Surgery Research Articles

Does surgeon or hospital volume influence outcome in dedicated colorectal units?-AViennese perspective.

Aclear relationship between higher surgeon volume and improved outcomes has not been convincingly established in rectal cancer surgery. The aim of this study was to evaluate the impact of individual surgeon's caseload and hospital volume on perioperative outcome. We retrospectively analyzed 336 consecutive patients undergoing oncological resection for rectal cancer at two Viennese hospitals between 1 January 2015 and 31 December 2020. The effect of baseline characteristics as well as surgeons' caseloads (low volume: 0-5cases per year, high volume > 5cases per year) on postoperative complication rates (Clavien-Dindo Classification groups of < 3 and ≥ 3) were evaluated. No differences in baseline characteristics were found between centers in terms of sex, smoking status, or comorbidities of patients. Interestingly, only 14.7% of surgeons met the criteria to be classified as high-volume surgeons, while accounting for 66.3% of all operations. There was asignificant difference in outcomes depending on the treating center in univariate and multivariate binary logistic regression analysis (odds ratio (OR) = 2.403, p = 0.008). Open surgery was associated with lower complication rates than minimally invasive approaches in univariate analysis (OR = 0.417, p = 0.003, 95%CI = 0.232-0.739) but not multivariate analysis. This indicated that the center's policy rather than surgeon volume or mode of surgery impact on postoperative outcomes. Treating center standards impacted on outcome, while individual caseload of surgeons or mode of surgery did not independently affect complication rates in this analysis. The majority of rectal cancer resections are performed by asmall number of surgeons in Viennese hospitals.

A retrospective analysis of patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis, over a 10-year period

IntroductionLaryngotracheal stenosis encompasses a diverse range of diagnoses, encompassing complete or partial narrowing of various subgroups of the upper airways, including the laryngeal structures and trachea, due to pathological scar formation. This increasingly prevalent pathology is of significant importance due to its potential for life-threatening consequences. Among the defined treatment modalities, tracheal resection and end-to-side anastomosis remain a valuable therapeutic alternative in appropriate indications. ObjectiveThe objective of this study was to retrospectively evaluate the outcomes of patients who underwent tracheal resection and end-to-end anastomosis at our clinic over the past decade. Material & methodAll patients who underwent tracheal resection and end-to-end anastomosis surgery for benign tracheal stenosis at the Department of Otolaryngology, Mustafa Kemal University Hospital between 2013 and 2023 were included in the study. The diagnosis of tracheal stenosis was based on endoscopic examination and computed tomography results. Interventions without postoperative symptoms and without the need for additional surgical intervention were considered successful. The study was approved by Hatay Mustafa Kemal University Ethics Committee with decision number 2023/27. ResultsA total of 29 patients were included in the study. The mean age of the patients was 26.48 years. 3 patients (10.35 %) had a comorbidity. In all patients orotracheal intubation or intubation and tracheotomy was the aetiological cause. There were no intraoperative complications. In the postoperative period, wound infection was observed in 3 patients (10.35 %) and subcutaneous emphysema in 2 patients (6.9 %). In 1 patient (3.45 %) recurrent respiratory distress was observed, restenosis was considered and tracheotomy was performed. Our complication rate was 20.69 %. When all patients were evaluated at the end of the postoperative follow-up period, the surgical success rate was calculated to be 96.55 %. ConclusionWith a surgical success rate of 96.55 % and a low complication rate in our study, we believe, in parallel with previous studies, that open surgery is a reliable, physiologically appropriate and successful method among the current treatments for tracheal stenosis.

Spatial Proteomic Profiling of Colorectal Cancer Revealed Its Tumor Microenvironment Heterogeneity.

Colorectal cancer is a predominant malignancy with a second mortality worldwide. Despite its prevalence, therapeutic options remain constrained and surgical operation is still the most useful therapy. In this regard, a comprehensive spatially resolved quantitative proteome atlas was constructed to explore the functional proteomic landscape of colorectal cancer. This strategy integrates histopathological analysis, laser capture microdissection, and proteomics. Spatial proteome profiling of 200 tissue section samples facilitated by the fully integrated sample preparation technology SISPROT enabled the identification of more than 4000 proteins on the Orbitrap Exploris 240 from 2 mm2 × 10 μm tissue sections. Compared with normal adjacent tissues, we identified a spectrum of cancer-associated proteins and dysregulated pathways across various regions of colorectal cancer including ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Additionally, we conducted proteomic analysis on tumoral epithelial cells and paracancerous epithelium from early to advanced stages in hallmark rectum cancer and sigmoid colon cancer. Bioinformatics analysis revealed functional proteins and cell-type signatures associated with different regions of colorectal tumors, suggesting potential clinical implications. Overall, this study provides a comprehensive spatially resolved functional proteome landscape of colorectal cancer, serving as a valuable resource for exploring potential biomarkers and therapeutic targets.

Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model.

To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. A large tertiary referral academic cardiac surgery ICU. There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (P = .30). Overall, implementation of an NP/PA-led postcardiac surgical ICU team (rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.

Antibiotic-impregnated envelopes reduce the rate of surgical site infection in deep brain stimulation pulse generators: a comparative study.

Deep brain stimulation (DBS) is a surgical procedure that has been used to treat a variety of neurological disorders including Parkinson's disease, essential tremor, and dystonia. While DBS is generally considered safe and effective, surgical site infections (SSIs) are a potential complication that can lead to significant morbidity and mortality. Our objective was to investigate the use of antibiotic-impregnated envelopes (AIEs) encasing implantable pulse generators (IPGs) to reduce the rate of infection at IPG sites and the costs. We conducted a retrospective analysis at a single center encompassing all procedures involving the placement of Implantable Pulse Generators (IPG), including both initial insertions and replacement surgeries. The study period spanned from January 2017 to May 2024. Starting in 2020, the routine utilization of AIE became standard practice at our institute for both primary DBS implantation and IPG replacements. Surgical techniques remained consistent, pre- and post-operative antibiotic protocols were standardized throughout the study period and all cases were undertaken by a single surgeon. 178 patients were included and the overall incidence of IPG SSIs was found to be 1.7% (1 infection in 58 patients; 20 primary IPG/38 IPG replacements) among those who received an AIE compared to 5% (6 infections in 120 patients; 36 primary IPG/84 replacement IPG) in patients where no AIE was utilized. This resulted in an odds ratio for infection that was 2.9 times higher in the absence of AIE. The decrease in infection rates was observed in both primary and replacement IPG implants. Notably, over 80% of patients with IPG infection required surgical intervention. The use of AIE further resulted in significant cost savings. To our knowledge, this is the largest series reporting the efficacy of Antibiotic impregnated envelope (AIE) in modifying infection rates associated with both initial and replacement Deep Brain Stimulation (DBS) Implantable Pulse Generators (IPGs). The implementation of AIEs led to a decrease in the occurrence of IPG-related infections, observed across both primary implantations and replacement surgeries, with associated economic benefits.

Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery.

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his careerPurpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy.Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.

Management of acetabular bone defect in revision hip arthroplasty

The number of hip revision surgeries is expected to increase in recent years, and reconstruction of acetabular defects is a challenge for joint surgeons. The principle of reconstruction of acetabular defects is to achieve initial and long-term stability between the prosthesis and the host bone. With the development of surgical techniques, prosthetic materials, and revision concepts, there is an urgent need for new acetabular bone defect evaluation systems to meet clinical needs. The uncemented porous hemispherical cup has become the main prosthesis in clinical application, and metal augments are gradually replacing the structural allograft. Modular reconstruction combined cups and augments has shown favorable clinical results, which can be used for large acetabular defects with acetabular distraction technique, such as pelvic discontinuity. The advantages and disadvantages of impaction bone grafting, jumbo cups, metal augments, acetabular reinforcement rings, custom components (including custom triflanged acetabular components), and acetabular distraction technique still need to be observed in long-term follow-up.

Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis.

Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date. A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed. Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes. This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.

Oncological outcomes of partial thickness calvarial resection for locally advanced scalp malignancies

ObjectiveTraditionally, locally advanced scalp malignancies have been managed through composite, full-thickness calvarial resection. The aim of this study is to explore the oncologic outcomes of partial calvarial resection for locally invasive scalp malignancies without medullary space invasion, employing a burr-down approach. Study designRetrospective case series. SettingTertiary referral center. MethodsThis study analyzed records of 26 adult patients diagnosed with scalp cancer that spread to the calvarial region. Data collected included demographics, medical history, adjuvant therapy details, imaging, surgical outcomes, and postoperative oncological results. Results26 patients with cancerous scalp lesions necessitating calvarial resection for deep margin control were identified in 22 men and 4 women. Mean age at diagnosis was 72.7 years. The most common histopathological diagnosis was Squamous cell carcinoma (n = 16). Partial removal of the calvarial lesions was achieved in all patients without any intraoperative complications. Twelve patients received adjuvant therapy consisting of the following modalities: radiation (6), chemotherapy (1), immunotherapy (1), a combination of immunotherapy and radiation (2), and a combination of chemotherapy and radiotherapy (2). There was a total of 7 recurrences: local (n = 3,11.5 %), regional (n = 3,11.5 %), distal (n = 1,3.8 %). Long term local control was achieved in (n = 23,88.4 %) of patients. The mean time of follow-up was 19.1 months, and the mean time to recurrence was 15.1 months. ConclusionPartial calvarial resection represents a viable, safe, and effective surgical technique for cancerous tissue removal, reducing risks associated with full thickness calvarial resection, and enhancing soft tissue healing when compared to the established gold standard.

Clinical practice guideline for robotic surgical system-assisted thyroid and parathyroid surgery (2024 edition)

The use of robotic operating systems is an advancement of intelligent precision, minimally invasive surgery. It has been used in the field of thyroid surgery with satisfactory results. .Robotic surgery system assisted thyroid and parathyroid surgical expert consersus(2016) as played an important role in the standardization and clinical popularization of robotic surgical system-assisted thyroid and parathyroid surgery. With the deepening of clinical practice, updates in minimally invasive concept, the replacement of robotic platforms and the continuous improvement of technology, robotic thyroid and parathyroid surgery has been further developed. Notably, it has made substantial progress in expanding indications and the training of robotic surgeons and teams. Based on the 2016 Chinese expert consensus, combined with recent related articles and clinical studies, the Clinical Practice Guideline for Robotic Surgical System-Assisted Thyroid and Parathyroid Surgery (2024 edition) was formed. The surgical team training, indications, preoperative evaluation, patient position and space establishment, thyroidectomy procedures, neck lymph node dissection skills were summarized and recommended. Furthermore, reasonable suggestions on reoperation, parathyroid surgery and management of postoperative complications were also put forward, aiming to better guide clinical practice.

Bibliometric Patent Review of Minimally Invasive Spine Surgery.

This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform. The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents. MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited. To conduct this study, we used the Lens platform to search for patents that included the terms "minimally invasive" and "spine" in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation. Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year. Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.

Opioid prescription following radical orchiectomy associated with new persistent opioid use

IntroductionOpioid dependence represents a public health crisis and can be observed after outpatient urologic procedures. The purpose of this study was to evaluate the risk of persistent opioid usage after radical orchiectomy for testicular cancer. Materials and methodsThe TriNetX Research network database was queried for men between 15 and 45 years undergoing radical orchiectomy for a diagnosis of testicular cancer. All patients with N+ or M+ disease, prior opioid use, and patients who underwent chemotherapy, radiotherapy, or retroperitoneal lymph node dissection were excluded. Patients were stratified whether they were prescribed opioids or not at time of orchiectomy. The incidence of new, persistent opioid use, defined as a prescription for opioids between 3 and 15 months after orchiectomy, was evaluated. ResultsA total of 2,911 men underwent radical orchiectomy for testicular cancer, of which 89.8% were prescribed opioids at time of orchiectomy. After propensity score matching for age, race, and history of psychiatric diagnosis, 592 patients were included (296 received opioids, 296 did not). Overall, 0% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 10.5% of patients who received postoperative opioids developed new persistent opioid use. Patients prescribed postoperative opioids for orchiectomy had statistically higher risk difference of developing new persistent opioid use (Risk Difference: 10.5%; 95% CI: 7.0-14.0; Z: 5.7; P < 0.01). ConclusionsPostoperative opioid prescription following radical orchiectomy is significantly associated with developing new persistent opioid use, with 1 in 10 young men who received postoperative opioids obtaining a new prescription for opioids well beyond the postoperative period. Future efforts should emphasize nonopioid pathways for pain control following this generally minor procedure.

Clinical Outcomes and Treatment Strategy of Mirizzi's Syndrome Treated With Surgery.

There is currently no standardized treatment for Mirizzi's syndrome (MS). We aim to explore the surgical treatment strategy for MS by analyzing its clinical characteristics and treatment outcomes. This retrospective study analyzed the clinical data of 130 patients with MS who underwent surgery at our hospital from April 2013 to April 2020. The study population comprised 130 patients with MS, with an approximately balanced sex ratio and a median age of 58.5 years. The preoperative diagnostic rate was 82.3%. The diagnostic accuracy of ERCP was 92.5%, higher than that of MRCP and ultrasound. All patients underwent surgical treatment, with 74 cases of laparoscopic surgery, 43 cases of laparotomy, and 13 cases of laparoscopic surgery converted to laparotomy. A total of 23 patients experienced short-term and long-term complications after surgery, with a complication rate of 17.7%. There was no statistical difference between laparoscopic surgery and open surgery in terms of intraoperative hemorrhage, operative time, and postoperative complication rate. However, the length of hospital stay was shorter in the laparoscopic surgery compared to the open surgery, which was statistically different from each other. ERCP is the gold standard for the diagnosis of MS, especially for identifying the type of MS. ERCP plays an important role in both the preoperative and postoperative phases of MS. Our study demonstrated that laparoscopic surgery was a safe and feasible option for MS treatment, even requires less hospitalization than open surgery.

The Effectiveness of Virtual and Augmented Reality in Surgical Pain Management: A Systematic Review of Randomized Controlled Trials.

Satisfactory management of postoperative pain remains challenging. Nonpharmacological modalities such as virtual and augmented reality (VR/AR) offer potential benefits and are becoming increasingly popular. This systematic review evaluates the effectiveness and safety of VR/AR interventions on postoperative pain and recovery. MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL databases were searched from inception to July 27, 2023, for randomized controlled trials (RCTs), published in English, evaluating the use of VR/AR interventions for surgical pain relief. Study selection and data extraction were performed by pairs of reviewers independently and in duplicate, and potential risk of bias was determined using the Risk of Bias-version 2 (RoB 2) tool. Our outcomes included pain relief, reduction of anxiety, satisfaction, and adverse effects. Due to substantial heterogeneity, a narrative synthesis without meta-analysis was performed. We included 35 trials among 2257 citations, categorized as surgery (n = 12), minor procedures (n = 15), and postoperative physiotherapy (n = 8). Surgical group included various surgeries, with 11 using immersive VR predominantly in the postoperative period, and most reporting no differences in pain, but potential for reduced anxiety and sedation requirements. In the minor procedures group, most studies reported decreased pain and anxiety during the procedural performance. Two studies reported increased heart rate, while 2 others reported better hemodynamic stability. Home-based AR physiotherapy achieved (n = 6) similar pain and functional outcomes after knee replacement, with 1 large study (n = 306) reporting reduction of mean costs by $2745 for provision of 12 weeks physiotherapy. There were some concerns around potential bias for most studies, as the nature of interventions make it challenging to blind assessors and participants. No important adverse effects were noted using VR/AR technology. Evidence from RCTs indicates that the use of immersive VR during minor procedures may reduce procedural pain, decrease anxiety, and improve satisfaction. However, small studies, inconsistent effect, and variation in the application of interventions are important limitations. Evidence to support the application of AR/VR for major surgeries is limited and needs to be further investigated. Use of home-based physiotherapy with AR likely has economic advantages, and facilitates virtual care for appropriate patients who can access and use the technology safely.

Identifying risk factors for postoperative ileus following open abdominal aortic aneurysm repair

Postoperative ileus (POI) is a common complication following major abdominal surgery. The majority of the data available regarding POI following abdominal surgery is from the gastrointestinal and urologic literature. These data have been extrapolated to vascular surgery, especially with regards to enhanced recovery programs for open abdominal aortic aneurysm (AAA) surgery. However, vascular patients are a unique patient population and extrapolation of gastrointestinal and urological data may not necessarily be appropriate. Therefore, the purpose of this study was to delineate the prevalence and risk factors of POI in patients undergoing open AAA surgery. This was a retrospective, single-institution study of patients who underwent open AAA surgery from January 2016 to July 2023. Patients were excluded if they had undergone non-elective repairs or had expired within 72 hours of their index operation. The primary outcome was rates of POI, which was defined as the presence of two or more of the following after the third postoperative day: nausea and/or vomiting, inability to tolerate oral food intake, absence of flatus, abdominal distension, or radiological evidence of ileus. A total of 123 patients met study criteria with an overall POI rate of 8.9% (n=11). Patients who developed a POI had significantly lower BMIs (24.3 kg/m2 versus 27.1 kg/m2, P=.003), were more likely to undergo a transperitoneal approach (81.8% versus 42.0%, P=.022), midline laparotomy (81.8% versus 37.5%, P=.008), longer total clamp times (151.6 minutes versus 97.7 minutes, P=.018), larger amounts of intraoperative crystalloid infusion (3495 mL versus 2628 mL, P=.029), and were more likely to return to the operating room (27.3% versus 3.6%, P=.016). Proximal clamp site was not associated with POI (P=.463). POI patients also had higher rates of post-operative vasopressor use (100% versus 61.1%, P=.014) and larger amounts of oral morphine equivalents in the first 3 post-operative days (488.0 mg + 216.0 versus 203.8 mg + 29.6 P=.016). Patients who developed POI had longer lengths of stay (12.5 days versus 7.6 days, P<.001), longer duration of NGT decompression (5.9 days versus 2.2 days, P<.001), and a longer period of time before diet tolerance (9.1 days versus 3.7 days, P<.001). Of those that developed a POI (n=11), 4 (36.4%) required total parental nutrition during the admission. POI is a morbid complication amongst patients undergoing elective open AAA surgery that significantly prolongs hospital stay. Patients at risk for developing a POI are those with lower BMIs, had an operative repair via a transperitoneal approach, midline laparotomy, longer clamp times, larger amounts of intraoperative crystalloid infusion, a return to the operating room, post-operative vasopressor use, and higher amounts of oral morphine equivalents. These data highlight important peri-operative opportunities to reduce the prevalence of POI.

Eagle’s syndrome: Modern systematic review and presentation of radiographic cases

Introduction: The styloid process is a bony structure of the base of the skull, which can undergo pathological structural changes. So, its elongation may possibly provoke Eagle’s syndrome, also known as stylohyoid syndrome, which is a head and neck pathological condition that rarely manifests with severely painful symptomatology. Objective: The present literature review aims to deal with the understanding of the pathophysiology, as well as the investigation of the diagnostic and therapeutic facts regarding Eagle’s syndrome. Materials – Methods: An extended research of modern literature through papers published in scientific journals has been conducted, deploying the databases PubMed and Google Scholar. Results: Eagle’s syndrome is a rare pathological condition, whose prevalence is approximately 4% of general population. In the literature, several pathogenetic patterns have been reported and they are divided into acquired and idiopathic biochemical mechanisms. In order to diagnose the disease, one should take the painful symptoms referred by the patient into consideration, in conjunction with specific clinical tests. However, the final diagnosis is set after the radiological evaluation. Eagle’s syndrome manifests with non-specific symptomatology, thus it should be differentiated from other diseases and conditions of the head and neck anatomical area. Regarding the therapy of the syndrome, a vast range of conservative choices is available nowadays, mainly basedon drugs, while at the same time there are surgical techniques with comparatively better long-term outcome. Conclusions: There is an expressively increased interest, regarding the diagnosis and the therapeutics of Eagle’s syndrome. Modern medical sciences attempt to gradually advance the diagnostic methodology and constantly improve the therapeutic choices of this disease. The ultimate purpose is the more effective management of the patients and the enhancement of their life quality.

Augmentation of Autologous Platelet-Rich Plasma in Hip Salvage in Stages I and II of Avascular Necrosis: Randomized Blinded Trial Comparing 3 Surgical Techniques in 82 Patients.

Avascular necrosis of the femoral head is common in routine orthopedic clinics. The challenge arises in managing early stages (I and II) without obvious radiological evidence. Authors explore this naïve research area by comparing surgical procedures in early AVN patients. A prospective multicentric study was performed from November 2020 to February 2023 on 82 patients treated with surgical decompression and adjuvants, concerning the defined inclusion and exclusion criteria. Radiopacity and intraosseous edema resolution and THA conversion rates were assessed. Hip pain VAS, groin/thigh pain, difficulty in sitting cross-legged incidence, pain-free walking distance, Harris hip scores, 30-s chair test, and complications were noted. Among 82 patients, the mean age was 28.46years. Male:female ratio of 3.9:1. 8.5% had bilateral affection and 48.78% had a positive family history. 93.90% presented with groin pain and difficulty in sitting cross-legged, restricted hip movements in 85.3%, and thigh pain in 54.87%. Harris hip scored worst in Group 3 followed by Group 2 and Group 1. 63.41% and 36.58% of patients had Grades 1 and 2 AVN, respectively. At 1week post-operatively, 96.3% and 93.9% of patients were relieved from groin and thigh pain, respectively (p < 0.001); the trend being Group 3 > Group 2 > Group 1. Hip pain VAS followed a similar trend. At 4weeks, Harris hip scores improved in Group 3 > Group 2 > Group 1. At 6months, the trend was Group 2 > Group 3 > Group 1. Group 3 had better 30-s chair test results, pain-free walking distance, and longer cross-legged sitting time. Complication rate of 3.6%. 6.09% of patients underwent THA later. Sclerotic patch and marrow edema resolution early in Group 3, i.e., 46 and 31days respectively, followed by Group 2 and Group 1. In Stages I and II AVN, biplanar core decompression (double) and intraosseous PRP injection is a promising salvage option; patients have better early hip scores (4weeks), and early groin and thigh pain recovery. Patients treated early have better clinical and radiological recovery.

American Rhinologic Society Expert Practice Statement: Indications and Recommendations for Septoplasty in Children.

The goal of this American Rhinologic Society Expert Practice Statement (EPS) is to provide recommendations and guidance through evidence-based consensus statements regarding pediatric septoplasty. This EPS was developed following the previously published methodology and approval process. The topics of interest included appropriate indications, safety and efficacy, timing, relevant quality of life instruments, and surgical techniques. Following a modified Delphi approach, six statements were developed, five of which reached consensus and one that did not. These statements and accompanying evidence are summarized along with an assessment of future needs.

Surgical treatment of colorectal endometriosis: an updated review.

This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis. The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design. The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.

Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections.

After caesarean section a uterine niche can be detected in 42-84% of all women and in 11-45% large defects with a residual myometrium <2.2mm occur. If the niche compromises >50% of myometrial thickness, risk of uterine rupture during birth increases. The suturing technique might contribute substantially on pathogenesis of niches. The objective of this study is to investigate the effect of the suturing technique on niche prevalence by using a standardized two-layer surgical technique. Women with one previous caesarean section were examined within 6-23 months after caesarean section using contrast medium-supported transvaginal sonography regarding the prevalence, sonomorphological aspect and clinical symptoms of a uterine niche. The surgical technique used was: dilatation of the cervix, interrupted suture of the first layer (excluding the endometrium), continuous closure of the visceral and parietal peritoneum. Using native vaginal sonography, no niches were visible in the whole cohort. In three cases, there was a small niche detectable with a depth between 2.3 and 3.9mm by contrast hysterosonography. Regarding the total myometrial thickness, the niche depth compromised less than 50%. All patients were symptom-free. In our study population, there were only three cases (9.1%) with a small uterine niche. Residual myometrium and niche percentage on myometrial thickness were excellent in all three cases. Thus, our results show that the uterotomy closure technique used in the study cohort might be superior with respect to the development of uterine niches compared with the expected prevalence.