Surgical Management Of Complications Research Articles

Complications after Polyacrylamide Hydrogel Injection for Facial Soft-Tissue Augmentation in China

Polyacrylamide hydrogel has been used for soft-tissue augmentation for more than 10 years. Although it is considered a nontoxic, nonimmunogenic material, complications after polyacrylamide hydrogel injections during facial soft-tissue augmentation have been reported. Between 2003 and 2009, 24 patients underwent surgical management of complications after facial soft-tissue augmentation. Histories, preoperative imaging, and photographs of operations were recorded. Complications included hematomas, infection, nodule formation, and migration. Ultimately, 23 of 24 cases underwent surgery to remove the gel; the remaining case underwent surgical drainage to remove it. As more complications have been reported, especially ones that are difficult to treat, the safety of polyacrylamide hydrogel needs to be reconsidered. The authors' experiences provide methods to remove polyacrylamide hydrogel if complications occur. Therapeutic, V.

Blepharoplasty Complications

There are three major areas of concern for a patient who has complications following a cosmetic blepharoplasty: cosmetic issues, functional issues, and uncomfortable/symptomatic issues or a combination of the above. An emphasis will be placed on avoiding cosmetic eyelid complications as well as the medical and surgical management of complications.

Sp805 Endoscopic Remodeling of Gastrojejunostomy after Gastric Bypass

Endoscopy has evolved into a major tool in the management of bariatric surgery complications,but has generally been confined to intralumenal therapies, with iatrogenic perforation considered a dreadful complication. Research in NOTES® has led to the development of new endoscopic tools, which have also found meaningful applications in the endoscopic management of surgical complications. The endoscopic suturing system is such an example. A 40-year-old woman underwent a gastric bypass 10 years ago with subsequent successful loss of weight. She now presented with new postprandial epigastric pain, nausea and vomiting. Upper endoscopy identified enlargement of the blind end of the Roux limb, commonly referred to as “candy cane”. It also demonstrated angulation of the efferent side of the Roux limb. This mechanical problem would traditionally require surgical revision of the gastro-jejunostomy with re-connection of the Roux limb to the gastric pouch and resection of the dilated candy cane.

Surgical management of complications of multimodal therapy

Multimodality therapies that include surgery, chemotherapy, radiotherapy, and various newer forms of targeted therapies have been commonly applied in childhood cancers. Such modalities are associated with complications that may adversely affect the outcome of cancer treatment. Acute complications that require surgical management form the focus of our discussion. These patients are often compromised by immunosuppression, thrombocytopenia, and malnutrition. The complications discussed include typhlitis, invasive aspergillosis (IA), pancreatitis, hemorrhagic cystitis, gastrointestinal hemorrhage, necrotizing skin and soft-tissue infections, and perianal infection. Familiarity with the spectrum of complications and their appropriate management approaches will minimize the patients' morbidity.

The surgical management of complications of vulval lichen sclerosus

To review the surgical procedures used to treat the complications of vulval lichen sclerosus at a single tertiary referral institution in north-east Scotland over a ten year period. A retrospective case note review of women who had surgery for ano-genital lichen sclerosus at Aberdeen Royal Infirmary between January 1999 and December 2009. The total number of women was 25 and the two most common procedures were Fenton's procedure (median perineotomy) and laser division of adhesions. Initial surgery resulted in an improvement of symptoms for 80% of women. When surgery for vulval lichen sclerosus is reserved for highly selected cases where there are complications secondary to adhesions, the proportion of women benefiting is high.

Management of surgical complications of thyroidectomy related to the superior and inferior laryngeal nerves

Thyroidectomy is a frequently performed operation nowadays and is generally considered to be a safe procedure. Though infrequent, the occurrence of complications may become life threatening or result in serious functional impairment. Due to the close anatomical relationship between the thyroid gland and superior and inferior laryngeal nerves, injury to these nerves could cause sensory-motor impairment of the laryngeal function and represent a major and feared complication of thyroidectomy.

On the Management of Hyperglycaemia in Critically Ill Patients Undergoing Surgery

Hyperglycaemia is a major health risk and a negative determinant of surgical outcome. Despite its increasing prevalence, the limited treatments for restoration of normoglycaemia make its effective management a highly complex individualized clinical art. In this context, we review the mechanisms leading to hyperglycaemic damage as the basis for effective management of surgical complications of diabetic and non diabetic critically ill patients.

Contemporary management of vascular Ehlers–Danlos syndrome

Vascular Ehlers-Danlos syndrome (EDS) results from mutations in the formation of type III collagen. This leads to various potentially lethal complications including rupture of the arterial vessels, intestinal organs, and the uterus. This review summarizes recent cohort studies that have improved our medical and surgical management of complications associated with vascular EDS. Vascular EDS is associated with a shortened overall survival due to potential complications, namely loss of connective tissue integrity in blood vessels and increased risk of arterial rupture. The traditional approach has been to treat such complications conservatively unless they are life threatening. There have been challenges to this treatment paradigm based on recent reports. Treatment with the beta blocker Celiprolol was shown in a randomized study to be associated with a three-fold decrease in arterial rupture in vascular EDS patients. Furthermore, it was shown by observational studies that elective surgical repair of blood vessels at risk of rupture may be safely undertaken at tertiary referral centers that have expertise in managing connective tissue disorders. Novel approaches using endovascular therapy with coil embolization have also been attempted with good results in the treatment of ruptured pseudoaneurysms, visceral aneurysms, and carotid-cavernous fistulas. New evidence-based treatments have greatly expanded the medical and surgical management options for patients with EDS. These patients are best managed by multidisciplinary teams of interventionalists, cardiologists, and geneticists in tertiary centers with expertise in managing connective tissue disorders.

Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection

Complication management appears to be of vital importance to differences in survival following surgery between surgical units. Failure-to-rescue (FTR) rates have not yet distinguished surgical from general medical complications. The aim of this study was to assess whether variability exists in FTR rates after reoperation for serious surgical complications following colorectal cancer resections in England. The Hospital Episode Statistics (HES) database was used to identify patients undergoing primary resection for colorectal cancer between 2000 and 2008 in English National Health Service (NHS) trusts. Units were ranked into quintiles according to overall risk-adjusted mortality. Highest and lowest mortality quintiles were compared with respect to reoperation rates and FTR-surgical (FTR-S) rates. FTR-S was defined as the proportion of patients with an unplanned reoperation who died within the same admission. Some 144 542 patients undergoing resection for colorectal cancer in 150 English NHS trusts were included. On ranking according to risk-adjusted mortality, rates varied significantly between lowest and highest mortality quintiles (5·4 and 9·3 per cent respectively; P = 0·029). Lowest and highest mortality quintiles had equivalent adjusted reoperation rates (both 4·8 per cent; P = 0·211). FTR-S rates were significantly higher at units within the worst mortality quintile (16·8 versus 11·1 per cent; P = 0·002). FTR-S rates differed significantly between English colorectal units, highlighting variability in ability to prevent death in this high-risk group. This variability may represent differences in serious surgical complication management. FTR-S represents a readily collectable marker of surgical complication management that is likely to be applicable to other surgical specialties.

Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery

Thoracic outlet syndrome (TOS) is one of the most complicated diseases in thoracic surgery with regard to both diagnosis and treatment. Surgical removal of the first rib and cervical rib, if present, has been suggested as the treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS and the management of surgical complications are presented. A total of 109 cases with the diagnosis of TOS were operated on between January 1995 and April 2010. Ninety-five of the cases were females (87.2 %) and 14 (12.8 %) were males with a mean age of 35.7 (16-58). A total of 131 operations were performed, of which 21 were bilateral and one was a recurrent operation. The diagnosis was neurogenic TOS in 107 (98.2 %) and vascular TOS in two (1.8 %) patients. All neurogenic TOS operations were performed via the transaxillary route. A posterior thoracoplasty approach was used for recurrent TOS in one case. A total of 23 (21.1 %) cases had a cervical rib. Fibromuscular bands were observed in 68 (62.3 %) cases. The rates for favorable and poor surgical outcome were 125 (95.4 %) and 6 (4.6 %), respectively. The most common complication was apical pneumothorax in 32 (24.6 %) cases, followed by wound infection in four (3 %), lymphatic leak, axillary hematoma and mild brachial plexus traction palsy in one (0.8 %) case. Mortality was not observed. In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.

Prevention and management of the complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury

Objective To investigate the occurrence, prevention and management of surgical complication of contralateral C7 nerve root transfer through the prespinal route to repair the brachial plexus nerve root avulsion injury. Methods From Feb. 2002 to Aug. 2009, 425 patients were performed the contralateral C7 nerve root transfer through the prespinal route with this procedure. There were 379 males and 46 females,with the average age of 21 years (range, 3 months to 56 years). The contralateral C7 nerve root was sectioned at the distal of the middle trunk in 15 cases, at the distal of the anterior and posterior division in 410 patients. The surgical complications related to the health C7 nerve root section and the make of tunnel through the prespinal route and others were analyzed retrospectively. Results The incidence rate of complication was 5.2%(22/425). The surgical complications related to the make of prespinal route including 2 cases had the severe bleeding during the operation because of vertebral artery injury; transitory laryrecurrent nerve palsy occurred in 5 cases, the pain and numbness occurred on the donor upper limber in 4 cases when the patients swallowed. The complications related to the section of contralateral C7 nerve root including the extension of finger and thumb was dysfunction in 5 patients after the operation, 3 cases had the severely pain on the health upper limber, Horner's sign occurred on donor side in 2 children suffered birth palsy, and C6 nerve root was mistaken sectioned as C7 in 1 case. Other serious perioperative complication including the thromboses of the cerebral trunk occurred in 1 case 42 hours postoperative and died in hospital 38 days after the operation. Conclusion The procedure of contralateral C7 nerve root transfer through the prespinal route is safe. The effective method to prevent this complication occurrence is to expose the origin segment of vertebral artery when making prespinal route. Key words: Brachial plexus; Nerve transfer; Postoperative complications

Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs). The records of all (n=56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database. A wide range of ASD sizes (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. Complications leading to surgery included embolisation (n=29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n=12), significant residual shunt (n=12), aortic or atrial perforation or erosion (n=9), haemopericardium with tamponade (n=5), aortic or mitral valve injury (n=2) and endocarditis (n=1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p=0.001). Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandatory.

Cytoreductive procedures—strategies to reduce postoperative morbidity and management of surgical complications with special emphasis on anastomotic leaks

Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) for the therapy of peritoneal carcinomatosis are associated with substantial morbidity and acceptable mortality. Patient selection, learning curve, patient warming, and reduced blood loss are the main factors to decrease morbidity. Morbidity is mostly associated with bowl fistulas and anastomotic leakages. Depending on the site of leaks they may be managed conservatively or by reoperation. For standardization of study reports on morbidity and mortality the CTCAE classification is recommended.

Surgical Complications of Hyperglycaemia

We review the mechanisms leading to hyperglycaemic damage and draw functional extrapolations aiming to an improved management of surgical complications, which are common among diabetic patients.

The prevention and management of surgical complications in Miles operation

Objective To explore the prevention and management of surgieal complications in Miles operation.Methods Retrospectively analyzed the main complications appeared in 176 patients of Miles operation.Results There was the eolostomy-related complications in 19 cases.Presacral venous plexus hemorrhage in 4 cases.Intestinal obstruction in 10 cases.Wound infection of perineum in 12 eases.Lesion of urinary tract in 1 case.The common complication rate of Miles operation was 26.1%.Conclusion Mastering operation skill and adherence to sound snrgical principles is the key to prevent and to decrease intra-postoperative complication. Key words: Rectal neoplasms Operation; Complications

Corneal Imaging with Anterior Segment Optical Coherence Tomography for Lamellar Keratoplasty Procedures

To assess and describe the uses of anterior segment optical coherence tomography (OCT) in the evaluation of the cornea before and after lamellar corneal transplantation procedures. Prospective, noncomparative, observational case series. Seven eyes of seven patients undergoing anterior and posterior lamellar corneal transplantation procedures at the Singapore National Eye Centre were included in the study. High-resolution anterior segment OCT scans of the cornea and anterior segment were performed both before and after lamellar transplantation procedures on the cornea with the Visante anterior segment OCT system (Visante OCT; Carl Zeiss Meditec, Inc, Dublin, California, USA), and the imaging findings were correlated with the clinical picture. Measurements of lamella thickness were performed with the software provided. Anterior segment OCT images were able to provide valuable information on donor apposition, Descemet membrane detachment after deep anterior lamellar keratoplasty (DALK), posterior lamellar dislocation, primary graft failure, and anterior chamber crowding with consequent chamber angle encroachment and pupillary block after Descemet stripping automated endothelial keratoplasty (DSAEK). Anterior segment OCT is a valuable imaging tool for assessing the feasibility of lamellar transplantation surgery in the diseased cornea and in the management of surgical complications after such procedures.

Is Primary Anastomosis Safe in the Surgical Management of Complications of Acute Diverticulitis?

The purpose of this article is to determine whether primary anastomosis is a safe option in the surgical management of complications of acute diverticulitis in low-risk patients. Over the past century, the management of diverticulitis has evolved from a three-stage procedure to resection and primary anastomosis. In the beginning of the century, Mayo described drainage and proximal colostomy, a three-stage procedure. This was done by performing a diverting colostomy but leaving the diseased segment of colon, hoping that the inflammation would subside. Later, the patient went back for resection of the diseased segment. Then a third procedure was performed for reversal of the colostomy. Around the late 1970s to early 1980s, it was found that patients had better outcomes if the diseased segment was resected during the first operation-the Hartman procedure. During the late 1990s to early 2000s, some surgeons began performing resection and primary anastomosis in selected groups of patients with diverticulitis. There have been a number of studies published showing that resection and primary anastomosis has an acceptable morbidity and mortality. However, most of these studies are retrospective and do not achieve statistical significance. They also do not attempt to establish guidelines to help decide which patients are good candidates for resection and primary anastomosis. The goal of this study is to establish safe and reasonable practice guidelinesthat can be applied to a selected group of (low-risk) patients. This study is a retrospective review of all the patients treated surgically for complications of acute diverticulitis from 1998 to 2003 at United Hospital Medical Center in Port Chester, New York. Patients were classified as high or low risk based on their age, APACHE II score, American Society of Anesthesiologists class, and Hinchey score. There were a total of 66 patients operated on for complications of acute diverticulitis (left-sided) over this 5-year period. Thirty-six of them underwent resection and primary anastomosis and 30 underwent the Hartman procedure. Of the 36 who underwent resection and primary anastomosis, 19 were considered low risk. There were no complications in this low-risk group who underwent primary anastomosis. Patients who were low risk based on the mentioned criteria can safely undergo resection and primary anastomosis.

Retroperitoneal displacement of ovary and fallopian tube: a complication of surgical management of incarcerated inguinal hernia in female infants

Sliding indirect inguinal hernias containing the ipsilateral uterine adnexa are not uncommon in female infants. We report a case of a 12-year-old girl presenting with a benign tumor (serous cystadenofibroma) in a retroperitoneally located ovary. The patient had a history of hernia repair in the neonatal period. Displacement of the ovary and fallopian tube in the retroperitoneal space is a rarely reported complication of pediatric inguinal hernia surgery. Uncorrected, this can result in hormonal dysfunction, decreased fertility, and difficult and unclear situations during abdominal surgery in adulthood. A laparoscopic approach for hernia repair may prevent this complication.

OUTCOMES OF TRANSCONJUNCTIVAL SUTURELESS 25-GAUGE VITRECTOMY WITH SILICONE OIL INFUSION

To evaluate the outcomes and complications of surgical management with 25-gauge pars plana vitrectomy (PPV) and silicone oil (SO) tamponade in complex vitreoretinal diseases. Retrospective review of a consecutive, interventional case series at a single center. Thirty-five eyes of 35 patients were included in the study. The indications for vitrectomy included tractional retinal detachment (11 eyes), macular hole (6 eyes), proliferative vitreoretinopathy or recurrent retinal detachment (9 eyes), neovascular glaucoma (3 eyes), giant retinal tear (3 eyes), and pathologic myopia with epiretinal membrane or macular hole (3 eyes). All patients underwent 25-gauge PPV with either 1,000-centistoke (n = 31) or 5,000-centistoke (n = 4) SO tamponade infused through a 24-gauge angiocatheter. No intraoperative complications were noted. The median preoperative visual acuity was counting fingers (range, 20/50 to light perception). The median postoperative visual acuity after a median follow-up of 6 months (range, 1-19 months) was 20/200 (range, 20/30 to light perception). A small subconjunctival SO bleb was identified in two patients. Recurrent retinal detachment occurred in three patients. No significant complications relating to the use of SO in the setting of 25-gauge PPV occurred. Advances in 25-gauge PPV instrumentation have enabled expanding indications for 25-gauge PPV. 25-Gauge PPV with SO tamponade is safe and efficient and can be considered in the surgical management of complex vitreoretinal disease.

Acute Pericardial Tamponade as a Remote Complication of a CardioSEAL Atrial Septal Defect Closure Device

CLOSURE OF A secundum atrial septal defect (ASD) or a patent foramen ovale (PFO) using a percutaneously deployed transcatheter occlusion device has emerged as a safe, less invasive, and widely accepted alterative to open surgical repair of these common congenital heart defects in adults 1 Chessa M. Carminati M. Butera G. et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 2002; 39: 1061-1065 Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar , 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar and children. 3 Butera G. De Rosa G. Chessa M. et al. Transcatheter closure of atrial septal defect in young children Results and follow-up. J Am Coll Cardiol. 2003; 42: 241-245 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar Despite the demonstrated utility of transcatheter occlusion devices in the vast majority of patients, as many as 8% of patients undergoing percutaneous closure of an ASD or PFO require surgical intervention for device failure or the management of complications. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar A wide variety of acute and chronic complications of transcatheter devices has been previously described in the literature, including the presence of a hemodynamically significant residual shunt after device deployment 5 Bohm J. Bittigau K. Kohler F. et al. Surgical removal of atrial septal defect occlusion system-devices. Eur J Cardiothorac Surg. 1997; 12: 869-872 Crossref PubMed Scopus (43) Google Scholar ; recurrent cerebral embolism 6 Z’Brun A. Dai-Do D. Meier B. et al. Recurrent systemic embolism after transcatheter closure of a patent foramen ovale. Eur J Cardiothorac Surg. 1997; 12: 813-814 Crossref PubMed Google Scholar ; device deformation, malposition or embolization 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; thrombus formation 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar ; entanglement of the device in a Chiari network 8 Cooke J.C. Gelman J.S. Harper R.W. Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device. J Am Soc Echocardiogr. 1999; 12: 601-603 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ; endocarditis 9 Goldstein J.A. Beardslee M.A. Xu H. et al. Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale. Catheter Cardiovasc Interv. 2002; 55: 217-220 Crossref PubMed Scopus (34) Google Scholar ; device-induced mitral regurgitation 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; and cardiac perforation. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar In this report, the authors describe the occurrence of acute pericardial tamponade 5 years after implantation of a CardioSEAL septal occluder (Nitinol Medical Technology, Boston, MA) as a result of erosion of a device wire support through the dome of the left atrium (LA) and briefly discuss the perioperative management of the patient.