Method Of Surgical Repair Research Articles

Comparative analysis of surgical treatment results for osteoporotic burst fractures of thoracolumbar vertebral bodies

Introduction Surgical methods for osteoporotic burst vertebral body fracture repair have their advantages and shortcomings. The use of circumferential stabilization and corrective vertebrotomies in elderly patients is highly invasive and carries great surgical risk. On the other hand, minimally invasive methods lead to recurrence of the deformity. Thus, in the treatment of patients with such pathology, it is necessary to choose a surgical method that allows achieving optimal results.Purpose of the work was to compare the results of surgical treatment for osteoporotic burst fractures in thoracolumbar vertebral bodies using the developed method and methods of circular and hybrid stabilization based on clinical and radiological criteria.Materials and methods The study was retrospective. Three groups of patients were formed according to the type of surgical intervention. Inclusion criteria were patients with primary osteoporosis who did not receive osteotropic therapy before surgery, with osteoporotic fractures (type OF3 and OF4) of the vertebral bodies of the thoracolumbar location (Th10–L2). The follow-up period was 12 months. The following criteria were assessed: the amount of kyphosis correction (according to the Cobb method), the amount of residual postoperative kyphotic deformity, as well as its recurrence in the long-term postoperative period; sagittal balance of the torso (Barrey index), subjective evaluation of the patient’s condition (VAS). Quality of life assessment was not performed.Results There were no statistically significant differences in the dynamics of sagittal balance during the follow-up period between the groups (p > 0.99). There was no difference between groups in clinical outcomes (VAS) at follow-up (p > 0.05). A statistically significant difference in the magnitude of kyphotic deformity and its correction in the specified postoperative periods was revealed between the hybrid fixation groups and the corrective vertebrotomy group. No difference was found with the circular stabilization group.Discussion Due to the high risks of poor outcomes of anterior spinal fusion, in particular, implant subsidence, to avoid anterior spinal fusion, we used a method of focal kyphosis correction and posterior spinal fusion with autologous bone. The method proposed by the authors for the correction of focal kyphotic deformity in the treatment of patients with osteoporotic burst fractures of the vertebral bodies combines satisfactory correction of focal kyphosis with minimal surgical invasiveness, which reduces the risks of complications and poor outcomes. The proposed method may also be combined with hybrid fixation.Conclusion The developed method for focal kyphotic deformity correction in the treatment of osteoporotic burst fractures of vertebral bodies provides satisfactory correction of focal kyphosis, reduces the risks of complications and poor outcomes in comparison with circular and hybrid stabilization.

Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience.

Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.

Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhoea

Objective:To investigate the clinical features, imaging findings, surgical methods， diagnostic and treatment experience of spontaneous cerebrospinal fluid otorrhoea. Methods:The clinical data of 11 patients with spontaneous cerebrospinal fluid otorrhoea treated surgically at our hospital from May 2018 to May 2023 were retrospectively analyzed. The medical data included medical history, imaging data, leak location, surgical repair method, treatment effect and postoperative follow-up. Results:Among the 11 surgical patients, 4 patients were initially diagnosed with secretory otitis media, 1 was initially diagnosed with purulent otitis media, and 5 patients had a history of meningitis or presented because meningitis as the initial diagnosis. There were 2 cases of cerebrospinal fluid leakage repaired through the ear canal pathway and 9 cases of cerebrospinal fluid leakage repaired through the mastoid pathway. During the operation, leaks were located in the stapes floor plate in 4 cases, sinus meningeal angle in 1 case, posterior cranial fossa combined with middle cranial fossa in 1 case, middle cranial fossa in 4 cases, and labyrinthine segment of the internal auditory canal and facial nerve canal in 1 case. Ten patient was successfully repaired, and another patient developed intracranial hypertension after surgery, with symptoms alleviated by a lateral ventriculoperitoneal shunt. Postoperative follow-up ranged from 6 months to 4 years, and there was no CSF otorrhoea and meningitis recurrence. Conclusion:The incidence of spontaneous cerebrospinal fluid otorrhea is low, the clinical symptoms are atypical, and the rate of delayed diagnosis or missed diagnosis and misdiagnosis is high. Surgery is currently the preferred treatment for spontaneous cerebrospinal fluid otorrhoea, and satisfactory results are usually achieved; During diagnosis and treatment, it is crucial to be vigilant for intracranial hypertension to prevent serious complications and irreversible damage.

Comparative analysis of comorbidity, surgical complications, pharmacotherapeutic needs, and rehabilitation requirements in transabdominal preperitoneal hernia repair versus conventional operative treatment—current results and benefits

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay.

Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.

Surgical Repair of Psittacine Femorotibial Luxation: A Case Series.

Luxation of the psittacine femorotibial joint most commonly occurs following trauma or as a development abnormality. Historically, this injury is considered to have a poor prognosis in birds; however, surgical management may result in acceptable and functional outcomes. This case series describes the surgical techniques, complications, and outcomes of 7 cases of femorotibial luxation in psittacine birds. Of the 7 cases, 6 were chronic injuries. Surgical repair methods included conjoined intramedullary pinning, transarticular pinning with an external skeletal fixator (ESF), a combination of extracapsular stabilization and ESF, ESF alone, and a combination of conjoined intramedullary pins with an ESF. An acceptable outcome was achieved in 75% (6/8) of luxated femorotibial joints managed with surgical methods. All cases were female birds of various species, suggesting a possible sex predisposition for stifle luxation.

Surgical Repair of Psittacine Femorotibial Luxation: A Case Series.

Luxation of the psittacine femorotibial joint most commonly occurs following trauma or as a development abnormality. Historically, this injury is considered to have a poor prognosis in birds; however, surgical management may result in acceptable and functional outcomes. This case series describes the surgical techniques, complications, and outcomes of 7 cases of femorotibial luxation in psittacine birds. Of the 7 cases, 6 were chronic injuries. Surgical repair methods included conjoined intramedullary pinning, transarticular pinning with an external skeletal fixator (ESF), a combination of extracapsular stabilization and ESF, ESF alone, and a combination of conjoined intramedullary pins with an ESF. An acceptable outcome was achieved in 75% (6/8) of luxated femorotibial joints managed with surgical methods. All cases were female birds of various species, suggesting a possible sex predisposition for stifle luxation.

Endoscopic retroperitoneal repair of superior lumbar hernia (Grynfeltt hernia) using self-fixating mesh to prevent nerve injury: a case report

BackgroundThe primary superior lumbar hernia, also called the Grynfeltt Hernia, is a rare entity; hence, a standard surgical repair method has not been established. It is important for this repair procedure not only to prevent recurrence by placing an adequate size of mesh but also to avoid nerve injury. The endoscopic retroperitoneal approach is considered a useful technique for this procedure, requiring no mobilization of the colon and providing good visibility of the surrounding nerves. A self-fixating mesh does not require a traumatic fixation, which is considered advantageous for nerve preservation.Case presentationA 72-year-old woman, complaining of left lumbar swelling, was diagnosed with a primary left superior lumbar hernia and underwent endoscopic retroperitoneal hernia repair. With the patient in the right lateral decubitus position, five small ports were inserted, and the retroperitoneal space was dissected. The 2.0 × 1.0-cm hernial orifice was found, and the 12th subcostal nerve above the hernial orifice and the iliohypogastric and the ilioinguinal nerves below the hernial orifice were identified. A 15 × 10-cm self-fixating mesh was placed in the retroperitoneal space without mesh tacking. The postoperative course was uneventful, and the patient was discharged on the first postoperative day. Two years after surgery, there was no sign of recurrence, and chronic pain and neuropathic symptoms were absent.ConclusionsEndoscopic retroperitoneal repair of primary superior lumbar hernia using a self-fixating mesh seems to be useful for nerve preservation.

Managing massive palatial defect secondary to palatoplasty failures: an in-depth analysis.

Massive palatal defects resulting from palatoplasty failures arising from cleft palate repair complications present ongoing challenges in clinical practice. The purpose of this review is to provide up-to-date insights into aetiology, risk factors, surgical techniques, and adjunctive therapies, aiming to enhance the understanding of such complex cases, and optimize patient outcomes. Primary palatoplasty has fistula recurrence rates ranging from 2.4% to 55%. Factors such as cleft width, surgical repair method, and patient characteristics, influence the likelihood of failure. Classifications such as the Pakistan Comprehensive Classification and Richardson's criteria aid in assessing defects. Surgical options range from local flaps and revision palatoplasty to regional flaps (e.g., buccinator myomucosal, facial artery-based flaps, tongue flaps, nasal septal flaps) to free microvascular flaps. Alternative approaches include obturator prostheses, and acellular dermal matrix has been used as an adjuvant to multiple repair techniques. Hyperbaric oxygen therapy has emerged as an adjunctive therapy to enhance tissue healing. This comprehensive review underscores the intricate challenges associated with massive palatal defects resulting from palatoplasty failures. The diverse range of surgical and nonsurgical options emphasizes the importance of patient-centric, individualized approaches. Practitioners, armed with evidence-based insights, can navigate these complexities, offering tailored interventions for improved patient outcomes.

Evaluating suturing methods for surgical repair of muscle belly lacerations: a scoping review of biomechanical studies

Evaluating suturing methods for surgical repair of muscle belly lacerations: a scoping review of biomechanical studies

Promoting cell proliferation and collagen production with ascorbic acid 2-phosphate-releasing poly(l-lactide-co-ε-caprolactone) membranes for treating pelvic organ prolapse.

Pelvic organ prolapse (POP) afflicts millions of women globally. In POP, the weakened support of the pelvic floor results in the descent of pelvic organs into the vagina, causing a feeling of bulging, problems in urination, defaecation and/or sexual function. However, the existing surgical repair methods for relapsed POP remain insufficient, highlighting the urgent need for more effective alternatives. Collagen is an essential component in pelvic floor tissues, providing structural support, and its production is controlled by ascorbic acid. Therefore, we investigated novel ascorbic acid 2-phosphate (A2P)-releasing poly(l-lactide-co-ε-caprolactone) (PLCLA2P) membranes in vitro to promote cell proliferation and extracellular matrix protein production to strengthen the natural support of the pelvic fascia for POP applications. We analysed the mechanical properties and the impact of PLCLA2P on cellular responses through cell culture analysis using human vaginal fibroblasts (hVFs) and human adipose-derived stem/stromal cells (hASCs) compared to PLCL. In addition, the A2P release from PLCLA2P membranes was assessed in vitro. The PLCLA2P demonstrated slightly lower tensile strength (2.2 ± 0.4 MPa) compared to PLCL (3.7 ± 0.6 MPa) for the first 4 weeks in vitro. The A2P was most rapidly released during the first 48 h of in vitro incubation. Our findings demonstrated significantly increased proliferation and collagen production of both hVFs and hASCs on A2P-releasing PLCLA2P compared to PLCL. In addition, extracellular collagen Type I fibres were detected in hVFs, suggesting enhanced collagen maturation on PLCLA2P. Moreover, increased extracellular matrix protein expression was detected on PLCLA2P in both hVFs and hASCs compared to plain PLCL. In conclusion, these findings highlight the potential of PLCLA2P as a promising candidate for promoting tissue regeneration in applications aimed for POP tissue engineering applications.

Minimal Posterior Pole Vitrectomy and Fixing the Inverted Internal Limiting Membrane Flap with DisCoVisc for Macular Hole: No Gas or Air Tamponade.

To investigate an alternative surgical method for macular hole repair without fluid-air exchange, gas tamponade, and prone positioning. Eighteen eyes of 17 patients with macular holes underwent minimal posterior pole vitrectomy with an inverted internal limiting membrane flap technique. Ophthalmic viscosurgical device was used to fix the inverted internal limiting membrane flap in the balanced salt solution. No fluid-air exchange, gas tamponade, or prone positioning was needed. Follow-ups were performed at 1 day, 1 week, and the last visit (ranging from 3 to 6 months) after surgery. Optical coherence tomography examination, intraocular pressure, and best-corrected visual acuity measurements were performed preoperatively and at every follow-up, postoperatively. Primary closure of the macular hole was observed in all 18 eyes (100%). Optical coherence tomography showed U-type closure in 12 eyes, V-type closure in five eyes, and W-type closure in one eye. Preoperative, postoperative 1 week, and last follow-up best-corrected visual acuity were 0.90 (Snellen equivalent 20/159) ± 0.31 LogMAR, 0.72 (Snellen equivalent 20/105) ± 0.33 LogMAR, and 0.48 (Snellen equivalent 20/60) ± 0.32 LogMAR, respectively. Postoperative visual acuity was significantly improved compared with preoperative values ( F = 19.250, P = 0.000). No significant difference in intraocular pressure was found compared with preoperative values ( F = 1.933, P = 0.168). No significant complications were observed. This surgical method can effectively close macular holes, improve visual acuity, enhance surgical efficiency, reduce surgical complications, and improve patients' postoperative experience without the need for fluid-air exchange, gas tamponade, or prone positioning.

Advances in 3D Bioprinting of Biomimetic and Engineered Meniscal Grafts.

The meniscus plays a crucial role in loads distribution and protection of articular cartilage. Meniscal injury can result in cartilage degeneration, loss of mechanical stability in the knee joint and ultimately lead to arthritis. Surgical interventions provide only short-term pain relief but fail to repair or regenerate the injured meniscus. Emerging tissue engineering approaches based on 3D bioprinting provide alternatives to current surgical methods for meniscus repair. In this review, we summarize the current bioprinting techniques employed in developing engineered meniscus grafts and discuss the latest strategies for mimicking the gradient structure, composition and viscoelastic properties of native meniscus. We highlight recent progress in gene-activated matrices for meniscus regeneration as well. Finally, we provide a perspective on the future development of 3D bioprinting for meniscus repair, emphasizing the potential of this technology to revolutionize meniscus regeneration and improve patient outcomes. This article is protected by copyright. All rights reserved.

The Biomechanical Role of the Deltoid Ligament on Ankle Stability: Injury, Repair, and Augmentation

Background: Deltoid ligament injuries occur in isolation as well as with ankle fractures and other ligament injuries. Both operative treatment and nonoperative treatment are used, but debate on optimal treatment continues. Likewise, the best method of surgical repair of the deltoid ligament remains unclear. Purpose: To determine the biomechanical role of native anterior and posterior components of the deltoid ligament in ankle stability and to determine the efficacy of simple suture versus augmented repair. Study Design: Controlled laboratory study. Methods: Ten cadaveric ankles (mean age, 51 years; age range, 34-64 years; all male specimens) were mounted on a 6 degrees of freedom robotic arm. Each specimen underwent biomechanical testing in 8 states: (1) intact, (2) anterior deltoid cut, (3) anterior repair, (4) tibiocalcaneal augmentation, (5) deep anterior tibiotalar augmentation, (6) posterior deltoid cut, (7) posterior repair, and (8) complete deltoid cut. Testing consisted of anterior drawer, eversion, and external rotation (ER), each performed at neutral and 25° of plantarflexion. A 1-factor, random-intercepts, linear mixed-effect model was created, and all pairwise comparisons were made between testing states. Results: Cutting the anterior deltoid introduced ER (+2.1°; P = .009) and eversion laxity (+6.2° of eversion; P < .001) at 25 degrees of plantarflexion. Anterior deltoid repair restored native ER but not eversion. Tibiocalcaneal augmentation reduced eversion laxity, but tibiotalar augmentation provided no additional benefit. The posterior deltoid tear showed no increase in laxity. Complete tear introduced significant anterior translation, ER, and eversion laxity (+7.6 mm of anterior translation, +13.8° ER and +33.6° of eversion; P < .001). Conclusion: A complete deltoid tear caused severe instability of the ankle joint. Augmented anterior repair was sufficient to stabilize the complete tear, and no additional benefit was provided by posterior repair. For isolated anterior tear, repair with tibiocalcaneal augmentation was the optimal treatment. Clinical Relevance: Deltoid repair with augmentation may reduce or avoid the need for prolonged postoperative immobilization and encourage accelerated rehabilitation, preventing stiffness and promoting earlier return to preinjury activity.

Difficulties of nasocutaneous fistula repair, following lacrimal outflow system malignancy resection

ABSTRACT Purpose To evaluate the incidence of nasocutaneous fistula (NCF) development, following en bloc resection of lacrimal outflow system malignancies (LOSM), and describe the methods of surgical repair. Methods Retrospective review of all patients who underwent resection of LOSM with reconstruction and post-treatment protocol at the University of Miami between 1997 and 2021. Results Of the 23 included patients, 10 (43%) developed postoperative NCF. All NCFs developed within one year of surgical resection or completion of radiation therapy. NCF was seen more frequently in patients who underwent adjuvant radiation therapy and those who had reconstruction of the orbital wall with titanium implants. All patients underwent at least one revisional surgery to close the NCF, including local flap transposition (9/10), paramedian forehead flap (5/10), pericranial flap (1/10), nasoseptal flap (2/10), and microvascular free flap (1/10). Local tissue transfer, pericranial, paramedian, and nasoseptal forehead flaps failed in most cases. Two patients had long-term closure; one patient who underwent a paramedian flap and a second who underwent a radial forearm free flap, suggesting that well-vascularized flaps may be the most viable option for repair. Conclusions NCF is a known complication, following en bloc resection of lacrimal outflow system malignancies. Risk factors for formation may include adjuvant radiation therapy and use of titanium implants for reconstruction. Surgeons should consider utilizing robust vascular-pedicled flaps or microvascular free flaps for repair of NCF in this clinical scenario.

Six different surgical method options according to etiology in repair of arteriovenous fistula aneurysms

Aim: This study aims to evaluate the considerations that should be taken into account when choosing a surgical method and the early results of six methods used for repair in patients who underwent surgical repair due to arteriovenous fistula (AVF) aneurysms. Material and Methods: One hundred and five patients who underwent AVF aneurysm repair between 2012 and 2020 were reviewed retrospectively. Methods for surgical repair were used according to the etiology: Plication, Arteriotomy constrictions and plication, Aneurysm excision and creation of a new fistula, Saphenous vein or synthetic graft interposition, End-to-end anastomosis and plication after aneurysm excision, Banding method. Results: Sixty-one of the cases were male and 44 were female. The mean age was 56.6 (27-75) years. The total number of surgeries was 119, including the surgeries and reoperations performed in 2 planned sessions. As surgical method, 44 Plication, 13 Arteriotomy constrictions and plication, 10 Aneurysm excision and creation of a new fistula, 25 Saphenous vein or synthetic graft interposition, 13 End-to-end anastomosis and plication after aneurysm excision and 14 Banding methods were used. AVF flow of 38 patients was measured to be over 1700 ml/min, and 34 of these patients had an arteriotomy length of more than 7 mm. In patients who underwent repair due to high flow rate, an average of 30-65% flow reduction was achieved compared to the preoperative period. In the first postoperative 3 months, 7 (6%) patients required reoperation. Fistula loss did not occur in any of the patients who underwent repair. Conclusion: The etiology of aneurysm, flow rate, aneurysm localization, and the presence of intimal hyperplasia or chronic thrombus are important in choosing an aneurysm repair method. We think that the results will be positively affected if the surgical method is determined according to the association of one or few of these factors.

Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in China: A meta-analysis.

In China, laparoscopic inguinal hernia repair (LIHR) under the day surgery mode (DSM) has developed rapidly as an important surgical method for inguinal hernia repair, and it has unique advantages in many aspects. Compared with inpatient surgery mode (ISM), there are some differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction. Many studies have shown that LIHR in DSM can significantly shorten hospital stay, effectively reduce hospitalization costs, and improve patient satisfaction. Accordingly, this study aimed to compare the differences in intraoperative and postoperative related indicators, hospitalization costs, and patient satisfaction of LIHR between DSM and ISM in China. The PubMed/Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wan Fang databases were searched for randomized controlled trials, cohort studies from the establishment of the database to July 1, 2022. Odds ratio (OR), mean difference, standardized mean difference (SMD), and 95% confidence interval were selected as the effect scale indices for the evaluation of the difference in hospitalization costs, hospital stay, operation time, recovery time, complications, and patient satisfaction. All of these were compared using RevMan 5.3 Software (The Cochrane Collaboration, Copenhagen, Denmark). Nine studies involving 1176 patients, 590 in the DSM group and 586 in the ISM group, were included. The hospital stay (d) (SMD = -7.27, 95% confidence interval, CI: -8.68 to -5.87, P < .001), hospitalization costs (SMD = -7.89, 95% CI: -10.25 to -5.53, P < .001) in DSM group were significantly lower than the ISM group. Additionally, the patient dissatisfaction (OR = 0.05, 95% CI: 0.01-0.17, P < .001) in DSM group was significantly lower than the ISM group. Nevertheless, no significant differences were found in the operation time (minute) (mean difference = -0.32, 95% CI: -1.78 to 1.14, P = .67), recovery time (h) (SMD = -3.27, 95% CI: -6.95 to 0.41, P = .08), and postoperative complications (OR = 0.80, 95% CI: 0.47-1.36, P = .41) between the 2 groups. In China, compared with ISM, LIHR under DSM can significantly shorten hospital stay, greatly reduce hospitalization costs, and significantly improve patient satisfaction. There were no significant differences in operation time, recovery time and postoperative complications.

Repair of uterine rupture following vaginal delivery: A comparison between minimally invasive and open repair.

To compare operative data and patient satisfaction between open and laparoscopic surgery for postpartum-diagnosed uterine rupture. In this questionnaire-based cohort study, the authors collected all cases of postpartum-diagnosed uterine rupture after vaginal delivery between 2016 and 2020 in a single academic tertiary center. The cohort was divided according to surgical method of repair, and demographic, clinical, operative and postoperative data were collected and compared between groups. A phone questionnaire on various satisfaction domains was conducted and satisfaction rates were compared between groups. Eight cases of uterine rupture following vaginal delivery were treated by laparoscopy and eight were treated by laparotomy. The median operative time was 103 min (interquartile range [IQR], 86.3-129.0 min) for the laparoscopy group and 61 min (IQR, 59.0-75.0 min) for the laparotomy group (P= 0.04). Blood transfusion was required in 25% of women who underwent laparoscopy, as compared with 88% of women who underwent laparotomy (P= 0.01 < 0.05). Median hospitalization time was 3 days (IQR, 3-4 days) in the laparoscopy group and 4 days (IQR, 4-4 days) in the laparotomy group (P= 0.2). Overall satisfaction, satisfaction from recovery, satisfaction from scars, satisfaction from ability to care for the neonate, and postoperative pain and mood were all improved in the laparoscopy group, as compared with the laparotomy group. Minimally invasive surgery is a viable surgical option for patients with uterine rupture diagnosed after vaginal delivery and may result in better patient recovery and satisfaction.

Prolapse of intestinal stoma.

Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

Revision Gastrojejunostomy Versus Suturing With and Without Omental Patch for Perforated Marginal Ulcer Treatment After Roux-en-Y Gastric Bypass

BackgroundUlceration at the gastrojejunostomy is a late bariatric surgery complication in 0.6–16% of Roux-en-Y gastric bypass (RYGB) patients. As there is no general consensus on management of acute ulcer perforations, we compare two methods of surgical repair: the most commonly performed procedure, suturing of ulcer with or without omental patch versus revision gastrojejunostomy (RG). MethodsA retrospective chart review of cases at a single large, Midwestern US high-volume bariatric center from November 2, 2006 through March 11, 2021 identified 144 RYGB patients undergoing surgical repair for a perforated ulcer: 72 treated by SGP and 72 by RG. Outcomes, including length of stay, leaks, readmissions, and reoperations, were compared. Categorical variables were compared by Chi-square tests and continuous variables by ANOVA. ResultsPatients were primarily female (77.1%) and Caucasian (97.2%), 49.7±12.5 years old, and 90.6±26.6 kg. Most had laparoscopic RYGBs (98.6%). There were no demographic differences between groups. Of the RG patients, 11.4% experienced ulcer recurrence versus 41.7% of SGP patients (p < .001), and 2.8% of RG versus 11.1% of SGP patients required a reversal (p < .05). No significant differences between groups occurred in time to perforation (3.2 vs. 2.5 years for RG and SGP groups, respectively), length of stay (5.0 vs. 6.8 days), leaks (1.4% vs. 2.8%), readmissions (4.2% vs. 4.2%), or reoperations (2.8% vs 5.6%). ConclusionsPatients developing perforated marginal ulcers after RYGB can be safely and effectively treated by revision gastrojejunostomy with a lower likelihood of ulcer recurrence. Short-term morbidity was comparable to suturing with or without an omental patch.