Surgery Research Articles

Single-port laparoscopic surgery for cecum cancer with intussusception: a case report

BackgroundMost adult cases of intussusception are caused by colorectal cancer, and emergency surgery is performed when symptoms such as abdominal pain and vomiting are present. The patient must customarily undergo both bowel decompression and radical surgery for colorectal cancer at the same time, and laparotomy is generally the procedure of choice.Case presentationAn 86-year-old woman presented to our hospital with diarrhea and bloody stools. Preoperative examination revealed the presence of a cancerous tumor in the advanced part of the transverse colon and bowel intussusception. Radical surgery was successfully performed using the laparoscopic single-port technique through a small incision at the umbilical site to treat intussusception caused by cecum cancer.ConclusionsWith only one wound site at the umbilicus, this single-port laparoscopic approach is much less invasive than endoscopic surgery that requires four to five incision wounds to perform the procedure. Furthermore, the patient was discharged without major complications and this surgical technique could be of great benefit if established as a standard procedure in the future.

"What really matters to the patients?": assessing the impact of wound healing on the quality of life in patients undergoing incisional hernia repair.

We aim to evaluate the impact of surgical wound complications in the first 30 postoperative days after incisional hernia repair on the long-term quality of life of patients. In addition, the impact of the surgical technique and preoperative comorbidities on the quality of life of patients will also be evaluated. Prospective cohort study, which evaluates 115 patients who underwent incisional hernioplasty between 2019 and 2020, using the onlay and retromuscular techniques. These patients were initially assessed with regard to surgical wound outcomes in the first 30 postoperative days (surgical site infection (SSI) or surgical site occurrence (SSO)), and then, assessed after three years, through a specific quality of life questionnaire, the Hernia Related Quality of Life Survey (HerQLes). After some patients were lost to follow-up during the study period, due to death, difficulty in contact, refusal to respond to the questionnaire, eighty patients were evaluated. Of these, 11 patients (13.8%) had SSI in the first 30 postoperative days and 37 (46.3%) had some type of SSO. The impact of both SSI and SSO on quality of life indices was not identified. When analyzing others variables, we observed that the Body Mass Index (BMI) had a significant impact on the patients' quality of life. Likewise, hernia size and mesh size were identified as variables related to a worse quality of life outcome. No difference was observed regarding the surgical techniques used. In the present study, no relationship was identified between surgical wound outcomes (SSO and SSI) and worse quality of life results using the HerQLes score. We observed that both BMI and the size of meshes and hernias showed an inversely proportional relationship with quality of life indices. However, more studies evaluating preoperative quality of life indices and comparing them with postoperative indices should be carried out to evaluate these correlations.

P-582 Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study

Abstract Study question Do women diagnosed with gynecologic cancer have worse pregnancy and neonatal outcomes of assisted reproductive technology (ART) ? Summary answer Decreased live birth rate was observed in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers. What is known already Gynecologic malignancies comprise approximately 13% of female cancer diagnoses, and oncological treatments such as surgery, chemotherapy, abdominal or pelvic radiotherapy, and hormonotherapy may induce infertility, premature ovarian failure, or early menopause, resulting in a loss of reproductive potential. ART has emerged as an important option for cancer patients undergoing treatment, but the reproductive outcomes of ART among cancer survivors remain poorly understood. Limited research exists regarding the impact of a history of gynecologic cancer on reproductive outcomes of ART. Study design, size, duration 136 women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were retrospectively enrolled in this study. 241 infertile women without any history of cancer were matched to the cancer group. Participants/materials, setting, methods Women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were included. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type. Main results and the role of chance A total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significant shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P < 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P < 0.001). Maternal and neonatal complications did not significantly differ between the groups (P > 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P < 0.001, respectively). Limitations, reasons for caution Our study was limited by the retrospective design in nature and small sample size of its patient cohort. In addition, the effect of cancer treatments was not evaluated specifically in the current study due to the limited number of patients and possible inconsistency in surgical operations. Wider implications of the findings Our study provides data support for further exploration of the effects of endometrial cancer, cervical cancer, and other gynecologic cancers on fertility. Comprehensive ovarian function assessment, detailed counseling, individualized fertility guidance, and close follow-up after ART therapy are recommended for patients with gynecologic malignancy history. Trial registration number Not applicable

A national survey on the impact of the coronavirus pandemic on gynecologic surgical training.

The objective of this study was to assess the impact of the coronavirus pandemic on gynecology surgical training. A national cross-sectional online survey was distributed to all trainees and trainers in the higher specialist training program for obstetrics and gynecology in Ireland. The survey consisted of questions on topics which included: the volume of surgical procedures performed before and since the pandemic, confidence in performing various gynecologic procedures before and since the pandemic and questions regarding the impact of the pandemic on wellbeing and work practices. Trainers and trainees experienced a significant reduction in operative volumes for most procedure types. Analysis showed a significant reduction in the number of minor procedures performed by trainees (z = -2.7, P = 0.007) and a significant reduction in the number of all procedure types performed by trainers (minor procedures z = -3.78, P = <0.001; intermediate procedures z = -4.48, P = < 0.001; major procedures z = -3.69, P = < 0.001). Respondents reported they had less time for research and audit, were less able to attend courses or conferences and worried about the impact of their work on their families. In conclusion, this study has highlighted the current difficulties facing surgical trainees in gynecology because of the COVID-19 pandemic. These challenges have compounded an already challenging training environment for gynecology trainees. Efforts must be made to continue to provide high-quality tailored training to ensure the development of the next generation of gynecologic surgeons.

Percutaneous Pharmacological Thrombolysis as an Effective Primary Mode of Management of Thrombosed Prosthetic Arterio-Venous Grafts

Abstract Background Thrombosis of prosthetic arterio-venous graft (PAVG) is the most common cause of failure of using this access for haemodialysis (HD) in end stage kidney disease (ESKD) patients. Many different open surgical and vascular techniques were described to restore the function of thrombosed PAVG. Objectives We wanted to assess the feasibility and patency rates following the continuous thrombolysis infusion using tissue Plasminogen Activator (tPA) followed by angiogram and angioplasty of stenotic segment(s) in thrombosed PAVG. Methods We performed retrospective analysis of prospectively collected data from patients who had a thrombosed AVG from January 2020 to January 2022. Thrombolysis took place maximum 7 days after thrombosis was diagnosed. We have excluded patients who were referred to us more than a week after thrombosis occurred and patients with relative or absolute contraindication for thrombolysis and/or anticoagulation. Results During the two years of the study, there were 58 patients referred to our centre with thrombosed PAVG. We have excluded 28 patients who didn’t fulfill inclusion criteria. We have performed PAVG continuous thrombolysis infusion using tPA till we have achieved reopening of the thrombosed PAVG followed by angiography and angioplasty. All patients had venous anastomosis stenosis while 17 patients had stenosis in the graft and only 5 had a stenosis at the arterial anastomosis. During the period of follow up primary patency was achieved in 80% of our patients while our primary assisted patency was 86.67% Conclusions Endovascular tPA thrombolysis for early thrombosis of prosthetic AVAs is feasible, safe, and is associated with an excellent technical success and very good 12 months patency rate.

1087 Factors That Impact Cold Ischaemia Time for Deceased Donor Kidney Transplants: Results of a National Transplant Access to Theatre Audit (NTACT)

Abstract Aim Deceased donor kidney utilisation confronts challenges leading to prolonged cold ischemia time (CIT), affecting graft survival. Despite these challenges, an understanding of the obstacles remains unclear. This audit aims to identify the factors that prolong CIT. Method A multicentre, prospective audit of adult deceased donor kidney-only transplants spanned 14 UK transplant centres from February to September 2022. Data, encompassing time intervals between important checkpoints pre-transplantation and perceived reasons for delays, were collected through RedCap. Descriptive statistics was used for analysis. Results Data from 476 kidney-only transplants were gathered (29 excluded for incomplete/incorrect data). Of these, 230 were donations after brainstem death (DBD) organs, and 202 were donations after circulatory death (DCD) organs. Median CIT was 10:55 (IQR:08:11-15:13) for DBD organs and 11:19 (IQR:08:31-15:10) for DCD organs, with 42% of DCD and 15% of DBD organs surpassing national CIT recommendations. Median time from organ arrival to knife to skin was 04:02 (IQR:02:35-07:35). Full and virtual crossmatches constituted 35% and 65%, respectively, with 16% of results arriving after the organ arrives at centre. Anaesthetic time had a median duration of 00:55 (IQR:00:39-01:10) and Knife to skin to organ perfusion was 01:25 (01:10-01:51). Delays reported in 34% of transplant cases, most common causes were the availability of surgical and anaesthetic teams, porters, and the operating theatre. Conclusions This audit allowed us to uncover the factors that prolong CIT at each stage of the transplantation post-arrival. These findings will guide the establishment of realistic targets for optimizing processes in the future.

Laparoscopic vs Open Orchiopexy for Palpable Undescended Testis in Children

Abstract Background Cryptorchidism is the absence of one or both testes in the scrotum and is generally synonymous with undescended testis. Undescended testis is the most common genital disorder identified at birth. Undescended testes occur in 1–3% of full-term and up to 45% of preterm male neonates. Approximately 80% of undescended testes are clinically palpable and 20% are non-palpable. Aim of the Work To compare between laparoscopic and open orchiopexy evaluating final testicular position, success rate, and complications. Patients and Methods A prospective comparative study was made in Urology department, Ain Shams University Hospital for Twelve months starting from 1st of June 2021 to 1st of May 2022 on 50 children (aged from 1-18 years) with UDT and were included in the study and divided in to 2 groups 25 for each study group. Results In the present study the mean age in group I was 8.1± 0.99 y and in group II was 9.28± 0.91 y with no significant difference. The mean operative time in group I was 63.6 ± 5.56 min, and in group II was 58.44. ± 5.28 min with no statistically significant difference. There was in group I all the studied cases had no testicular atrophy, no testicular ascent, no need for redo-orchiopexy and a hernial sac was detected in all cases. In group II all the studied cases had no testicular atrophy, 92% had negative testicular ascent and 96% had a hernial sac. As regard to complications, only 2 patients presented with wound infection in group I and in group II there were a case with wound infection, a case with hydrocele and 2 cases with scrotal haematoma with no significant difference. Conclusion For the treatment of inguinal cryptorchidism, laparoscopic orchiopexy is a safer and less invasive option than open groin surgery. In children with palpable undescended testis, laparoscopic orchiopexy is linked with improved testicular position and a better success rate as open orchiopexy.

Cardiac Magnetic Resonance Feature Tracking Analysis for Change in Right Ventricular Function After Cardioplegic Arrest

Using echocardiography to assess right ventricular (RV) function after cardioplegic arrest is challenging. Cardiac magnetic resonance (CMR) imaging is a superior alternative, with the feature tracking technique enabling quantitative assessment of myocardial deformation. This single-center, prospective study from 2020 to 2022 assessed RV function in 42 patients who underwent open heart surgery with cardioplegic arrest. CMR data were collected preoperatively, one week postoperatively, and at follow-up (6-12 months after surgery), and assessed using the CMR feature tracking technique. Postoperatively, there was no significant change in RV end-diastolic volume, but RV end-systolic volume significantly decreased, leading to a notable increase in RV ejection fraction. By follow-up, both RV end-diastolic and end-systolic volumes had significantly reduced compared with the preoperative values. Right ventricular longitudinal contractility decreased after surgery but recovered to the preoperative values by follow-up, while RV circumferential contractility improved postoperatively and remained superior to the preoperative levels at follow-up. On CMR imaging, significant changes in RV systolic motion were observed after cardioplegic arrest, with decreased longitudinal but increased circumferential contractility. At follow up, these changes had reverted to the preoperative patterns by the mid-term (6-12 months).

Carbohydrate antigen 125 on epicardial fat and its association with local inflammation and fibrosis-related markers

BackgroundCarbohydrate antigen 125 (CA125) is a proteolytic fragment of MUC-16 that is increased in heart failure (HF) and associated with inflammation, fluid overload, and worse adverse events. Our main objective was to study the expression of CA125 on epicardium and its association with inflammation, adipogenesis, and fibrosis.MethodsEpicardial fat biopsies and blood were obtained from 151 non-selected patients undergoing open heart surgery. Immunohistochemistry, ELISA, or real-time PCR were used for analyzing protein or mRNA expression levels of CA125 and markers of inflammatory cells, fibroblasts, and adipocytes. Epithelial or stromal cells from epicardium were isolated and cultured to identify CA125 and its association with the adipogenesis and fibrosis pathways, respectively.ResultsThe median age was 71 (63–74) years, 106 patients (70%) were male, and 62 (41%) had an established diagnosis of HF before surgery. The slice of epicardial fat biopsy determined a positive and colorimetric staining on the epithelial layer after incubating with the CA125 M11 antibody, providing the first description of CA125 expression in the human epicardium. Epicardial CA125 showed a strong and positive correlation with markers of inflammation and fibrosis in the epicardial fat tissue while exhibiting a negative correlation with markers of the adipogenesis pathway. This relationship remained significant after adjusting for potential confounders such as a prior HF diagnosis and plasma CA125 levels.ConclusionEpicardial cells express CA125, which is positively associated with inflammatory and fibroblast markers in epicardial adipose tissue. These results suggest that CA125 may be biologically involved in HF progression (transition from adipogenesis to fibrosis).Graphical

Biomarker-guided detection of acute kidney injury in abdominal aortic surgery: the new and the old.

Acute kidney injury (AKI) is a common complication in patients undergoing major vascular surgery. Despite significant research efforts in this area, the incidence of AKI remains high, posing a significant challenge to healthcare systems, especially in situations where resources are limited. Early prediction of AKI severity and individualized postoperative care is therefore essential. The primary objective of this exploratory study was to assess the diagnostic value of urine cell-cycle arrest biomarkers [(TIMP-2) × (IGFBP7)] and soluble urokinase plasminogen activator receptor (suPAR) for predicting moderate or severe AKI within 24 h after open aortic surgery, and compared to routine kidney biomarkers. Seventy-five patients undergoing elective aortic surgery were included. Clinical parameters, urine and blood samples were collected preoperatively, immediately postoperatively, and 24 h later. AKI was defined using KDIGO criteria. Individual and combined diagnostic performance of biomarkers were evaluated. Of the 75 patients, 61% developed AKI, of which 28% developed moderate or severe AKI within 24 h of surgery. Baseline demographics, comorbidities and kidney parameters did not differ between patients with moderate or severe AKI (AKI II/III) and none or mild AKI (AKI 0/I), except for higher preoperative suPAR levels in later AKI II/III patients. Urine osmolality, Cystatin C and serum creatinine had the highest predictive power for AKI II/III with AUCs of 0.75-0.72. (TIMP-2) × (IGFBP7), and neither (TIMP-2) × (IGFBP7) nor suPAR individually showed superior diagnostic value. Combining CysC or SCr with urine osmolality and 6 h urine output gave the best performance with AUCs of 0.86 (95% CI, 0.74-0.96) and 0.85 (95% CI, 0.75-0.95) respectively. Our study suggests that routine parameters like urine osmolality, CysC, SCr and 6 h urine output perform best in predicting postoperative AKI after aortic surgery compared to the new biomarkers (TIMP-2) × (IGFBP7) and suPAR. Combining biomarkers, particularly CysC or SCr with urine output, urine osmolality, may enhance diagnostic accuracy. Further validation in larger cohorts and clinical settings is warranted to establish their clinical utility.

Liver Clot: The Rare Post-Extraction Complication Striking within 72 Hours

Oral and Maxillofacial Surgeons may encounter complications while performing major as well as minor surgical procedures, either intraoperatively or postoperatively. Bleeding after a dental extraction is a frequent complication following surgery. This article discusses an uncommon postoperative complication characterized by prolonged bleeding and the formation of a "liver clot" coagulum, observed 72 hours following the extraction of root stump in an elderly female during a follow-up visit.

The Identification and Preservation of Parathyroid Gland during Thyroidectomy Using Carbon Nanoparticles

Abstract Background During thyroidectomy, the parathyroid gland as well as the recurrent laryngeal nerve iatrogenic injuries are the most serious complications in goiter surgery. However, recurrent laryngeal nerve injury has been reduced to minimum as a result of meticulous surgical techniques and intraoperative nerve monitoring. Objective To determine the potential role of intraoperative CN injections for identification and preservation of parathyroid glands, thereby reducing the postoperative hypocalcaemia and whether CNs can really improve the extent of thyroidectomy and neck dissection and help identify metastatic lymph nodes. Patients and Methods We did a prospective cohort study with comparative between two groups of patients, one group established with the conventional technique of thyroidectomy while the other group established using CN injection to see which group with less post-operative hypocalcemia. A hundred patients with benign and malignant goiter disorders underwent thyroidectomy assigned into two groups: group 1 (control group) included 50 cases established with the conventional technique and group 2 (interventional group) included 50 cases operated upon with CN injection technique. Results The results showed that in group 2; 47 patients had normal Ca ++ level (94%) while 3 cases had low Ca ++ level (hypocalcemia) (6%). But in group 1; 37 patients had normal Ca ++ level (74%) while 13 cases had low Ca ++ level (hypocalcemia) (26%). The three patients in group 2 and the 13 patients in group 1 who developed hypocalcemia were managed with IV and oral supplementation of calcium and vitamin D and recovery occurred within a period of 1 week to 1 month. Conclusion CN injection technique is safe, effective, and technically feasible which helped us to keep parathyroid gland during thyroidectomy and that led us to reduce the percentage of incidence post- operative complications. Also, it helped us to identify the parathyroid gland during the surgery, the safety for thyroid surgery is based on the protection and visualization of the normal anatomy of parathyroid glands and their blood supplies according to the CNs injection technique, as verified in our research. Others see that the sooner the parathyroid glands are identified, the lower the surgeon’s level of stress. New studies with larger numbers of cases and also application of the technique by different surgeons are important to confirm the reliability and effectiveness of this technique.

Locoregional Therapy for Early and Locally Advanced Breast Cancer

Objective: The objective of this article is to conduct a comprehensive review of recent advances in locoregional therapies for early and locally advanced breast cancer, emphasizing the integration of these approaches into comprehensive treatment plans. Initially, this study explores contemporary findings related to surgical techniques, radiation therapy, and the integration of systemic treatments, such as targeted therapies and chemotherapy, as part of a cohesive treatment strategy. Theoretical Framework: Breast cancer remains a significant public health issue, with locoregional therapy playing a critical role in the management of early and locally advanced stages of the disease. The evolution of treatment strategies reflects a deepening understanding of the disease's biological behavior and the necessity for tailored therapeutic approaches. Method: A systematic review was conducted using major scientific databases to collect relevant articles on recent advances in locoregional therapy for breast cancer, from surgical innovations to advanced radiation techniques. Specific keywords were used to identify studies that address new findings and interdisciplinary approaches, facilitating the synthesis of effective strategies and the identification of gaps in current research. Results and Discussion: Recent research has improved surgical precision and radiation delivery techniques, reducing side effects and enhancing treatment efficacy. Innovations in intraoperative radiation and the growing use of neoadjuvant therapies offer promising results, optimizing tumor control and preserving patient quality of life. However, challenges remain in achieving consistent results across different patient populations, underscoring the need for personalized treatment plans tailored to individual patient characteristics and tumor biology.

Transoral snare removal of subepiglottic cysts.

The objective of this demonstration was to describe and simulate a surgical technique for removing subepiglottic cysts in horses via an oral approach under endoscopic guidance using a cadaver model for simulation and clinical data. The technique aims to provide a minimally invasive method for the removal of these cysts. 2 clinical case images from the Washington State University Teaching Hospital were used in the video. In a third horse euthanized for reasons unrelated to the study, the procedure was simulated after the head was frozen and transected transversally. Files from 2 horses were reviewed, and the relevant parts were selected. The horse head was set on a stand, and a simulated cyst was implanted under the mucosa, made of the fingertip from a glove filled with carboxymethyl cellulose gel, and sutured. The procedure was performed by one of the authors (CAR) and recorded. A bronchoesophageal grasping forceps and cautery snare were used to simulate a clinical situation in dorsal recumbency. The cyst was successfully removed as in the real procedure, and the demonstration was recorded for educational use. The review of the videos shows that the simulated procedure is also achievable in a real clinical environment. This technique provides a minimally invasive method for the removal of subepiglottic cysts in horses. The demonstration of this procedure is crucial for the training of surgeons, as it allows the visualization of the procedure in a controlled setting, free from the complications of real clinical situations.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Regional Anesthesia with Tourniquet for Hand Flexor Tendon Repair Surgeries in Adults

Abstract Background Flexor tendon injuries represent a significant percentage of admissions in emergency departments in Egypt. A bloodless surgical field is important to perform a hand surgery. Traditionally, a tourniquet is used for hemostasis, and the standered anesthetic techniques utilized in hand surgery were general anesthesia, intravenous regional anesthesia, or brachial plexus block. Recently the evolving Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique where patient is operated on under local anesthesia and hemostasis is achieved via adrenaline could be a better choice. Aim of this work is to compare the intraoperative pain scores, induction time, operating time, blood loss, postoperative pain scores, and patient satisfaction with WALANT versus supraclavicular brachial plexus block (SC-BPB ) with tourniquet, in patients undergoing flexor tendon repair. Patients and Methods In the current study 52 patients who underwent flexor tendon intervention were divided randomly into two groups, each group consisting of 26 patients. Group A: Patients in this group received WALANT. Group B: Patients in this group received SC-BPB with a tourniquet applied to the arm. Results Intraoperative Wong-Baker Faces scale revealed no statistically significant difference in intraoperative pain scores in both groups, except during injection (p = 0.04). Tourniquet-related pain was reported in 23% of patients of SC-BPB group (p = 0.001). Induction time was significantly shorter in WALANT (p &amp;lt; 0.01) but time needed to obtain sufficient hemostasis is significantly more in WALANT than SC-BPB (p &amp;lt; 0.01) while surgical time was similar in both groups (p = 0.538). Blood loss in spite of being minimal it was statistically significant higher in WALANT (p &amp;lt; 0.01). Conclusion WALANT anesthesia was found to be better alternative to SC-BPB in flexor tendon repair surgeries in adults being more simple technique and no need for special skills or ultrasound device, less time consumed in induction and less injection pain also no tourniquet-related pain, intraoperative active motion of the hand is preserved facilitating surgical technique, better effect on postoperative analgesia and more patient and surgeon satisfaction.

Endoscopic Transforaminal versus Interlaminar Discectomy in Management of Lumbar Disc Herniation: A Systematic Review of Outcomes and Complications

Abstract Background Lumbar herniated discs are common manifestations of degenerative spine diseases, being the main cause of radiated lower back pain. Aim of the Work The aim of this study is to compare between the transforaminal approach and the interlaminar approach in the incidence of complications and clinical prognosis scores in patients with lumbar disc herniation. Patients and Methods Literature searches was conducted using the following databases:” PubMed, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following key words: “percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, operative complications, minimally invasive, discectomy, endoscopic” from studies published after 2010. Results Although there is no significant difference between the two groups of comparison regarding percentage of postoperative complications, VAS scores, or ODI scores, However, PEID was superior to PETD regarding fluoroscopy times and operative time. The increased radiation exposure might be caused by the higher iliac crest, narrower foramina, or larger facet joints, which increased the difficulty of percutaneous puncture. Repeated fluoroscopy must be used to guide the puncture. In addition, the hypertrophy of ligamenta flava might also contribute to the difficulty of puncture and further increase radiation exposure in the PETD group. Conclusion This review provides evidence that both PEID and PETD are safe, effective, and minimally invasive surgical methods for the treatment of lumbar disc herniation, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.

Salter versus Dega Osteotomy in Developmental Hip Dysplasia: A Systematic Review and a Meta-Analysis

Abstract Background The early treatment of developmental hip dysplasia is our goal to achieve concentric hip reduction and normal hip anatomy and function. Many osteotomies were used to achieve our goal, the most common techniques are used for maintaining this reduction, are Dega and Salter osteotomies. For this reason we have done our systematic review and meta- analysis to figure which technique has better radiological and clinical results with less complications. Aim The aim of the work is to review the difference between Dega and Salter Osteotomy according to surgical techniques, Suitable age of each technique, Advantages and disadvantages for each technique, Final clinical and radiographic outcomes and Complications. Subject and Methods This study performed a search for all published articles that evaluated Dega or Salter osteotomy in the management of developmental dysplasia of the hip. Results From a total of 879 articles, 24 with level of evidence grade IV articles were included in our review. A total of 1212 hips cases with a mean follow up of 294.5 months were included. For Severin score, we did not find significant difference after performing both techniques regarding hips with grade 1; Salter [OR = 0. 62, (95% CI = 0.47: 0.77), I2=96.46%, P &amp;lt; 0.001)] and Dega [OR = 0.65, (95% CI = 0.46: 0.84), I2=92.85%, P &amp;lt; 0.001)]. Also the proportion of hips with grade 4 was nearly similar in both groups; Salter [OR = 0. 02, (95% CI = 0.01: 0.03), I2=0%, P = 0.51)] and Dega [OR = 0.02, (95% CI = 0.003: 0.04), I2=11.61%, P = 0.34)]. For McKay score, we did not find significant difference after performing both techniques regarding hips with excellent classification; Salter [OR = 0. 50, (95% CI = 0.28: 0.72), I2=98.1%, P &amp;lt; 0.001)] and Dega [OR = 0.40, (95% CI = 0.16: 0.64), I2=95.56%, P &amp;lt; 0.001)]. In term of hips with poor classifications both techniques performed equally; Salter [OR = 0.027, (95% CI = 0.013: 0.04), I2=0%, P = 0.67)] and Dega [OR = 0.04, (95% CI = 0.003: 0.082), I2=74.78, P = 0.001)]. Conclusion Based on the information in our publication, we believe that Salter and Dega are well-established surgical treatments for hip dysplasia with comparable efficacy. Dega demonstrates marginally superior radiological and clinical data.

Serial Transverse Enteroplasty (STEP) versus Longitudinal Intestinal Lengthening and Tailoring (LILT): Systematic Review and Meta-Analysis of Outcomes and Complications

Abstract Background The prevalence of SBS is 3-4 per million. It occurs in about 15% of adult patients who undergo intestinal resection, with 3/4th of these cases resulting from massive intestinal resection and 1/4th from multiple sequential resections. About 70% of patients in whom SBS develops are discharged from the hospital and a similar percentage remain alive a year later. This improved survival rate has been achieved primarily by the ability to deliver long-term nutritional support. Objective To compare between Serial Transverse Enteroplasty (STEP) and Longitudinal Intestinal Lengthening and Tailoring (LILT) in the incidence of complications and clinical prognosis regarding morbidity and mortality in patients with Short Bowel Syndrome (SBS). Patients and Methods The search was carried out using the electronic national library of medicine PubMed database, Cochrane library and manual reference of articles published on serial transverse enteroplasty (STEP) versus longitudinal intestinal lengthening and tailoring (LILT) in management of patients with SBS. Conclusive search was done and duplicate studies were excluded. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available on the Internet till 2022. Results LILT and STEP are both valuable treatment strategies used in the management of pediatric SBS. However, currently, it is not possible to advise surgeons on accurate patient selection and to predict the result of either intervention. There is very limited published data on bowel lengthening procedure exclusively in adults. Most reported series exclusively or predominantly discuss the pediatric population with some adults included in one series and two additional single case reports. Conclusion Both STEP and LILT are potentially safe and effective methods for the treatment of SBS, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed. This review should be a gateway to open the scope on the field of Autologous Intestinal Reconstruction Surgeries (AIRS) and plan for a more detailed prospective studies with close monitoring of the data regarding outcomes, complications and follow up.

Laser Hemorrhoidoplasty vs Conventional Milligan-Morgan Hemorrhoidectomy for Treatment of Third and Fourth Degree Hemorrhoids: A Prospective Comparative Study

Abstract Background Hemorrhoids are the most common disease of anal canal affecting a large number of people at least once during their lifetime and can interfere with their daily functioning. Surgical treatment is the best available option for symptomatic hemorrhoid cases, which are refractory to medical treatment. In spite of many modifications made to the hemorrhoid surgical techniques, postoperative pain and discomfort remain the major concern for patients, which is why they often refuse to undergo surgical treatment. Laser ablation has opened new possibilities for the minimally invasive treatment of hemorrhoids. Objective To compare the outcomes between laser hemorrhoidoplasty and the conventional Milligan-Morgan hemorrhoidectomy for treatment of third and fourth degree haemorrhoids especially postoperative pain, bleeding, and recurrence. Patients and Methods Recent studies have proven that laser ablation was much better regarding postoperative pain and hemorrhage in the various degrees of hemorrhoids. Our study also confirmed that laser ablation technique has shorter operative time, less severe postoperative pain, bleeding and comparable regression of hemorrhoid columns. Studies with longer follow-up period (around 2 years) have also reported effectiveness of laser for the treatment of hemorrhoids which was confirmed in our study over 6 months. Results Although some studies showed that wound inflammation or hemorrhoid thrombosis could be a problem however our study showed no postoperative local infection in the group treated with laser ablation and only two patients were presented with thrombosis of external hemorrhoid 7–10 days after the surgery, which was resolved with medical treatment. Conclusion Laser hemorroidoplasty has better outcomes than the traditional surgical resection of hemorrhoid disease for the control of grade III and IV symptomatic refractory hemorrhoids specially regarding post-operative pain and bleeding which are the main concerns for most patients.

Surgical Outcome of the Endoscopic Endonasal Approach in Giant Pituitary Adenomas: A Systematic Review

Abstract Background Pituitary adenomas are the third most common intracranial tumors comprising about 10%–15% of all tumors. Giant pituitary adenomas (GPAs) are a subset of pituitary tumors. Most giant adenomas are slowly growing and histologically benign in nature despite the giant in size and difficulties to manage. Diverse surgical techniques including microscopic transsphenoidal, endoscopic transsphenoidal, transcranial transcavernous, and a combination of both suprasellar and infrasellar techniques have been developed to treat giant tumors with extension into surrounding structures. The development of the endonasal endoscopic approach for the resection of pituitary adenomas has been one of the most important advances for the treatment of pituitary tumors in the last decades since 1997. Aim of the Work analyze the collective outcomes from studies discussing endoscopic endonasal transsphenoidal approach in managing giant pituitary adenomas regarding extent of tumor resection, visual improvement and hormonal control. Methodology This systematic review included a discussion of all available studies meeting the eligible criteriaincluding: well conducted descriptive studies, cohort, articles, analytic studies and the literature of reviews. Results Surgical intent of gross or near total resection, primarily for the purpose of improving outcome, can be complicated by injuries that lead to a worse outcome and protracted clinical course. In this respect, patient-oriented outcomes (POEMs) are a point of emphasis in this review. Conclusion The endoscopic endonasal approach is an effective approach for giant pituitary adenomas with high rates of near or complete resection, visual improvement, and low rate of complications.