Surgical Outcomes Research Articles

Effect of thread direction on rotational stability in lag-screw fixation of sacroiliac luxation: An ex vivo cadaveric study in small-breed dogs.

To assess the effect of screw thread direction on rotational resistance in canine sacroiliac (SI) luxation models using left- and right-handed screws. Controlled laboratory study. Twenty-four adult canine pelves with proximal femora were examined. Four groups (n = 6 each) were established: right-handed screw/right SI luxation (RhRSI), right-handed screw/left SI luxation (RhLSI), left-handed screw/left SI luxation (LhLSI), and left-handed screw/right SI luxation (LhRSI). Under fluoroscopy, 2.4 mm cortical screws were placed into the SI joint in a lag fashion. An acute failure test measured force and torque at yield and peak points, with the ilium and femur positioned at a 108° angle and displacement at 0.099 cm/s. Torque (N cm) was calculated from force (N) and the moment arm (cm). Differences in median torque were found at yield and peak points. RhRSI gave 50.08 N cm versus 16.01 N cm for RhLSI (p < .01), and LhLSI showed 39.42 N cm versus 19.93 N cm for LhRSI (p < .03). At peak, RhRSI recorded 67.55 N cm compared to 28.14 N cm for RhLSI (p < .01), and LhLSI reached 51.79 N cm versus 28.28 N cm for LhRSI (p < .05). All samples failed by rotation without screw breakage or fractures. Right-handed screws provided greater rotational resistance in right-sided luxation, and left-handed screws in left-sided luxation, which demonstrated that screw thread direction influenced fixation stability in SI luxation. The findings suggest that selecting screw thread direction can enhance biomechanical stability in SI luxation repair, improving surgical outcomes for affected dogs.

The Effect of Community-Level Socioeconomic Status on Surgical Outcomes Following Revision Lumbar Fusion

The purpose of this study is to determine the impact of community-level socioeconomic status (SES) on surgical outcomes and patient reported outcome measures (PROMs) following revision lumbar fusion. Adult patients who underwent revision lumbar fusion surgery from 2011-2021 were grouped by Distressed Community Index (DCI) into Prosperous, Comfortable, Mid-tier, and At risk/Distressed cohorts. Demographics, surgical information, and PROMs were compared based on DCI community status. Outcome measures were collected preoperatively, three months postoperatively, and one year postoperatively. 853 patients were included in the final cohort. There was no difference in terms of surgical approach or utilization of a staged procedure between the patient groups. Readmission (p=0.752) and reoperation rates (p=0.467) were similar across all community groups. Furthermore, for patients who required reoperation, the incision and drainage or revision surgery rate in each cohort was not statistically different (p=0.902). Prosperous community patients reported significantly lower VAS Back pain preoperatively in comparison to patients from other DCI communities. All groups experienced a similar degree of postoperative improvement in VAS Back scores (p= 0.271). There were no other differences in pre- or postoperative PROMs analyzed. While there are socioeconomic differences based on DCI, community-level SES was not predictive of worse surgical outcomes following revision lumbar fusion. Patients from the most distressed communities were able to achieve similar improvement after revision surgery. This should encourage spine surgeons to feel comfortable discussing an indicated revision lumbar procedure with patients, and not view SES as a barrier to successful outcomes.

Evaluation of Oropharyngeal Structure and DISE Findings for Successful Soft Palatal Webbing Flap Pharyngoplasty.

Lateral pharyngeal wall collapse, linked to weak pharyngeal wall stability, is characteristic of severe obstructive sleep apnea (OSA) patients. Soft palate webbing flap palatopharyngoplasty (SPWFPP) has been introduced to enhance the stability of the lateral pharyngeal wall with minimal postoperative complications by eliminating the need for tonsillectomy. This study analyzed the anatomic findings of oropharynx for determination of outcome in OSA patients requiring SPWFPP. Twenty-eight OSA patients who underwent SPWFPP combined with septoturbinoplasty were included in this study. Patient medical records, including endoscopic findings, polysomnography (PSG) data, and drug-induced sleep endoscopy (DISE), were analyzed. PSG data revealed that SPWFPP provided significant improvements of AHI scores in severe OSA patients with lateral pharyngeal wall collapse, whereas AHI scores of mild and moderate OSA cases minimally declined after SPWFPP. Notably, among the patients who underwent SPWFPP, some experienced abrupt increases in AHI levels after surgery, particularly in mild OSA cases, and those patients showed collapse of the epiglottis before surgery according to DISE findings. The outcome of SPWFPP was successful in severe OSA patients whose epiglottis was not collapsible on preoperative DISE findings and in patients with palatal collapse of grade III or higher. SPWFPP provides good surgical outcomes even in severe OSA patients with lateral pharyngeal wall collapse. However, the surgical results may be worse in certain patients depending on epiglottis collapsibility. A close analysis of DISE findings before SPWFPP reveals important indicators for predicting better surgical results and selecting OSA patients suitable for SPWFPP.

Cranioplasty With Hydroxyapatite Implants: A Multidisciplinary Approach of Neurosurgeon and Plastic Surgeons to Improve Surgical Technique and Clinical Outcome.

Cranioplasty using Hydroxyapatite prosthesis is a conceptually simple procedure, but it may harbor several challenges for the surgeons. Several papers in the literature deal with cranioplasty using porous hydroxyapatite. The results are not homogeneous both because of the variability of the patients treated but also because Hydroxyapatite requires a more careful surgical technique to achieve maximum performance. The aim of the present study is to offer an insight of a single institution, multidisciplinary experience with custom-made Hydroxyapatite cranioplasty with surgical tips and tricks based on personal opinion and literature evidence. We will provide an overview of all the fundamental steps we believe to be useful to optimize surgical outcomes, including preoperative planning of cranioplasty; as cranioplasty flap/soft tissue coverage planning, infectious prophylaxis, patient positioning, incisional patterns, tissue dissection, primary bone demolition, and preparation of the craniectomy margins before implant positioning. The authors will also discuss methods for dural suspension, implant fixation and anchorage, margins polishing, drainage, suturing, and dressing. Cranioplasty using hydroxyapatite prosthesis is a valuable alternative for skull reconstruction with heterologous implants, and in our opinion a multidisciplinary approach integrating plastic surgeons and neurosurgeons' specific skills can facilitate surgical planning, reducing complications and allowing to achieve better functional and aesthetic results.

Retrospective study on the strength of magnetic resonance signs for predicting breast implant rupture: assessing the impact of radiologist expertise at a breast cancer referral center.

This study evaluates the diagnostic criteria of MRI for breast implant rupture and examines the influence of radiologist experience on the accuracy of rupture detection. A retrospective study was conducted in a single center, involving patients who underwent implant replacement surgery between March 2019 and October 2022. MRI evaluations by four radiologists of varying experience levels were compared with surgical outcomes. The study included 118 explanted prostheses, with 25 identified as ruptured. Expert radiologists demonstrated near-perfect agreement (κ = 0.94) in identifying rupture signs, with high PPV and NPV, whereas non-experts showed only moderate agreement (κ = 0.44). Indicators such as the linguine sign, subcapsular line, and keyhole sign were identified with high accuracy by experts, contrasting with non-experts' lower detection rates. Expertise in radiology significantly impacts the accurate diagnosis of breast implant ruptures. This study supports updating radiological guidelines and underscores the importance of specialized training and experience in improving diagnostic outcomes in breast implant assessments.

Presentation and outcome of Gastric Cancer at a Tertiary Care Center

Introduction: Gastric cancer is the fifth most common cancer globally and the fourth leading cause of cancer-related deaths. Early-stage disease can be managed with endoscopic therapy or surgery, while advanced gastric cancer requires a multimodal treatment approach, including extensive lymphadenectomy. This study aims to evaluate the clinicodemographic profile and treatment outcomes of gastric cancer patients and to establish an effective therapeutic strategy. Methods: This retrospective descriptive cross-sectional study was conducted in the Department of Surgery at Shree Birendra Hospital. It included patients with gastric malignancies who had complete medical records. Data on patient history, AJCC staging, operative details, and postoperative findings were analyzed. Surgical choices were based on the clinical indication in each case. Clinicopathological characteristics and surgical outcomes were compared across tumor stages. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 24. Results: The study included 90 patients (62 males, 28 females) aged between 23 and 82 years. The most common clinical presentations were abdominal pain (58%), gastric outlet obstruction (18%), lump (5%), anemia (5%), and peritonitis (4%). Adenocarcinoma was the predominant histological type (87.78%). Curative surgery was performed on 73 patients (81.11%), while 17 patients (18.89%) underwent palliative procedures. Morbidity occurred in 16 patients (17.7%), primarily due to chest complications and sepsis, and mortality was recorded in 5 patients (5.5%). Conclusion: This study highlights the predominance of locally advanced gastric cancer in males, with distal gastric cancer and well-differentiated adenocarcinoma being the most common. Chest complications and sepsis were the leading causes of morbidity and mortality. No patients received perioperative chemotherapy, underscoring the need for updated treatment protocols to improve outcomes.

Clinical Outcomes and Early Postoperative Complications in Boston Type I Keratoprosthesis Implantation: A Retrospective Study

Background/Objectives: The purpose of this study is to evaluate clinical outcomes and early postoperative complications in patients undergoing Boston type I keratoprosthesis (BKPro) implantation, with a specific focus on the onset and nature of ocular surface disorders during the early postoperative period. Methods: This retrospective study included 77 eyes that underwent BKPro implantation between 2019 and March 2022. Patients were treated at the Saint Barbara Hospital, Trauma Centre, Sosnowiec, Poland, and District Railway Hospital, Katowice, Poland. Data were collected from medical records, including patient demographics, medical history, surgical outcomes, postoperative visual acuity, and complications. The analysis incorporated both detailed medical history and direct clinical examination results. Results: The most common early postoperative complication was glaucoma, affecting 32 eyes (42%). Retroprosthetic membrane formation occurred in 20 eyes (26%), while partial extrusion of the BKPro was observed in 10 eyes (13%). Severe corneal surface damage was noted in patients with underlying autoimmune diseases (36%) and after chemical burns (24%). Five patients suffered from transient hypotony resulting from keratoprosthesis extrusion. The results highlight the complex nature of managing ocular surface conditions and the frequent challenges associated with early postoperative complications. Conclusions: BKPro implantation is an effective solution for severe corneal diseases that are resistant to conventional treatments. However, it is associated with a significant risk of early complications, particularly glaucoma and retroprosthetic membrane formation. Early identification and management of these complications are crucial for improving outcomes and maintaining visual function. Further research into optimizing postoperative care is needed to minimize these risks and enhance patient outcomes.

Comparative study of simultaneous and staged bilateral total knee arthroplasty: is age a key factor in surgical outcomes?

BackgroundThe present study aimed to compare the outcomes of simultaneous bilateral total knee arthroplasty (simBTKA) and staged bilateral total knee arthroplasty (stgBTKA) across different age groups, with a specific focus on patients under and over 65 years old.MethodsA retrospective cohort study design was employed to analyze the medical records of patients who underwent simBTKA or stgBTKA between August 2018 and May 2023. Patients were categorized into 4 groups based on age and surgical approach. Various outcome measures including knee extension strength, patient-reported outcome measures (PROMs), length of stay (LOS), operating room time (ORT), and complication rates were evaluated.ResultsThe study included a total of 162 patients, with 48 patients in the simBTKA group and 114 patients in the stgBTKA group. Across all age groups, simBTKA resulted in a significantly shorter LOS and ORT than stgBTKA (p < 0.05). However, there were no significant differences in PROMs or in knee extension strength between the two surgical approaches. The complication rates were comparable between the groups, with no reported deaths within one year after surgery.ConclusionCompared with stgBTKA, simBTKA demonstrated superior efficacy in terms of reduced hospitalization duration and ORT, irrespective of age. Both surgical approaches yielded comparable clinical outcomes and complication rates across all age groups. Overall, the findings suggest that simBTKA is a viable option for appropriately selected patients, offering outcomes comparable to those of stgBTKA, with the added benefit of reduced hospitalization time and operating room utilization.

Outcome of Triple Negative Breast Cancer(TNBC) as compared to other breast cancers in Bir Hospital, National Academy of Medical Sciences

Introduction: In Nepal, breast cancer is the second most common cancer accounting for a large number of deaths.The subtype Triple-negative breast cancer (TNBC) is linked to poor prognosis and is characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). This study describes the outcome of women with TNBC as compared to other breast cancers in Bir Hospital in Nepal. Methods: This was a cross-sectional study conducted in Bir Hospital, National Academy of Medical Sciences. The breast cancer data in Department of Surgery and Department of Oncology were collected from July 2021 to June 2024. The study data on demographic details, clinical findings, radiological and pathological investigations, operative procedures, neoadjuvant/adjuvant therapy, surgical and oncological outcomeswere collected. The study approval was taken from Institutional Review Board of National Academy of Medical Sciences. Results: There were 72 breast cancer patientsout of which 10 (13.8 %) were TNBC. Majority of the cases (70%) underwent modified radical mastectomy and 60% of them had received neoadjuvant therapy in TNBC cases. One out of 10 had positive margin post mastectomy. The proportion of TNBC patients with postoperative wound infection, seroma and flap necrosis were 10% each. The mean lymph node positivity was less in TNBC group as compared to other breast cancers.There was one recurrence, one metastasis and no mortality till one year follow up. Conclusion: The surgical outcome was satisfactory and with neo-adjuvant, surgery and adjuvant therapy, there is less tumor recurrence and satisfactory disease free survival and overall survival.

Mirror Aneurysms of the Pericallosal Artery Clipped During a Single Surgical Procedure: Case Report and Literature Review

Pericallosal artery aneurysms are rare, accounting for 2–9% of all intracranial aneurysms, and mirror aneurysms in this location are exceptionally uncommon, presenting unique surgical challenges due to their deep location and proximity to critical neurovascular structures. The aim of this case report is to describe the surgical management and successful outcome of a patient with mirror pericallosal artery aneurysms and to contribute insights into the clinical and surgical considerations for this rare condition. We report the case of a 71-year-old female with multiple cardiovascular and metabolic conditions, including hypertension and smoking—well-established risk factors for intracranial aneurysm formation and rupture. She presented with a Hunt and Hess grade II subarachnoid hemorrhage resulting in communicating internal hydrocephalus. Preoperative angiography revealed mirror aneurysms of the pericallosal artery. The patient underwent a left basal paramedian frontal craniotomy, during which a ruptured aneurysm on the right A2 segment and an unruptured aneurysm on the left A2 segment were identified. Both aneurysms were successfully clipped using curved Yasargil clips. Postoperative recovery was favorable, with no neurological deficits and stable imaging findings at a three-month follow-up. This case underscores the necessity for precise microsurgical intervention and a thorough understanding of pericallosal artery anatomy to manage such rare and challenging conditions effectively. The role of hyperlipidemia and statin use in intracranial aneurysm development remains debated and warrants further investigation. Our successful management of mirror pericallosal artery aneurysms contributes to the limited literature on this rare condition and highlights the importance of meticulous surgical techniques for favorable outcomes.

Treatment of Chronic Scapholunate Dissociation with FCR Tenodesis: A Systematic Review of the Results of MBT and 3LT Technique

AbstractA systematic literature review was performed to assess the results of modified Brunelli tenodesis modified Brunelli technique (MBT) and three-ligament tenodesis (3LT) in the treatment of chronic scapholunate (SL) ligament injuries reported between 1998 and 2001. This review describes the surgical techniques, clinical outcomes, radiological evaluations, and complication rates among 600 patients. Following adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 15 studies were included (289 MBT and 311 3LT procedures). A heterogeneity in surgical technique was noted. An average pain reduction of 3 points on the visual analog score and a flexion–extension arch compatible with most daily activities were found. Radiographic follow-up showed medium-term improvements, but loss of reduction was observed in the long term. Secondary degeneration was seen in 15% of cases. Radiographic decay did not correlate with clinical outcomes. The overall complication rate was 9%. This review underscores the satisfactory clinical outcome of both procedures. Nonetheless, both interventions pose risks of complications and/or degeneration in the long term.

The feasibility and clinical outcome of endoscopic transorbital transcavernous approaches with or without petrosectomy for petroclival lesions.

Petroclival tumors such as petroclival meningiomas or trigeminal schwannomas extending to the posterior cranial fossa are challenging to treat due to their deep-seated location and proximity to critical neurovascular structures. This study aimed to evaluate the feasibility, safety, and clinical outcomes of endoscopic transorbital surgery for the resection of central skull base tumors involving the petroclival area. The authors conducted a retrospective analysis of 32 patients with petroclival tumors including meningiomas and trigeminal schwannomas who underwent endoscopic transorbital surgery between September 2017 and December 2022. Preoperative clinical and radiological data were collected, and patients were followed up postoperatively for a median period of 34.7 months. Surgical technique, complications, and clinical outcomes were assessed. Endoscopic transorbital surgery provided a minimally invasive and direct corridor to the petroclival region. All 32 patients successfully underwent tumor resection, with gross-total or near-total tumor resection achieved in 28 patients. The mean tumor diameter was 3.5 cm. Based on tumor pathology, the endoscopic transorbital transcavernous trans-Meckel's cave approach (21 cases) or transorbital anterior transpetrosal approach (11 cases) was selected. The most common complication was facial paresthesia in 4 of 21 patients with trigeminal schwannomas and in 1 of 11 patients with petroclival meningiomas. Diplopia due to fourth cranial nerve injury occurred in 3 of 11 patients with petroclival meningiomas. Postoperative clinical improvement in neuralgic pain was observed in 3 of 4 patients. One patient developed a temporary facial palsy (House-Brackmann grade III) and another patient had transient paraparesis after removal of petroclival meningioma. Endoscopic transorbital surgery appears to be a safe and effective technique for the resection of petroclival lesions, offering excellent visualization and access to the tumor while minimizing morbidity. However, further studies with larger patient cohorts and longer follow-up are warranted to validate the long-term efficacy and safety of this approach. This study contributes to the growing body of evidence supporting the utility of endoscopic transorbital techniques in skull base surgery.

3D imaging techniques for the diagnosis and surgical planning of complex limb fractures: a systematic review

This systematic study will investigate how 3D imaging techniques have improved diagnosis and planning of surgeries for complex limb fractures. These fractures are caused of high-energy trauma which presents unique challenges, so advanced imaging technologies can help to mitigate them. We strictly adhere PRISMA guidelines to ensure thorough analysis and inclusion of relevant literature. The search was conducted on Web of Science and PubMed were all thoroughly searched between 2010 and 2023. Keyword combinations such as "3D imaging," "complex limb fractures," and "surgical planning" were employed using Boolean operators and as a result, 26 studies were included following screening based on strict inclusion criteria. 56% of studies used CT scans, demonstrating a 32% increase in diagnosis accuracy over 2D techniques for complicated fractures. In 28% of cases MRI improved soft tissue evaluation. 3D printing was utilized in 16% of investigations and it improved postoperative alignment in 94% of cases and shortened operating times by 18%. We can conclude that 3D imaging greatly enhances surgical planning, patient outcomes, and diagnostic precision in complex limb fractures and it provides useful resources for surgeons and patients by improving fracture visualization, reducing operating time, and promoting quicker recovery.

Bow Hunter’s syndrome surgical approach and outcome: Two new cases and literature review

Bow Hunter’s syndrome surgical approach and outcome: Two new cases and literature review

Comparative Analysis of Surgical Outcomes in Separation Surgery vs. Anterior Reconstruction for Metastatic Epidural Spinal Cord Compression.

Retrospectively matched case-control study. To compare intraoperative and postoperative outcomes between separation surgery and corpectomy with anterior reconstruction for patients with metastatic epidural spinal cord compression (MESCC). The primary goal of surgery for MESCC is to preserve and improve neurological function. Separation surgery may offer a less invasive alternative that still achieves neurological decompression and restores biomechanical stability, enabling surgeons to forego more invasive surgeries, such as corpectomy with anterior reconstruction. However, there is limited literature comparing these two surgical methods. Fifty-six patients aged 18 years or older who underwent either separation surgery followed by stereotactic body radiation therapy (n=28) or corpectomy with anterior reconstruction (n=28) for MESCC from 2017 to 2022 were included. Outcomes included estimated blood loss, operating time, intraoperative blood transfusion and complications. The Mann-Whitney U test was used for continuous data, and Fisher's exact test for categorical data. Patients undergoing separation surgery compared with anterior reconstruction experienced less blood loss (median 500ml [IQR 300-1,000] vs. 925ml [IQR 500-1,425]; P=0.036) and shorter operating times (median 214 minutes [IQR 164-281] vs. 286 minutes [IQR 220-328]; P=0.028). Intraoperative blood transfusion occurred in seven patients (25%) in the separation surgery group versus 14 patients (50%) in the anterior reconstruction group (P=0.10). There were no significant differences between both groups with regard to duration of hospitalization, complications, postoperative transfusions, reoperations, or survival (P<0.05). Separation surgery was found to have less blood loss and shorter operating times compared with corpectomy with anterior reconstruction. These findings suggest that separation surgery may be a viable therapeutic alternative for MESCC patients currently undergoing more invasive surgical approaches. Future studies should prospectively compare separation surgery and corpectomy with anterior reconstruction to provide additional evidence on their relative effectiveness in managing local tumor control. Treatment benefits, Level IV.

Evaluation of Surgical Results and Effectiveness of Laparoscopic Transabdominal Preperitoneal and Laparoscopic Totally Extraperitoneal Approaches in Bilateral Inguinal Hernia Repair: A Randomized Analysis.

Background: Laparoscopic surgery is recommended as the standard approach for bilateral inguinal hernia repair. There are few studies in the literature comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic total extraperitoneal (TEP) approaches for bilateral inguinal hernia repair. This study aimed to compare the surgical outcomes and effectiveness of laparoscopic TAPP and laparoscopic TEP methods applied in bilateral inguinal hernia repair. Methods: A total of 100 patients operated on for bilateral inguinal hernia by applying laparoscopic TAPP and laparoscopic TEP methods from January 2016 to March 2023 were included in the study. The patients were randomized equally in two groups. Postoperative follow-up results were statistically analyzed in terms of recurrence rate, swelling in the incisions, scrotal edema and swelling, suture dehiscence, and the average time to return to work. Results: In bilateral inguinal hernia patients operated with laparoscopic TAPP method compared with bilateral inguinal hernia patients operated with laparoscopic TEP method, postoperative recurrence rate was significantly lower (2% versus 16%), swelling in the incision sites was significantly less (4% versus 24%), and the average time to return to work was significantly shorter (3.6 ± 2.3 versus 6.3 ± 5.8) (P < .05). Scrotal edema and swelling and suture dehiscence results did not show significant differences between the two approaches (P > .05). Conclusions: Both methods are widely used in bilateral inguinal hernia repairs. Postoperative results revealed that the laparoscopic TAPP method with less postoperative recurrence rate and less swelling in the incision sites, and shorter average time of the patients to return to work appears to be superior to the laparoscopic TEP method.

Exploring the Role of Intracorporeal Ultrasound in Partial Nephrectomies: A Systematic Review.

Renal cell carcinoma accounts for the sixth most common cancer in the United Kingdom. With the increasing application of cross-sectional imaging, the frequency of incidental renal masses has increased over time. Laparoscopic and robot-assisted partial nephrectomy has become the standard of care in the management of size and stage-appropriate renal masses. The objective of this systematic review was to analyse the surgical outcomes when intracorporeal ultrasound was utilised as an adjunct in partial nephrectomy. A comprehensive search in PubMed and Google Scholar was performed in July 2024 for publications in the English language. The primary endpoint was to evaluate the role of intracorporeal ultrasound as an adjunct in robotic partial nephrectomies and its impact on tumour clearance. After identifying 609 records, 52 records were screened and 44 records were sought for retrieval. Eight publications were included in this systematic review comprising 765 patients. Seven of the eight studies reported outcomes from single centres. The mean percentage of negative surgical margins was 97.6% (range = 92.1-100%). The use of intracorporeal ultrasound as an adjunct in partial nephrectomy for T1 renal cell cancer has proven to improve the rates of negative surgical margins thereby reducing the incidence of local recurrence and distant metastasis.

Surgical Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery.

Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures. The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery. From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively. Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work. Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.

Is It Possible to Predict Difficulties During Laparoscopic Sleeve Gastrectomy? A Single Centre Experience

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery across the globe. Understanding preoperative risk factors for possible intraoperative complications can aid in predicting surgical outcomes and shaping the approach to the procedure. This study aimed to identify and analyze potential risk factors associated with intraoperative difficulties during LSG. Patients and methods: The analysis encompassed consecutive patients who underwent LSG from 2017 to 2020. Patients who encountered intraoperative difficulties during the procedure were categorized into Group 1, whereas those who did not experience such complications were placed in Group 2. To identify potential risk factors for intraoperative challenges, a thorough evaluation of demographic characteristics was conducted, including variables such as age, body mass index (BMI), comorbidities, and previous surgical history. Results: Group 1 included 37 patients (11.71%), while Group 2 comprised 279 patients (88.29%). Apart from higher rates of diabetes, pulmonary disease, and sleep apnea in Group 1, no significant differences were observed between the groups regarding demographic parameters. A univariate logistic regression analysis identified several risk factors associated with intraoperative difficulties, including a body mass index (BMI) greater than 50 kg/m2 (OR 2.15, 95%, CI 1.05–4.39, p = 0.0362), the experience of the operating surgeon (OR 9.22, 95% CI 4.31–19.72, p = 0.0058), the presence of diabetes (OR 2.44, 95% CI 1.19–4.98, p = 0.0146), and pulmonary disease (OR 12.22, 95% CI 1.97–75.75, p &lt; 0.0001). In multivariate logistic regression analysis, only the surgeon’s experience (OR 8.61, 95% CI 3.75–19.72, p &lt; 0.0001) remained a significant factor influencing intraoperative difficulties. Conclusions: The sole significant factor influencing the occurrence of intraoperative difficulties was the level of the surgeon’s experience

What are the minimal criteria of goal-directed perfusion (GDP) in adult cardiac surgery?

Introduction: Nowadays, many cardiac surgery teams are adopting the goal-directed perfusion (GDP) strategy in their practice to maintain optimal perfusion during cardiac surgeries and improve patient outcomes. Furthermore, it plays an indispensable role as a quality control tool to monitor both perfusionists’ practice and equipment (in addition to disposables used in the surgery. Objectives: To identify the role and the elements of GDP that facilitate better surgical outcomes. In addition, to compare between GDP and the traditional conventional perfusion strategy (CP) in terms of perfusion adequacy and surgical outcomes. Finally, to recognize challenges that may prevent the effective application of GDP and finding possible applicable solutions. Methods: A systematic literature review was conducted from three different databases PubMed, SpringerLink, and ScienceDirect. The selected studies were in English from the USA and Europe with a time frame starting from 2005. Results: The findings highlight the crucial role of the GDP strategy in protecting and preserving end-organ function after on-bypass cardiac surgery procedures. Furthermore, a clear understanding of the GDP implementation component and criteria was obtained. Alternatively, a satisfactory GDP level can be achieved by the optimal utilization of available resources. Discussion: Dismantling the GDP strategy into practically recognized components to ease the implementation at different levels of perfusion practice. Conclusion: The GDP approach involves the intensive monitoring of respiratory-related parameters to enhance surgical outcomes. The process includes blood preservation, optimal flow and intraoperative parameters management. Monitoring is the key element of GDP, which can be applied by using the sophisticated technology or the proper use of existing resources to develop protocols within the international guidelines and recommendations. Achieving an optimal perfusion requires concerted efforts of organizational, safety, and practical measurements.