Surgical Satisfaction Research Articles

Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes

Here we describe anatomic and quality of life (QOL) outcomes of an anterior and apical compartment prolapse repair involving a reduced mesh implant size and apex-only fixation. One hundred and fifteen patients undergoing the repair at a single urogynecology center were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) and inpatient chart reviews. A horizontal incision eliminated overlap with the mesh, and each sacrospinous ligament was approached anteriorly by blunt dissection. Recurrence was defined as apical (C), or anterior (Aa or Ba) ≥0, and secondary analyses were performed using POP-Q ≥ -1 as the anatomic threshold. Pelvic Floor Distress Inventory (PFDI), Surgical Satisfaction Questionnaires (SSQ) and a dyspareunia symptom scale were analyzed pre- and postoperatively. Fifty-three women with uterus in situ demonstrated a combined anterior-apical recurrence rate of 1.89 %, including no anterior (Ba ≥ -1) and one apical (C ≥ -1) recurrence. Forty-seven women undergoing repair for vault prolapse had recurrence rates ranging from 0 % in those with prior hysterectomy to 4.2 % in those undergoing concurrent hysterectomy. The rate of mesh exposure was 3/115 (2.6 %), including two in women with concurrent hysterectomy. Self-reported dyspareunia was more common preoperatively (13.4 %) than postoperatively (9.3 %). PFDI scores improved in all domains, and 93 % completing the SSQ reported they were satisfied and would choose the surgery again. This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.

Dexmedetomedine vs midazolam sedation in middle ear surgery under local anesthesia: Effect on surgical field and patient satisfaction

BackgroundA relatively bloodless microscopic field is essential to facilitate surgical exposure in Simple Middle Ear Surgery (SMES). Our aim was to compare dexmedetomedine with midazolam in reducing bleeding in SMES performed under local anesthesia.MethodsIn this prospective, double-blind, comparative study, 54 patients undergoing SMES randomly received intravenous sedative infusion of either: Dexmedetomedine (Group D) or midazolam (Group M) titrated to a bispectral index reading of 70–80. Pain on local anesthesia injection was assessed by a verbal rating scale. Using a 3-grades score, the surgeon assessed the quality of surgical bleeding. Mean Arterial Pressure (MAP) and Heart Rate (HR) were assessed. Time parameters recorded include: time to reach adequate sedation, surgery duration, sedation recovery and postanesthesia care unit discharge. Patient satisfaction, visual analog scale for intraoperative pain, and number of patients required rescue fentanyl were recorded. Adverse effects were also recorded.ResultsSurgical field bleeding score was significantly better in group D compared to group M (Grade I: 18 vs 4, Grade II: 9 vs 19, Grade III: 0 vs 4, respectively) p < 0.001. Intraoperative MAP and HR in group D were lower than their baseline values and the corresponding values in group M. Group M patients were earlier to reach adequate sedation level than those of group D, but they felt more pain either on local anesthetic injection or during operation. Rescue fentanyl was needed only for group M patients. Patient satisfaction was higher in group D. Time of surgery was longer in group M. Both groups were similar in sedation recovery and ward discharge times, as well as, incidence of side effects.ConclusionCompared to midazolam sedation in SMES performed under local anesthesia, Dexmedetomedine was associated with a near bloodless microscopic surgical field, shorter surgery time, greater patient satisfaction, and lower pain scores with no adverse effects.

Surgical procedures, costs and patient satisfaction

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) states that emergency patients must have prompt access to theatres, critical care facilities and appropriately-trained staff at all times. Due to the increased number of trauma cases treated by our orthopaedic teams a dedicated Day Surgery Trauma List (DSTL) was introduced. This article is a retrospective study of operations, cost implications and patient satisfaction of this list. We reviewed 49 patients operated on by the first author in six months from October 2008 to March 2009. The type of operation, place of operative decision and the time taken from the decision to actual operation was recorded. The cost was analysed with the help of the finance department. Patient satisfaction was calculated from a questionnaire. Decision to operate was taken in accident and emergency in 60% cases and 40% in fracture clinic. The average time from the decision to operation was two days. Cost-benefit to the NHS was £300 per case. 28 patients answered the questionnaire with overall patient satisfaction of 8.57 out of 10. The day surgery trauma list may be used to perform various orthopaedic trauma procedures with significant cost containment (£14 400 in six months). Benefits to patients were specified operative time, reduced waiting times and good clinical care.

Assessment of the Psychometric Properties of the Short‐Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) following Surgical Placement of Prolift+M: A Transvaginal Partially Absorbable Mesh System for the Treatment of Pelvic Organ Prolapse

Impairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient-reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a validated, widely used condition-specific questionnaire focused on sexual function among patients with POP or urinary incontinence. This study aims to report sexual function outcomes as measured by PISQ-12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP. The PISQ-12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation. Data for the study were collected from a prospective multicenter, single-arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ-12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness. As measured by the PISQ-12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ-12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ-12 items had good distributional properties at baseline, with substantial ceiling effects at follow-up visits reflecting improvements experienced by the patients. The PISQ-12 is a valid measure of sexual function in studies involving patients with POP.

Surgical Outcomes of Abdominal Versus Laparoscopic Sacral Colpopexy Related to Body Mass Index

ObjectiveObesity can predispose women to pelvic organ prolapse and can also affect the success of prolapse surgery. Sacral colpopexy is a common surgical approach used to treat significant prolapse, and may be performed by laparotomy or laparoscopy. The objective of this study was to determine whether surgical outcomes following abdominal sacral colpopexy (ASC) and laparoscopic sacral colpopexy (LSC) varied according to BMI. MethodsWe conducted a retrospective cohort study of women who had undergone ASC (n = 90) and LSC (n = 150). Preoperative, perioperative, and postoperative information was collected from patient charts and entered into a database according to BMI category (normal weight 18.5 to 24.9 kg/m2, overweight = 25 to 29.9 kg/m2, obese ≥ 30 kg/m2). Within each BMI group, outcomes were compared between ASC and LSC patients using Student t, Mann-Whitney U, and Fisher exact tests, and analyses of covariance. ResultsIn normal weight patients, postoperative apical measurements were worse in ASC patients (P = 0.01). In overweight patients, the ASC group had worse posterior measurements (P = 0.05) and fewer mesh/suture erosions (P = 0.03) but more recurrent prolapse symptoms (P = 0.007). In obese patients, the ASC group had better anterior measurements (P = 0.008). There were no differences in any BMI category for prolapse stage, surgical satisfaction, or classification of surgical success or failure (P > 0.05). ConclusionDifferences between ASC and LSC were identified when patients were categorized according to BMI. These findings may be useful in counselling patients and planning the appropriate surgical approach for sacral colpopexy based on BMI.

Quality of Life and Sexual Health after Sex Reassignment Surgery in Transsexual Men

Although sexual health after genital surgery is an important outcome factor for many transsexual persons, little attention has been attributed to this subject. To provide data on quality of life and sexual health after sex reassignment surgery (SRS) in transsexual men. A single-center, cross-sectional study in 49 transsexual men (mean age 37 years) after long-term testosterone therapy and on average 8 years after SRS. Ninety-four percent of the participants had phalloplasty. Self-reported physical and mental health using the Dutch version of the Short Form-36 Health Survey; sexual functioning before and after SRS using a newly constructed specific questionnaire. Compared with a Dutch reference population of community-dwelling men, transsexual men scored well on self-perceived physical and mental health. The majority reported having been sexually active before hormone treatment, with more than a quarter having been vaginally penetrated frequently before starting hormone therapy. There was a tendency toward less vaginal involvement during hormone therapy and before SRS. Most participants reported an increase in frequency of masturbation, sexual arousal, and ability to achieve orgasm after testosterone treatment and SRS. Almost all participants were able to achieve orgasm during masturbation and sexual intercourse, and the majority reported a change in orgasmic feelings toward a more powerful and shorter orgasm. Surgical satisfaction was high, despite a relatively high complication rate. Results of the current study indicate transsexual men generally have a good quality of life and experience satisfactory sexual function after SRS.

Changes in Back Pain After Percutaneous Endoscopic Lumbar Discectomy and Annuloplasty for Lumbar Disc Herniation: A Prospective Study

Percutaneous endoscopic lumbar discectomy and annuloplasty (PELDA) is a minimally invasive spinal technique for lumbar disc herniation. Following discectomy, the relief of leg pain is common; however, the relief of back pain is less predictable. The purpose of this study was to evaluate changes in back pain and to examine the predisposing factors for postoperative back pain following PELDA. In this prospective study, 58 patients with leg and back pain associated with disc herniation underwent PELDA. The patients were divided into two groups: unfavorable and favorable. Patients were defined as having unfavorable outcomes if the percentage improvement of back pain <50% or the postoperative Oswestry Disability Index (ODI) >20% at postoperative 24 months. The preoperative demographic, clinical, and radiologic factors for each group were statistically analyzed. Fifty-two patients were enrolled in this study. The mean visual analog scale scores for back pain and the ODI scores significantly improved from 6.6 and 55.9% preoperatively to 2.5 and 12.7% at the 24-month follow-up. The surgical satisfaction rate was 78.4% at the final follow-up. Eighteen (34.6%) patients had unfavorable outcomes. Patients with advanced disc degeneration of operative levels had significantly worse outcomes than those with mild disc degeneration (odds ratio: 6.316, 95% confidence interval 1.25-31.86, P < 0.05). The severity of postoperative back pain was negatively correlated with surgical satisfaction (correlation coefficient: -0.564, P = 0.00). PELDA can relieve back pain as well as leg pain through direct decompression and thermal ablation of the annular defect. Disc degeneration can be expected to influence clinical outcomes following PELDA.

Effects of Lidocaine Infiltration on Cost of Rhinoplasty Made Under General Anesthesia

This study aimed to compare the effects of combined and noncombined lidocaine with adrenaline infiltration in general anesthesia (GA) procedures, in which the standard anesthesia depth is monitored by Bispectral Index monitoring, on minimum alveolar concentration (MAC) levels and the costs. Following approval by the local ethics committee, an American Society of Anesthesiologists physical status I–II group of 40 adult patients for whom elective rhinoplasties under GA were planned was divided into 2 double-blind randomized groups. In group 1, GA and lidocaine + adrenaline were administered, whereas in group 2, only GA and adrenaline were administered. All the patients who had been taken to the operation room underwent electrocardiography and measurements of the peripheral oxygen saturation, end-tidal carbon dioxide, heart rate, mean blood pressure, and Bispectral Index monitoring. Using the operation time and the MAC% values, the total consumed inhalation agent amounts were calculated, and the cost difference was determined. The mean blood pressure values were lower in group 1 (P < 0.05). In group 1, the MAC% was 20.83% lower than that of group 2; the consumed desflurane amount was 20.29%, and the cost was 20.29% lower than that of group 2 (P < 0.05). In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability. In addition, surgical satisfaction increased in the lidocaine + adrenaline group because of small number of agitated patients during the recovery period.

The Surgical Satisfaction Questionnaire (SSQ-8): A Validated Tool for Assessment of Patient Satisfaction Following Surgery To Correct Prolapse and/or Incontinence

To develop a validated questionnaire to assess patient satisfaction following surgery to correct urinary incontinence and/or pelvic organ prolapse. Existing surgical satisfaction surveys focus on the physician or facility rather than the surgical outcome itself. Many times patient satisfaction does not correlate with objective surgical outcomes, or even subjective symptom reporting. There are currently no surgical satisfaction assessment tools designed for any type of surgery, specifically pelvic reconstructive surgery. The process and results of validating a post surgical patient satisfaction questionnaire. A private urogynecology practice in Pennsylvania. 400 women underwent surgery to correct stress urinary incontinence and/or pelvic organ prolapse, each completed the SSQ-8 at 4 months and 1 year. A separate group of 157 women completed the SSQ-8 and an office based satisfaction survey developed by Press Ganey. The lead author developed 12 questions that seemed directly relevant to surgical satisfaction. Face validity was further established by a group of 8 Urogynecologists and 4 Urogynecology nurses who honed it to 8 likert scale questions deemed relevant and non-redundant. Test-retest reliability was assessed by administering the survey to patients at 4 months and 1 year post-op. External validity was assessed by administering a well-established Press Ganey survey designed for medical practices to patients that had also completed the SSQ-8. The questionnaire's test-retest reliability was .80 p<.0001, assuring predictability between the 2 test intervals. The internal consistency reliability, based on Cronbach's alpha was .79. The Bonferroni-adjusted p-value < .02 denoted statistical significance due to the multiple comparisons. The association between SSQ-8 and medical practice survey summary scores revealed a moderate and statistically significant positive correlation (r=.28, p=.004). This questionnaire (SSQ-8) is a valid and reliable tool to measure patient satisfaction after pelvic surgery.

Planung und intraoperative Kontrollen in der Rhinochirurgie

We present a technique to quantify computer simulation in rhinoplasty and to make individual templates to be used intraoperatively. With these templates the exact position and shape of the nasal dorsum, tip, columella and anterioar nasal spine can be controlled and adjusted. Due to our experience this techniques contributes to precise surgical outcome and patient's satisfaction.

Prospective Long-Term Evaluation of Allograft Meniscus Transplantation: A Minimum 7-Year Follow-up (SS-33)

Introduction Meniscal allograft transplantation (MAT) has been hypothesized as a treatment option for young, meniscus-deficient patients. The long-term efficacy of this procedure is lacking in literature; thus, the purpose of this study is to report the long-term results (minimum 7 years postoperative) of meniscal allograft transplantation. Methods A retrospective review of prospectively collected data with a minimum 7-year follow-up having undergone MAT by a single surgeon (senior author) between November 1997 and July 2002 was performed. Three patients (10.3%) in this cohort had a failed allograft and went on to have a subsequent intervention and were excluded from further analysis. Preoperative subjective data and physical examination findings were compared to the follow-up findings. When possible, a radiographic evaluation of the knee was obtained and assessed for bone plug/bridge healing and joint space integrity. Patient outcome evaluations were performed using the SF-12 Physical/Mental, Lysholm, IKDC, and the KOOS (Pain, Symptom, Activities of Daily Living, Sports, and Quality of Life) scores. In addition, patients were asked to rate their overall surgical satisfaction and whether the patient would have the surgery performed on the contralateral knee given similar circumstances. Finally, preselected subgroup analysis was also performed. Results Twenty-two patients met the inclusion criteria with a mean follow-up of 8.49 years. Postoperative validated subjective scores showed statistically significant improvement from mean preoperative values. The mean postoperative satisfaction rate was 8.80 out of 10. Moreover, 90.9% of the patients stated that they would elect to have this surgery again. In addition, all measures exhibited sustained improvements in the 2-, 4-, and 7-year postoperative states as compared to the preoperative states (Table 1). Subgroup analysis of meniscal allograft transplantation performed concomitantly with other procedures (n=14) and those performed in isolation (n = 8) showed increased scores from mean preoperative to follow-up values on all knee scoring scales. No statistical difference was found on subjective data when comparing patients above (n=14) and below (n=8) a BMI of 25 kg/m 2 . There were, also, no significant differences between failed allograft meniscus transplantations and successful allograft meniscus transplantations with respect to subjective preoperative parameters. Follow-up physical examination revealed minimal patellofemoral joint tenderness and effusion with near-normal range of motion. Radiographic evaluation demonstrated consistent successful bony integration of the bone plugs/bridge from the allograft meniscus. Conclusion The patient population reported improvement on all validated surveys postoperatively. Additional analysis of our cohort demonstrated maintained levels of improvement at 7 years postoperatively when compared to 2- and 4-year follow-up scores. This data suggests that meniscal allograft transplantation is a durable treatment option for meniscus deficient patients, as it is effective in reducing pain, increasing range of motion and improving joint function in the long term. Data collected on the 3 reported allograft transplantation failures demonstrated that patient anatomy and lifestyle play an important role in allowing for an optimal outcome. While the results of this long-term study are encouraging, further research is needed to better assess the extent that allograft meniscus transplantation has in preventing the progression of osteoarthritis and maintaining an improved level of pain and function.

Surgical outcomes following total Prolift: Colpopexy versus hysteropexy

Total Prolift(®) is a pelvic floor repair system that is performed transvaginally and can be carried out with or without the uterus in situ. To compare surgical outcomes following total Prolift colpopexy (TPC) and total Prolift hysteropexy (TPH). This was a retrospective cohort study of women that underwent TPC (n = 65) or TPH (n = 24). Outcomes were compared between groups using Student's t-test, ANCOVA and Fisher's exact tests (P ≤ 0.05). There were no significant differences between TPC and TPH for all peri-operative variables. Patients were followed 6-12 months after surgery. Post-operatively, TPC patients had significantly higher pelvic organ prolapse-quantification (POP-Q) point C measurements (P = 0.05); however, all other POP-Q measurements were similar, including POP-Q apical stage of prolapse, with 99% in the TPC group and 92% in the TPH group at stage I or less. Post-operative mesh erosion, prolapse symptoms, surgical satisfaction, sexual activity and dyspareunia rates did not significantly differ between groups. This study showed that TPC and TPH have similar surgical outcomes, except for vaginal vault measurements reflected by POP-Q point C.

Laparoscopic sacral colpoperineopexy: abdominal versus abdominal–vaginal posterior graft attachment

Laparoscopic sacral colpoperineopexy (LSCP) involves posterior graft extension to the perineum for improved posterior support. The objective of this study was to determine whether posterior measurements differed between those that had graft extension done abdominally (A-LSCP) or abdomino-vaginally (AV-LSCP). This was a retrospective cohort study of patients that underwent A-LSCP (n = 17) and AV-LSCP (n = 51). Pre-, peri-, and postoperative variables were compared using Student's t, Fisher's exact, and analysis of covariance tests. Follow-up was 6 to 12 months. There were no differences between A-LSCP and AV-LSCP for any vaginal measurements or stage of prolapse (P > 0.05). Although not statistically different, A-LSCP patients had lower rates of mesh erosion and dyspareunia (P > 0.05). AV-LSCP patients had fewer prolapse symptoms (P = 0.01), but both groups had similar surgical satisfaction (P= 0.8). A-LSCP and AV-LSCP had comparable effects on posterior vaginal measurements; however, mesh erosion and subjective outcomes differed between the two approaches.

An Approach to Consistent Patient Education

Patient education is instrumental to postoperative recovery. To that end, the nurse must be able to decipher the discharge instructions and the patient and caregivers must be able to understand them. Ambulatory surgery patients are in the clinical setting for shorter periods; therefore, nurses need to provide these patients with effective educational tools that will assist them in achieving optimal surgical outcomes. In an effort to improve our perioperative and discharge orders, which were being handwritten, I created standardized forms that require little handwriting and allow surgeons to complete their orders by checkmarking the items. Use of these forms has improved turnover time, provided nurses and patients with orders that are easier to read and understand, and produced fewer incidences in which information is left off orders or misunderstood. Following up with patients to ensure their comprehension and active participation in their postsurgical care allows the nurses to assess the success of surgical care and patient satisfaction.

Evaluation of a transvaginal mesh delivery system for the correction of pelvic organ prolapse: subjective and objective findings at least 1 year after surgery

We sought to track objective and subjective outcomes ≥1 year after transvaginal mesh system to correct prolapse. This was a retrospective cohort study of 120 women who received a transvaginal mesh procedure (Avaulta Solo, CR Bard Inc, Covington, GA). Outcomes were pelvic organ prolapse quantification values; Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores; and a surgical satisfaction survey. "Surgical failure" was defined as pelvic organ prolapse quantification point >0, and/or any reports of vaginal bulge. Of 120 patients, 116 (97%) were followed up for a mean of 14.4 months (range, 12-30). In all, 74 patients had only anterior mesh, 21 only posterior mesh, and 21 both meshes. Surgical cure rate was 81%. Surgical failure was more common if preoperative point C ≥+2 (35% vs 16%; P = .04). Mesh erosion and de novo pain occurred in 11.7% and 3.3%, respectively. Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores improved (P < .01). Objective and subjective improvements occurred at ≥1 year, yet failure rates were high when preoperative point C was ≥+2.

The effect of tension-free vaginal tape placement on distal anterior vaginal wall support at the time of laparoscopic sacral colpoperineopexy

The occurrence of stress urinary incontinence and pelvic organ prolapse can often coexist resulting in the need for concomitant surgical procedures to treat both conditions. The purpose of this study was to determine if tension-free vaginal tape (TVT) at the time of laparoscopic sacral colpoperineopexy (LSCP) had an effect on distal anterior vaginal wall support. This was a retrospective cohort study of patients that had LSCP between January 2005 and December 2007 (n = 121). These patients were divided according to those with (n = 63) and without TVT (n = 58) at the time of LSCP. Pre- and postoperative information was compared between groups using Student's t tests, ANCOVA, and Fisher's exact tests (P ≤ 0.05). Preoperatively, there were no significant differences between groups for all demographic and anatomic variables (P > 0.05). Patients were followed-up until 12 months after surgery. Patients with and without TVT had similar postoperative anterior vaginal wall measurements (points Aa and Ba) and stage of prolapse (P > 0.05). There were also no differences between groups with regard to recurrent prolapse symptoms or surgical satisfaction (P > 0.05). Tension-free vaginal tape at the time of LSCP did not improve postoperative distal anterior vaginal support.

One-Year Outcome of Concurrent Anterior and Posterior Transvaginal Mesh Surgery for Treatment of Advanced Urogenital Prolapse: Case Series

Study Objective To estimate the safety and efficacy of performing concurrent anterior and posterior transvaginal mesh surgery using a commercially available kit (Gynecare PROLIFT Pelvic Floor Repair System; Ethicon, Inc., Somerville, NJ) for treatment of advanced urogenital prolapse (stage III or higher, Pelvic Organ Prolapse Quantification [POP-Q] system staging). Design Case control series study (Canadian Task Force classification II-2). Setting Medical school–affiliated hospital. Patients Forty-three patients with severe prolapse, POP-Q stage III (n = 23) or IV (n = 20), underwent surgery and were followed up for more than 1 year. In patients with any prolapse greater than stage I, surgery were considered to have functional failure. The Surgical Satisfaction Questionnaire was used for subjective evaluation at 1 year postoperatively. Interventions Extensive pelvic reconstructive procedures were primarily performed using a combination of the PROLIFT anterior and posterior pelvic systems (i.e., similar to sparing the intermediate section of the PROLIFT total pelvic system). The concurrent pelvic surgery included sequential vaginal total hysterectomy, perineorrhaphy, and suburethra sling, if indicated. Additional subjective and objective evaluations included POP-Q staging, urodynamic assessment, and preoperative and 12-month postoperative questionnaires. Measurements and Main Results Objective and subjective data were available for 42 patients. The subjective cure rate and objective success rate for prolapse at 12-month follow-up was 95.2% and 97.6%, respectively. Mean follow-up was 15.7 months, operation time was 79.2 minutes, operative blood loss was 109.1 mL, and postoperative hospital stay was 4.1 days. Intraoperative and postoperative complications were minor. All patients voided spontaneously before discharge. One mesh extrusion, no wound defective healing, and no rejection were observed. Two patients developed asymptomatic recurrent rectocele (stage II, POP-Q staging) that required no surgical intervention. Urodynamic parameters related to voiding dysfunction improved after surgery. Significant improvements were found using the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Conclusion Using concurrent anterior and posterior transvaginal mesh for pelvic reconstructive surgery is a safe and an effective method for treating advanced pelvic prolapse. Mesh-related complications are likely minimal, and mesh protrusion at the apex is likely to not occur. Further studies with longer follow-up are required to evaluate long-term effectiveness.

Restoration of the maxillary anterior tooth using immediate implantation with simultaneous ridge augmentation

Atrophy is most severe during the first month of post-extraction in the anterior maxilla with the degree of horizontal bone resorption being nearly twice as high as that of vertical bone resorption. The loss of the buccal alveolar plate following tooth extraction may lead to palatal implant positioning of the implants. Thus, immediate or early implant placement in the extraction socket has been suggested, because it would reduce the time period and the number of surgical intervention and yield higher patient satisfaction compared with delayed placed implants. However, placement of an implant immediately after tooth extraction may result in a gap between the occlusal portion of the implant and the surrounding alveolar bone crest. In this case report, an implant-supported restoration which is in harmony with the surrounding hard and soft tissue was created by the immediate implant placement with ridge augmentation in anterior region with high satisfaction from the patient.

Initiating a Multisubspecialty Orthopaedic Outcomes Program and Utilizing the Data to Guide Practice

Evidence-based medicine integrates research findings, clinical expertise, and patient values to provide the highest quality patient care. An orthopaedic outcomes database can assist surgeons in assessing associations between surgical procedures, function, survivorship, complication rates, patient satisfaction, and quality of life as guidance for practice. Outcomes are used to validate techniques or procedures, to benchmark best practices, and to identify areas requiring more clinical research. Tracking the success and failure rates of implants and surgical procedures is important. An outcomes database allows for short-term, midterm, and long-term prospective follow-up studies of specific cohorts and also facilitates studies that are retrospective in design. Several countries have initiated orthopaedic outcomes registries or databases. The oldest registry is the Swedish Knee Arthroplasty Register that was started in 19751. Other countries have followed with the development of their own joint registries in England, New Zealand, Germany, Finland, Denmark, and Norway2-7. In 1994, the American Academy of Orthopaedic Surgeons (AAOS) attempted to create an outcomes evaluation system. The Musculoskeletal Outcomes Data Evaluation and Management System did not come to fruition and was terminated in 2000. The attempt was made to collect information on patients undergoing total hip and knee arthroplasty or spine surgery. Difficulties were multifactorial, but were mainly due to inadequate data, record-keeping, or follow-up, which made cleaning the data to extract useful information impossible8. Although the United States lacks a national orthopaedic registry, several institutions have developed their own databases. For example, Mayo Clinic initiated a database in 1969 that included over 56,000 joint arthroplasties by 19979. The Anderson Orthopaedic Research Institute has over two decades' worth of hip and knee arthroplasty outcomes in its database10, while the Center for Hip and Knee Surgery in Indiana11, the Hospital for Special …

Surgical Resident Satisfaction with the Current Surgical Training Program in the Riyadh Area

Surgical Resident Satisfaction with the Current Surgical Training Program in the Riyadh Area