Surgical Management Of Patients Research Articles

Some Aspects Regarding the Psychology of the Surgical Patient

The need for a medical consultation always generates an unpleasant sensation, which becomes more accentuated, when the doctor is a surgeon. The surgeon is next to the dentist, gynecologist and psychiatrist, the doctor to whom the patient turns with the greatest fear. The operative indication and the discussion of therapeutic perspectives can trigger a psycho-emotional imbalance, leading to tomophobia. In fact, it is a complex psychological reaction, including odynophobia (fear of pain), dysmorphophobia (fear of postoperative bodily sequelae), hypnophobia (fear of anesthetic sleep, from which one could not wake up), trypanophobia (fear of injections, needles, scalpel), pantophobia (fear of everything that happens around, in this case, in the hospital environment) and above all, thanatophobia (fear of death). Therefore, it can be stated that the surgical intervention is a test of the psycho-affective capacity.
 The paper presents the authors' experience in 20 years (2002-2021), related to the psychological management of surgical patients, subjected to medium or large-scale surgical interventions (75% performed in emergency mode), in 958 patients.
 Mental stress can have consequences, both on the reactivity of the surgical patient and on his postoperative evolution. In the time crunch and in the absence of a psychologist, available to offer specific advice on medical objectives, the management of perioperative anxiety rests with the surgeon and the nursing staff.

(186) Modified Extra-Tunical Grafting for Peyronie's Disease Associated Indentation Deformity

Abstract Introduction Peyronie’s disease is characterized by penile plaque or scar within the tunica albuginea. This results in penile deformity, most commonly penile curvature but also volume loss deformity such as hourglass or indentation. This volume loss occurs in up to 65% of men with Peyroine’s disease. Surgical management for patients with significant deformity includes plaque incision/partial excision and penile grafting with an absorbable grafting material. In the original description of extra-tunical grafting, the grafting material was placed over Buck’s fascia via a ventral longitudinal incision. In our modified technique, the grafting material is placed under Buck’s fascia and superficial to the tunica albuginea, which allows the grafting material to be less palpable in the flaccid condition. Objective To demonstrate a modified approach to Extra-Tunical Grafting for peyronie’s disease indentation deformity. Methods Intra-operative video of modified extra-tunical grafting was recorded with an overhead surgical camera. Results Successful modified extra-tunical grafting with excellent penile straightening and restoration of penile girth and minimal palpability of the graft. Conclusions Our modified extra-tunical grafting technique is a reasonable option compared to the standard grafting technique Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast.

Treatment Strategies for Hypertrophic Cardiomyopathy: Surgical

Septal myectomy is a well-established procedure for septal reduction in patients with obstructive hypertrophic cardiomyopathy (HCM) who have not responded to medical treatment. The surgical approach is tailored to the unique pathophysiology and septal morphology of the patient. Extended transaortic myectomy is the standard procedure for patients with isolated subaortic obstruction, the most common type of HCM. However, transapical myectomy is a useful adjunct for patients with long or midventricular obstruction and is our preferred technique for ventricular enlargement in patients with severe symptomatic diastolic heart failure because of extensive apical hypertrophy. Septal myectomy provides excellent postoperative outcomes as regards symptom relief and functional improvement, and operative morbidity and mortality rates are low in experienced centers. This article summarizes our current surgical management of patients with HCM and details operative methods and outcomes.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective: This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax. Methods: Eighty patients diagnosed with tuberculous pyothorax, admitted to the hospital between January 2023 and September 2023, were randomly selected for this study. The patients were divided into control and study groups using a numerical table method. The control group underwent general anesthesia with bronchial intubation, while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block. Subsequently, the patients were monitored to assess mean arterial pressure, heart rate variations, and adverse reactions to anesthesia. Results: The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision, immediate end of surgery, and immediate extubation periods compared to the control group (P < 0.05). Furthermore, the Ricker and Ramsay scores in the study group were significantly lower than those in the control group (P < 0.05). Conclusion: The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults

The treatment of burn injury patients is aunique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with atotal body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.

The enigma of incisional hernia prediction unraveled: external validation of a prognostic model in colorectal cancer patients.

Accurate prediction of hernia occurrence is vital for surgical decision-making and patient management, particularly in colorectal surgery patients. While a hernia prediction model has been developed, its performance in external populations remain to be investigated. This study aims to validate the existing model on an external dataset of patients who underwent colorectal surgery. The "Penn Hernia Calculator" model was externally validated using the Hughes Abdominal Repair Trial (HART) data, a randomized trial comparing colorectal cancer surgery closure techniques. The data encompassed demographics, comorbidities, and surgical specifics. Patients without complete follow-up were omitted. Model performance was assessed using key metrics, including area under the curve (AUC-ROC and AUC-PR) and Brier score. Reporting followed the TRIPOD consensus. An external international dataset consisting of 802 colorectal surgery patients were identified, of which 674 patients with up to 2years follow-up were included. Average patient age was 68years, with 63.8% male. The average BMI was 28.1. Prevalence of diabetes, hypertension, and smoking were 15.7%, 16.3%, and 36.5%, respectively. Additionally, 7.9% of patients had a previous hernia. The most common operation types were low anterior resection (35.3%) and right hemicolectomy (34.4%). Hernia were observed in 24% of cases by 2-year follow-up. The external validation model revealed an AUC-ROC of 0.66, AUC-PR of 0.72, and a Brier score of 0.2. The hernia prediction model demonstrated moderate performance in the external validation. Its potential generalizability, specifically in those undergoing colorectal surgery, may suggest utility in identifying and managing high-risk hernia candidates.

Concomitant Traumatic Brain Injury Delays Surgery in Patients With Traumatic Spinal Cord Injury.

Growing evidence supports prompt surgical decompression for patients with traumatic spinal cord injury (tSCI). Rates of concomitant tSCI and traumatic brain injury (TBI) range from 10% to 30%. Concomitant TBI may delay tSCI diagnosis and surgical intervention. Little is known about real-world management of this common injury constellation that carries significant clinical consequences. This study aimed to quantify the impact of concomitant TBI on surgical timing in a national cohort of patients with tSCI. Patient data were obtained from the National Trauma Data Bank (2007-2016). Patients admitted for tSCI and who received surgical intervention were included. Delayed surgical intervention was defined as surgery after 24 hours of admission. Multivariable hierarchical regression models were constructed to measure the risk-adjusted association between concomitant TBI and delayed surgical intervention. Secondary outcome included favorable discharge status. We identified 14 964 patients with surgically managed tSCI across 377 North American trauma centers, of whom 2444 (16.3%) had concomitant TBI and 4610 (30.8%) had central cord syndrome (CCS). The median time to surgery was 20.0 hours for patients without concomitant TBI and 24.8 hours for patients with concomitant TBI. Hierarchical regression modeling revealed that concomitant TBI was independently associated with delayed surgery in patients with tSCI (odds ratio [OR], 1.3; 95% CI, 1.1-1.6). Although CCS was associated with delayed surgery (OR, 1.5; 95% CI, 1.4-1.7), we did not observe a significant interaction between concomitant TBI and CCS. In the subset of patients with concomitant tSCI and TBI, patients with severe TBI were significantly more likely to experience a surgical delay than patients with mild TBI (OR, 1.4; 95% CI, 1.0-1.9). Concomitant TBI delays surgical management for patients with tSCI. This effect is largest for patients with tSCI with severe TBI. These findings should serve to increase awareness of concomitant TBI and tSCI and the likelihood that this may delay time-sensitive surgery.

Intestinal Obstruction Due to Ileotransverse Anastomosis Stenosis Secondary to Crohn's Disease: A Case Report

Introduction: Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. This report explores a case of intestinal obstruction resulting from stenosis of ileotransverse anastomosis, secondary to Crohn's disease. Epidemiology: The macroscopic features of Crohn's disease vary, including patchy inflammation, ulcers, and stenosis. Stenosis is a common occurrence, particularly in the terminal ileum, affecting 30-40% of individuals with Crohn's disease. OBJECTIVE: To describe a clinical case of intestinal obstruction due to ileotransverse anastomosis stenosis secondary to Crohn's disease, aiming to recognize its behavior and determine surgical management in patients with a high suspicion of this condition. Patient and Method: A 35-year-old female diagnosed with ankylosing spondylitis, recent Crohn's disease, and intestinal obstruction. Surgical history includes exploratory laparotomy, right hemicolectomy, and ileotransverse anastomosis due to acute appendicitis. Current symptoms led to surgical exploration, revealing extensive adhesions and stenosis at the anastomosis. Results: The patient underwent resection of the affected intestinal segment and the creation of a terminal ileostomy, successfully resolving the obstruction. Comprehensive preoperative evaluation, diagnostic confirmation through imaging, and appropriate surgical intervention played critical roles in achieving a positive outcome. Discussion: The discussion emphasizes the complexities associated with Crohn's disease surgery, highlighting common complications such as infection, fistulas, and anastomotic stenosis. The case underscores the need for a cautious surgical approach and the importance of early consideration of Crohn's disease in patients with intestinal obstruction. Conclusions: This case report underscores the significance of recognizing Crohn's disease in patients presenting with intestinal obstruction. Appropriate surgical management, though challenging due to the heightened risk of complications, is essential for improving treatment outcomes. A comprehensive approach, from timely diagnosis to surgical intervention, is crucial for effectively addressing Crohn's disease manifestations and enhancing patient quality of life.

The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey.

Despite advances and improvements in the management of surgical patients, emergency and trauma surgery is associated with high morbidity and mortality. This may be due in part to delays in definitive surgical management in the operating room (OR). There is a lack of studies focused on ORprioritization and resource allocation in emergency surgery. The Operating Room management for emergency Surgical Activity (ORSA) study was conceived to assess the management of operating theatres and resources from a global perspective among expert international acute care surgeons. The ORSA study was conceived as an international web survey. The questionnaire was composed of 23 multiple-choice and open questions. Data were collected over 3 months. Participation in the survey was voluntary and anonymous. One hundred forty-seven emergency and acute care surgeons answered the questionnaire; the response rate was 58.8%. The majority of the participants come from Europe. One hundred nineteen surgeons (81%; 119/147) declared to have at least one emergency OR in their hospital; for the other 20/147 surgeons (13.6%), there is not a dedicated emergency operating room. Forty-six (68/147)% of the surgeons use the elective OR to perform emergency procedures during the day. The planning of an emergency surgical procedure is done by phone by 70% (104/147) of the surgeons. There is no dedicated emergency OR in the majority of hospitals internationally. Elective surgical procedures are usually postponed or even cancelled to perform emergency surgery. It is a priority to validate an effective universal triaging and scheduling system to allocate emergency surgical procedures. The new Timing in Acute Care Surgery (TACS) was recently proposed and validated by a Delphi consensus as a clear and reproducible triage tool to timely perform an emergency surgical procedure according to the clinical severity of the surgical disease. The new TACS needs to be prospectively validated in clinical practice.Logistics have to be assessed using a multi-disciplinary approach to improve patients' safety, optimise the use of resources, and decrease costs.

The effect of surgical repair of the chest on postural stability among patients with pectus excavatum.

Pectus excavatum is the most encountered of chest wall deformities. It may produce respiratory and cardiovascular symptoms, hence surgical repair of this defect is performed. The procedure involving the insertion of metal bars under the sternum (the Nuss procedure) usually brings significant improvement to patients. However, the effect of the repair on the postural stability of patients has not been studied so far. To investigate the problem of patients' stability in the postoperative period male patients with pectus excavatum (n = 21) and healthy controls (n = 22) were included in the study. Using posturography methods, we showed a negative impact of the pectus excavatum repair surgery on patients' postural stability in the first postoperative phase. The centre of pressure displacement parameters used to measure postural stability were lower after the repair for both, the frontal and sagittal plane as well as for the velocity of displacements in the sagittal plane in the double stance with eyes open. Poorer postural stability was also found in patients with pectus excavatum when compared to healthy controls. Our findings may be useful for functional monitoring in the evaluation and surgical management of pectus excavatum patients and also when designing the rehabilitation of patients undergoing the Nuss procedure.

Preoperative risk factors for nonsatisfaction after lumbar interbody fusion

IntroductionLow back pain (LBP) is a common cause of impaired quality of life and disability and studies regarding surgical management of patients with LBP show a high variation in patient-reported success rate. Research questionTo find valuable preoperative clinical risk factors and variables associated with a non-satisfactory patient-reported outcome following surgery. Materials and methodsThe Danish surgical spine database (DaneSpine) was used to collect eight years of pre- and postoperative data on patients undergoing single-level fusions with either posterior- (PLIF) or transforaminal lumbar interbody fusions (TLIF). The primary outcome was patient nonsatisfaction. We collected data on European Quality of Life–5 Dimensions (EQ-5D), visual analogue scale (VAS), Oswestry Disability Index (ODI) score, pain intensity, duration of back pain, previous discectomy, and expectations regarding return to work after surgery at 2-year follow-up. ResultsThe cohort included 453 patients of which 19% reported treatment nonsatisfaction. The nonsatisfaction group demonstrated higher preoperative VAS scores for back pain (75 ± 19 vs. 68 ± 21, p = 0.006) and leg pain (65 ± 25 vs. 58 ± 28, p = 0.004). The preoperative EQ-5D score was significantly lower in the nonsatisfaction group (0.203 + 0.262 vs. 0.291 ± 0.312, p = 0.016). There was no statistical significance between patient nonsatisfaction and preoperative ODI score, age, body mass index, duration of back pain or expectations regarding return to work after surgery. Discussion and conclusionLow preoperative EQ-5D scores and high VAS leg and back pain scores were statistically significant with patient nonsatisfaction following surgery and may prove to be valuable tools in the preoperative screening and alignment of patient expectations.

Corneal and anterior segment parameters in patients with clinically unilateral pseudoexfoliation syndrome.

Pseudoexfoliation syndrome (PES) is an age-related systemic condition that predominantly affects ocular structures and is characterized by the deposition of material on the lens, ciliary body, zonules, corneal endothelium, iris, and pupillary margin. We compared the corneal endothelial morphology, anterior segment parameters, corneal densitometry, and corneal topographic characteristics between the clinically affected and apparently normal fellow eyes of patients with clinically unilateral PES. This was a comparative, cross-sectional study of 34 patients with clinically unilateral PES. The anterior segment was examined using a Scheimpflug imaging system, and the corneal endothelium was assessed using a noncontact specular microscope. Corneal endothelial cell density, polymegathism, and pleomorphism were assessed using the specular microscope. Furthermore, the Scheimpflug camera was used to measure the corneal power of the flat and steep axis, mean corneal power, maximum keratometry, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, and the corneal thickness at the apex point, center of the pupil, and the thinnest point. Corneal densitometry was evaluated at two concentric zones (0-2 mm and 0-12 mm). In total, 68 eyes from 34 patients were ultimately included in the study. The mean (standard deviation) age of the patients was 73.38 (8.75) years (range: 50-87 years). Among the included patients, 17 (50%) were male and 17 (50%) were female. The anterior segment parameters did not significantly differ between eyes with PES and their clinically unaffected fellow eyes (all P > 0.05). Similarly, no statistically significant difference was observed in corneal endothelial morphology (all P > 0.05). Our measured parameters do not differ between the clinically affected eye and the clinically unaffected fellow eye. This supports the theory that PES is a bilateral disorder. Considering the variety of complications associated with PES, bilateral involvement should be assumed in the clinical and surgical management of patients with clinically unilateral PES. In the future, new research could increase our understanding of this syndrome.

Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations.

Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.

Comparison Outcome of Patients with Rectal Tube and Without Rectal Tube Post Swenson Like Pull-Through Transanal Procedure at RSUP Prof Dr. I G.N.G. Ngoerah

Background: Surgical management of patients with Hirschsprung’s disease has experienced a significant improvement in getting a better outcome. This procedure can lead to complications of postoperative obstructive symptoms and anastomotic leaks and can affect the length of postoperative care. It is necessary to consider inserting a rectal tube or non-rectal tube after surgery to prevent complications. Objective: To determine the difference in patient outcomes with Hirschsprung’s disease between installing a rectal tube or non-rectal tube after Transanal Swenson-like pull-through surgery. Methods: This study uses a prospective observational design, with an actual experiment with a single-masked randomized study design. It involved 50 samples of patients with Hirschsprung’s disease at Prof. Dr. I.G.N.G. Ngoerah Denpasar from August 2021 to July 2022. Results: There were no obstructions (0%) and no anastomotic leaks (0%) in patients with a rectal tube and without a rectal tube post transanal Swenson-like pull-through procedure; there was no statistically significant difference. Length of stay was obtained from data on patients who had rectal tubes installed with an average value of 4.5 days (SD: 1.1) longer than the length of stay of patients without rectal tubes, obtained an average value of 2.2 days (SD: 0.4) with a mean difference of 2.3 days. The p-value was obtained at 0.000&lt;0.05. Conclusion: There is no difference in obstruction and anastomotic leakage incidence in patients with rectal tube placement and non-rectal tube post-transanal Swenson-like pull-through procedure. The length of stay for patients with non-rectal tube post-transanal Swenson-like pull-through procedures is shorter than those with a rectal tube, so it can reduce the use of financing for hospital care, and patients do not need to use a rectal tube for home care.

Disparities in surgical management and outcomes of patients with primary liver cancer in Louisiana

Disparities in surgical management and outcomes of patients with primary liver cancer in Louisiana

Effects of surgical management for gastrointestinal stromal tumor patients with liver metastasis on survival outcomes.

To investigate the effect of surgical resection on survival in gastrointestinal stromal tumors synchronous liver metastasis (GIST-SLM) and to develop clinically usable predictive models for overall survival (OS) and cancer-specific survival (CSS) in patients. We identified patients in the SEER database diagnosed with GISTs from 2010 to 2019. We used propensity score matching (PSM) to balance the bias between the Surgery and No surgery groups. Kaplan-Meier(K-M) analysis was used to detect differences in OS and CSS between the two groups. The nomogram to predict 1, 3, and 5-year OS and CSS were developed and evaluated. After PSM, 228 patients were included in this study. There were significant differences in 1, 3, and 5-year OS and CSS between the two groups (OS: 93.5% vs. 84.4%, 73.2% vs. 55.3%, 60.9% vs. 36.9%, P=0.014; CSS: 3.5% vs.86.2%,75.3% vs.57.9%, 62.6% vs. 42.9%, P=0.02). We also found that patients who received surgery combined with targeted therapy had better OS and CSS at 1, 3, and 5 years than those who received surgery only (OS: 96.6% vs.90.9%, 74.9% vs. 56.8%, 61.7% vs. 35.5%, P=0.022; CSS: 96.6% vs. 92.1%, 77.4% vs.59.2%,63.8% vs. 42.0%, P=0.023). The area under the curve (AUC) was 0.774, 0.737, and 0.741 for 1, 3, and 5-year OS, respectively, with 0.782 and 0.742 for 1, 3, and 5-year CSS. In the model, C-index was 0.703 for OS and 0.705 for CSS and showed good consistency. Surgical treatment can improve the OS and CSS of patients with GIST-SLM. In addition, the combination with chemotherapy may be more favorable for the long-term survival of patients. Meanwhile, we constructed the nomograms for predicting OS and CSS at 1, 3, and 5-year, and validated them internally. Our model can contribute to clinical management and treatment strategy optimization.

Surgical Management and Considerations for Patients with Localized High-Risk Prostate Cancer.

Localized high-risk (HR) prostate cancer (PCa) is a heterogenous disease state with a wide range of presentations and outcomes. Historically, non-surgical management with radiotherapy and androgen deprivation therapy was the treatment option of choice. However, surgical resection with radical prostatectomy (RP) and pelvic lymph node dissection (PLND) is increasingly utilized as a primary treatment modality for patients with HRPCa. Recent studies have demonstrated that surgery is an equivalent treatment option in select patients with the potential to avoid the side effects from androgen deprivation therapy and radiotherapy combined. Advances in imaging techniques and biomarkers have also improved staging and patient selection for surgical resection. Advances in robotic surgical technology grant surgeons various techniques to perform RP, even in patients with HR disease, which can reduce the morbidity of the procedure without sacrificing oncologic outcomes. Clinical trials are not only being performed to assess the safety and oncologic outcomes of these surgical techniques, but to also evaluate the role of surgical resection as a part of a multimodal treatment plan. Further research is needed to determine the ideal role of surgery to potentially provide a more personalized and tailored treatment plan for patients with localized HR PCa.

Post-thyroidectomy hypocalcemia in Saudi Arabia: a review of incidence rates and risk factors

Post-thyroidectomy hypocalcemia is a frequent and variable complication in Saudi Arabia, which can extend hospital stays and raise healthcare costs. A systematic search was performed using databases for studies published before January 2024 documenting hypocalcemia rates in Saudi Arabian adults following thyroidectomy. Eighteen studies met our criteria, encompassing 3,455 patients. The analyses revealed substantial variability across included studies in terms of sample size, design, and reported hypocalcemia rates. Overall rates ranged from 0.07% to 67.4% (averaging 24.4%), with transient cases being more prevalent (averaging 26.8%). Permanent hypocalcemia rates were lower (averaging 1.3%, ranging from 0% to 3.7%). Preoperative and postoperative parathyroid hormone (PTH) levels consistently predicted hypocalcemia. Additional potential contributing factors included the number of parathyroid glands (PGs) identified during surgery, gender, pre-surgical hyperthyroidism, and surgical expertise and experience. These findings translate to several implications for surgical practice and patient management. Close monitoring of PTH levels holds significant importance. Selective identification of PGs during surgery might decrease the risk of hypoparathyroidism. In addition, surgeon training and supervision are pivotal for achieving optimal outcomes. Identifying patients at risk for hypocalcemia early might facilitate earlier discharge. In conclusion, post-thyroidectomy hypocalcemia poses a variable and widespread complication in Saudi Arabia. Comprehending its risk factors and implementing targeted strategies have the potential to improve patient management and outcomes.

Prevalence, Surgical, and Medical Management of Patients with Endometriosis amongst Indian Women

Objective: This study aims to determine the prevalence of endometriosis in women in South India, the epidemiological factors involved, and evaluate the symptomatic burden associated with it. Design: A large-scale Hospital-based study was conducted among women of reproductive age (16 to 44 years) in the state of Telangana between March 2018 and March 2023. A randomized multi-stage stratified sampling method was adopted and included 2,400 women who were screened using a validated structured questionnaire. Patients presenting with symptoms indicative of endometriosis underwent additional assessment using abdominal ultrasonography (AUS) and serum cancer antigen 125 (CA125) tests. For confirmation, laparoscopy was offered to the patients who consented. Patients who declined laparoscopy were given the option of undergoing magnetic resonance imaging (MRI) instead. Results: Among 2,400 women who participated, 60 women have been diagnosed with endometriosis during the 5-year study period. The prevalence of endometriosis was found to be 2.5%. The mean age of participants was 15.2 ± 3.5 years and the mean age at menarche was found to be 12.9 ± 1.1 years. Out of 60 participants diagnosed with endometriosis 30% (n = 18) experienced irregular menstrual cycles. Approximately 33.3% (n = 20) of the women reported experiencing Dysmenorrhea, with 28.4% (n = 17) complaining of dyspareunia. Among the cases with menstrual pain, exhibited ultrasound findings suggestive of endometriosis, with elevated CA125 levels observed in 45% (n = 27) of these cases. All 60 patients who consented to laparoscopic confirmation, exhibited positive histo-pathological evidence of endometriosis. The prevalence of endometriosis is found to be significant in women of reproductive age group and found to be associated with high rates of infertility in 15 (25%) patients. The results of this study showed that the prevalence of endometriosis is found to be 2.5% which is similar to the other studies reported. The severity of endometriosis during laparoscopy was assessed using the rAFS staging system, revealing rates of 55% and 45% for disease in Stages I &amp; II, Stages III, &amp; IV, respectively. Conclusion: Our study concludes that endometriosis predominantly affects women in the reproductive age group and is often associated with primary infertility. The laparoscopic findings are identified as a standard tool for both diagnosis and treatment of endometriosis.

A clinical case of successful treatment of acute phlegmonous appendicitis incarcerated in a hernial sac (Amyand’s hernia)

Atypical localization of the vermiform appendix (VA) in acute appendicitis can lead to diagnostic and tactical errors in emergency abdominal surgery. The rarest and most atypical localization of the VA is within the hernial sac. This type of hernia is defined as Amyand’s hernia. The optimal scope of surgical intervention and access method (laparoscopic or open) for Amyand’s hernia have not been definitively determined. Questions remain regarding the necessity of removing an unaffected vermiform appendix, the approach to hernioplasty in destructive appendicitis, and the feasibility of using a mesh implant for hernioplasty. In cases of a sliding hernia, the destruction of the hernial sac can lead to difficulties with suturing the peritoneum, assessing the state of the strangulated testicle in men, and performing an orchidectomy. Therefore, it is imperative to establish an algorithm for the evaluation and surgical management of patients with strangulated inguinal hernias. Objective — present a clinical case of successful treatment of Amyand’s hernia with acute phlegmonous appendicitis incarcerated in a strangulated inguinal hernial sac and reactive orchoepididymitis, focusing on the selection of medical and diagnostic strategies to reduce the risk of complications. The clinical case illustrates the effective management of a patient who presented with acute phlegmonous appendicitis and purulent orchoepididymitis. These abnormalities were found to be atypically localised within the sac of a strangulated right‑sided inguinal hernia, known as Amyand’s hernia. The necessary surgical procedures included an appendectomy and an orchidectomy. Conclusions. Inflammation of the vermiform appendix in Amyand’s hernia can lead to various unpredictable purulent complications, such as acute typhlitis, purulent peritonitis, necrotizing orchoepididymitis, and Fournier’s phlegmon, necessitating extensive surgical intervention. The collective global and personal experience in treating Amyand’s hernia suggests the possibility of establishing standardised protocols for diagnosing and selecting a surgical intervention technique.