfranc Injuries with Isolated Longitudinal Instability

Category: Midfoot/Forefoot; Other Introduction/Purpose: A longitudinal Lisfranc variant injury occurs from a longitudinal force on the midfoot directed through the first ray and medial cuneiform. This is unique in that other Lisfranc injury patterns typically result from an axial-directed force or a rotational force that externally rotates the midfoot. More common Lisfranc injury patterns can have instability longitudinally, but usually it is accompanied by coronal instability and even axial instability. To date, there has been no study with a cohort of Lisfranc injuries with isolated longitudinal instability. The purpose of this study was to report patient-reported outcome measures (PROMs) for those undergoing surgical treatment for longitudinal Lisfranc injuries. Methods: Retrospective chart review was completed to identify patients with surgically treated longitudinal Lisfranc injuries by a single surgeon between April 2018 and February 2022. Intraoperative fluoroscopy was used to confirm Lisfranc injuries positive for only longitudinal instability and negative for coronal and axial instability. Surgical technique consisted of open reduction internal fixation (ORIF) with a compression screw from the medial to middle cuneiform and a “homerun” compression screw from the medial cuneiform to the base of the second metatarsal. PROMs, collected preoperatively and postoperatively, included the Foot and Ankle Ability Measure (FAAM), Veterans RAND 12-Item Health Survey (VR-12), and visual analog scale (VAS) pain scale. Patient satisfaction was assessed through a survey consisting of a 0-100 rating scale with “least satisfied” being 0 and “most satisfied” being 100. Statistical analyses to determine significance were completed through sample t-tests assuming unequal variance with significance set at P<.05. Results: Fourteen patients (14 feet) with an average age of 25.2±15.7 years sustained longitudinal Lisfranc injuries. Eleven of 14 patients competed in competitive sports when injured with football (n=5) being the most prevalent sport. Eleven patients underwent hardware removal an average of 3.6 months following their primary surgery. There were three cases of broken hardware, and one revision in which ORIF was converted to fusion. The average latest follow-up time for PROMs were 25.9 (range, 12-44) months. Results demonstrate a significant improvement in FAAM Total, FAAM ADL, and FAAM Sports scores at latest follow-up (Figure 1). There was also improvement in VR-12 Mental, VR-12 Physical, and VAS scores, though not statistically significant. Mean patient satisfaction at latest follow-up was 99/100. Conclusion: This study is the first to present data from a cohort of isolated longitudinal Lisfranc injuries. There is significant debate about surgical management of Lisfranc injuries. The improvement in PROMs at latest follow-up and high patient satisfaction suggests that ORIF may be an optimal surgical approach for management of longitudinal Lisfranc injuries.

Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study

BackgroundThe two-child policy implemented in China resulted in a surge of high-risk pregnancies among advanced maternal aged women and presented a window of opportunity to identify a large number of placenta accreta spectrum (PAS) cases, which often invoke severe blood loss and hysterectomy. We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning.MethodsCross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL + CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018.ResultsFrom a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL + CST had a significant reduction in intraoperative blood loss (β=-312 ml, P < .001), RBC transfusion (β=-1.08 unit, P = .001), but required more surgery time (β = 16.43 min, P = .01). MRI-measured placenta thickness, when above 50 mm, can increase blood loss (β = 315 ml, P = .01), RBC transfusion (β = 1.28 unit, P = .01), surgery time (β = 48.84 min, P < .001) and hospital stay (β = 2.58 day, P < .001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation.ConclusionsA conservative surgical management approach of UAL + CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery.Clinical trial registration number: ChiCTR2000035202.

Comparative Study between Anterior and Posterior Approaches in Management of Cervical Spondylotic Myelopathy

Background The best surgical approach for management of degenerative cervical myelopathy remains area of debate between spinal surgeons. The purpose of this study compare between anterior approach (anterior cervical discectomy with fusion) and posterior approach (laminectomy with and without fusion) for treatment of multilevel spondylotic myelopathy according to clinical, radiological outcomes, recovery rates and complications. Material and Methods A total of 20 patients were operated by anterior cervical discectomy and fusion (ACDF) and 20 patients were operated by cervical laminectomy with and without fusion in this study. Preoperative and postoperative clinical assessment were done using modified Japanese Orthopedic Association (mJOA) score and Myelopathy scale (MS). Postoperative complications, recovery rate and intraoperative blood loss are recorded. Preoperative and postoperative radiological analysis were done using Cobb angle measurement (C2-7 angle) and canal diameter assessment by measuring the canal through the center of each vertebra and intervertebral discs (C2–C7) on 10 transverse planes on mid-sagittal T2WI image. Results There was significant decrease in pre-operative mJOA scale in posterior approach group; compared to anterior group (P = 0.41). There was highly significant decrease in duration of symptoms in anterior approach group; compared to anterior group (P &amp;lt; 0.01) and significant decrease in pre-operative MS scale in anterior approach group; compared to anterior group (P &amp;lt; 0.05). There is non-significant difference as regards post-operative mJOA scale and MS scale between anterior and posterior group (p &amp;gt; 0.05). Although recovery rate was higher in anterior group than posterior group (49.5 ± 27.2 vs 39.51 ± 11.30), but finally There was no significant difference as regards postoperative recovery, improvement and complications rates (p &amp;gt; 0.05). postoperative canal diameter change was greater in posterior surgery than anterior group (11.1 ± 1.98 vs 9.5 ± 0.76). Reoperation rate was higher in anterior group. Postoperative C5 palsy and axial neck pain were higher in posterior group. Conclusions Both anterior and posterior approaches were successful to treat multilevel CSM, but no definitive surgical approach was proved for management of CSM and each case should be evaluated carefully for determination of best surgical approach according to preoperative Cobb angle and canal diameter.

SP10.16 Impact of joint surgical and medical management on outcomes in inflammatory bowel disease. A retrospective review of medical management and surgical outcomes in a District General

Abstract Aim A combined medical and surgical team approach for management of inflammatory bowel disease (IBD) facilitates optimized medical and surgical management through dedicated MDTs and clinics. These benefits were delivered during the COVID-19 pandemic impacting planned medical care. Method Data was collected for all IBD patients undergoing resection surgery over 16 years of age covering a 2-year period before and a 2-year period after the impact of COVID-19 pandemic and start of a combined IBD practice. It included demographics, immune-suppression and planned and unplanned surgery between January 2018 to September 2021. Results 62 patients underwent major resection surgery. Six were excluded for non-IBD related indication (malignancy, infective colitis and volvulus). Of the remaining 56 patients, 20 (35.7%) had Crohn’s Disease, 35 (62.5%) had Ulcerative colitis and one (1.8%) with indeterminate colitis on histopathology. The median age was 43.6 years (16 to 80) with 64.3% females. In the first 2-year period, 73.7% (14) underwent surgery with high perioperative immunosuppression. This reduced to 26.3% (5) in the combined IBD period. Proportion of patients undergoing emergency surgery declined from 59% to 12.5%. Use of biologics increased from 29% to 50% of patients with the average of 0.71 vs 2.13 failed biologics use before surgical intervention. Conclusion Combined medical and surgical IBD practice offers optimised care through timely escalation of medical treatment and reduces risks associated with major emergency surgery. Despite the restrictions to planned surgical treatment during the COVID-19 pandemic, improved outcomes were achieved with combined practice for IBD patients.

Robot-assisted laparoscopic pyeloplasty is a valid option for ureteropelvic junction obstruction repair in adults with congenital renal abnormalities: a case series study

BackgroundCongenital renal anomalies are rare but may be associated with obstruction of the ureteropelvic junction. Given the rarity of simultaneous ureteropelvic junction obstruction [UPJO] and renal anomalies in the adult population, there is limited literature on approaching these patients. We report our experience with robotic assisted laparoscopic pyeloplasty for UPJO repair in this subset of patients.MethodsData on adult patients with simultaneous congenital renal abnormalities and UPJO who underwent robotic assisted laparoscopic pyeloplasty between 2008 and 2020 was reviewed. Pre-operative data, intraoperative parameters as well as post-operative data including symptom resolution and radiologic findings were recorded.ResultsTen patients, 4 female and 6 males, with a mean age of 47 years were identified as having simultaneous congenital renal abnormalities and UPJO. Anomalies identified were horseshoe kidney in four patients, duplex kidney with obstruction of one moiety in two patients, malrotated kidney in two patients, and pelvic kidney in two patients. Eight out of ten were symptomatic at presentation with flank pain being the most common symptom. Eight patients underwent robotic pyeloplasty via the dismembered technique, while two underwent robotic Y-V pyeloplasty. With a mean follow up time of 13 months, 8/9 (88%) symptomatic patients enjoyed symptom resolution. Post-op renogram was available for nine patients and showed resolution of obstruction in all patients (100%). One patient developed a urine leak which was managed successfully with drainage.ConclusionsRobotic assisted laparoscopic pyeloplasty is a safe, feasible and effective surgical approach in management of adult patients with concomitant UPJO and renal anomalies.

Comparative analysis of surgical management approaches for hydatid liver cysts: conventional vs. minimally invasive techniques

IntroductionHydatid liver disease is a prevalent condition in endemic areas, particularly in the Middle East and North Africa. The use of laparoscopy as a treatment option has gained popularity. However, there is still ongoing debate regarding the optimal approach for surgical management. In this study, we present our experience with the surgical treatment of hydatid liver disease comparing conventional and minimally invasive approaches, including laparoscopic and robotic options.MethodsWe conducted a retrospective review of patients who underwent surgery for hydatid liver disease at our institution. Data was collected on the patients’ clinical presentations, cyst characteristics, surgical procedures performed, intraoperative findings, and postoperative complications.ResultsA total of 98 hydatid liver cysts were surgically managed in 57 patients. The mean age of the patients was 37.2 ± 10.2 years, with 38 (66.7%) being male. Among the patients, 14 (24.6%) underwent conventional surgery (6 partial pericystectomy, 4 total pericystectomy, and 4 liver resection), 37 (64.9%) underwent laparoscopic surgery (31 partial pericystectomy, 4 total pericystectomy, and 2 liver resection), and 6 (10.5%) underwent robotic surgery (6 partial pericystectomy). There were no significant differences between the conventional surgery and minimally invasive groups in terms of patient age, gender, cyst size, or number. However, laparotomy was associated with a higher number of total pericystectomy and liver resection procedures compared to the minimally invasive approach (P = 0.010). Nonetheless, the operation time and blood loss were comparable between both groups. Perioperative complications occurred in 19 (33.3%) patients, with 16 (84%) experiencing minor issues. Bile leak occurred in 8 (14%) patients, resolving spontaneously in 5 patients. There was no significant difference (P = 0.314) in the incidence of complications between the two groups. Conventional surgery, however, was associated with a significantly longer hospital stay (P = 0.034). During follow-up, there were no cases of mortality or cyst recurrence in our cohort.ConclusionMinimally invasive approaches for hydatid liver cysts offer advantages such as shorter hospitalization and potentially quicker recovery, making them valuable treatment options when accompanied by careful patient selection and adherence to proper surgical techniques.

From Clinical Scenarios to the Management of Lower Urinary Tract Symptoms in Children: A Focus for the General Pediatrician.

Lower urinary tract symptoms (LUTS) are a relevant problem in the pediatric population, having a very high prevalence. Diurnal incontinence and nocturnal enuresis are surely the most frequent symptoms, presenting, respectively, in up to 30% of school-age children and up to 10% of children between 6 and 7 years. Stypsis is the most common comorbidity, and it must be considered in the management of LUTS; indeed, the treatment of constipation is curative in most cases for both incontinence and enuresis. The presence or absence of diurnal symptoms in nocturnal enuresis and urgency in diurnal incontinence helps in the differential diagnosis. Urotherapy is always the first-line treatment, while oxybutynin and desmopressin (where appropriate) may help if the first-line treatment is unsuccessful. It is essential to identify conditions that are potentially dangerous for kidney and urinary tract well-being, for which LUTS can be the first manifestation. Starting from a series of clinical scenarios, we will underline the diagnostic clues behind LUTS in children and we will summarize clinical and surgical approaches for the proper management of these conditions.

No difference in survival for primary cutaneous Merkel cell carcinoma after Mohs micrographic surgery and wide local excision

The preferred treatment for clinically node-negative Merkel cell carcinoma (MCC) is surgical excision in conjunction with sentinel lymph node biopsy. There is limited large-scale research on survival outcomes by surgical approach for management of the primary tumor. To compare overall and MCC-specific survival outcomes in clinically and pathologically node-negative MCC patients treated with wide-local excision (WLE) and Mohs micrographic surgery (MMS) in a nationally representative sample. Overall and MCC-specific survival outcomes for primary MCC tumors contained in the SEER-18 database from 1989 to 2015 were stratified by surgical modality and analyzed via competing risk analysis. A total of 2,359 US adults with MCC were included in the analysis. For overall and MCC-specific survival, there was no significant difference in survival outcomes between WLE and MMS on multivariable analysis ((HR 1.04 [95% CI 0.88 - 1.22]; SHR 0.76 [95% CI 0.53 - 1.09]). Sentinel lymph node biopsy (SLNB) was associated with improved overall survival and MCC-specific survival. Retrospective design of SEER and the lack of covariates such as comorbidities and immunostaining. There is no survival disadvantage for MMS compared to WLE as the surgical modality for primary cutaneous MCC. SLNB should be coordinated prior to MMS.

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis.

A unique surgical approach - the minimally invasive direct interbody fusion (MIS-DTIF) - was previously introduced in our proof-of-concept study, which included four patients who underwent thoracic interbody fusion below the scapula at the T6/7 vertebral level. However, due to the novelty of this method, a report of associated operative parameters such as pain, function, and clinical outcomes from an expanded patient cohort was needed to assess the validity of our results. Following IRB approval, data wereanalyzed retrospectively from electronic health records between 2014 and 2021. Inclusion criteria were patients ≥18 years old who underwent minimally invasive thoracic interbody fusion using the MIS-DTIF technique for at least one vertebral level. The primary outcomes included demographic/radiographic features (e.g., age). Secondary outcomes included perioperative clinical features(e.g., preoperative and ≥1-year final follow-up (FFU)). Tertiary outcomes included perioperative complications. Both preoperative and FFU patient-reported pain and functional outcomes (ODI scores) were analyzed using t-tests to establish significance. Results: A total of 13 patients who underwent MIS-DTIF surgery were observed, with eight male patients and five female patients. The average age was 49.2 years, with an average BMI of 30.5 kg/m2. Of the surgeries included, the majority (69.23%) were 1-level thoracic vertebrae fusions - with 2-level fusionsand≥ 3-level fusions accounting for 15.38% and 15.38% of cases, respectively. The mean operative time was 58.9 ± 19.9minutes, with an average fluoroscopy time of 285.7 ± 126.8secondsand an average actual blood loss volume of 109.0 ± 79.0mL. The average hospital length of stay was 1.1 (±1.7) days, and no clinically significant perioperative complications were observed in this patient cohort. The average follow-up period was 12.1 ± 9.6months, with preoperative and FFU back pain visual analog scale (VAS) scores showing highly significant improvement (p<0.001). In addition to pain reduction, quality of life improvements wasnoted, with significant differences in some of the ODI domains between preoperative and FFU scores (p<0.05), as well as the overall total score between preoperative and FFU ODI assessment (p<0.001) - both of which reflect increased patient function and decreased disability. This study provides further evidence for the safety and efficacy of the MIS-DTIF approach for surgical management of symptomatically refractory patients with thoracic disc herniation or stenosis owing to degenerative disc disease or compression fractures. Additionally, the data gathered suggests that this minimally invasive procedure offers many clinical benefits, including less tissue damage, decreased intraoperative blood loss, shortened surgery time, and shortened hospital length of stay. Finally, in addition to significant pain intensity improvement, this study showed that treated patients highly benefited from 'sleeping' and 'return-to-work' domains and other ODI functional domains in activities of daily living (ADLs). More clinical studies are recommended in larger patient cohorts to ascertain the findings reported in this study.

A new surgical approach for fertility-sparing management of diffuse endometrial G2 endometrioid adenocarcinoma: a step-by-step technique.

4% of endometrial cancers are diagnosed in young women and 70% are nulliparous. Preserve fertility in these patients is of major interest. It is demonstrated that hysteroscopic resection of focal well-differentiated endometrioid adenocarcinoma, followed by progestins achieve a complete response rate of 95.3%. Recently, fertility-sparing treatment was proposed also in case of moderately differentiated endometrioid tumors, with a relatively high remission rate. To show a new hysteroscopic approach, in case of fertility-sparing treatment of diffuse endometrial G2 endometrioid adenocarcinoma. Stepwise demonstration of the technique with narrated video footage for the fertility-sparing management of diffuse endometrial G2 endometrioid adenocarcinoma, combining the use of a 15 Fr bipolar miniresectoscope and 'three-steps' resection technique (Karl Storz, Tuttlingen, Germany) with a Tissue Removal Device (TRD) (Truclear Elite Mini, Medtronic). negative hysteroscopic assessment and endometrial biopsies at three and six months. Normal endometrial cavity and negative biopsies. Combined hysteroscopic technique, in case of diffuse endometrial G2 endometrioid adenocarcinoma, followed by double progestin therapy (Levonorgestrel releasing Intrauterine Device + Megestrole Acetate 160 mg/daily), may be associated with higher complete response rate; the use of TRD to complete the resection near tubal ostia may reduce risk of post-operative intrauterine adhesions and improve reproductive outcomes. A novel, fertility-sparing surgical approach for diffuse endometrial G2 endometroid adenocarcinoma.