Team Of Surgeons Research Articles

Ocular manifestations and treatment outcome of allergic fungal pan sinusitis

To know the incidence and treatment outcome of various ocular manifestations of allergic fungal pan sinusitis. A prospective study was conducted in a medical college hospital in south India for a period of 2 years which included all the cases of allergic fungal pansinusitis presented to the hospital. The cases were diagnosed by Bent-Kuhn criteria. The cases with ophthalmologic involvement were included in the study. CT scan of PNS, brain, orbit were done and the disease extent was noted. Cases with eye involvement were planned for surgical debridement after an initial prednisolone oral 1mg/kg over 2 weeks. Surgical debridement was done endoscopically by a team of ENT surgeon, oculoplastic surgeon and neurosurgeon. Histopathologic examination was done. Post-surgery the steroids were tapered over 2 weeks. Post operative follow up was done every day for first week followed by weekly once till a month and every 6 monthly once for a year in the form of clinical examination, CT scan was repeated after a week during post op period. In cases with suspected recurrence CT PNS was performed. Their outcomes were analyzed. 6 cases (33%) had ocular involvement. Proptosis was the most common (28%) finding followed by epiphora (22.2%), ophthalmoparesis (22.2%), diplopia (22.2%), ophthalmoplegia (11.%), complete loss of vision (5%). Surgical intervention led to early recovery in proptosis followed by others except with PL -ve case. Early treatment in AFPS prevents vision loss and has better outcomes.

Diabetes Status After Lateral Pancreaticojejunostomy and Frey's Procedure in Chronic Calcific Pancreatitis: An Observational Study.

IntroductionDiabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus. This study was conducted to determine the status of diabetes mellitus after Frey’s procedure and lateral pancreaticojejunostomy (LPJ) in diabetic and nondiabetic patients with chronic calcific pancreatitis (CCP) and to discuss the clinicopathological course as well as diabetes in CCP.Materials and methodsThis study was designed as a retrospective observational study consisting of 27 patients with CCP who were surgically treated either with the pancreatic head coring Frey’s procedure or with LPJ. Surgeries were performed in a tertiary care hospital of Eastern India by a team of surgeons following the same surgical principle. The diagnosis of CCP was made by clinical and radiological evaluations. Visual Analog Scale (VAS) scoring was used perioperatively to assess pain. Postoperatively, all the patients were monitored clinically; pain scoring and relevant investigations were done depending upon subjective and objective indications. Special attention was paid to diabetic patients through frequent follow-ups and tight glycemic control. All 27 patients were followed up with at least two outpatient follow-ups.ResultsThe trends in fasting blood sugar values in the LPJ group showed a small spike in the early postoperative period (two weeks) with a p-value of >0.05, and later on, it improved over 18 months of follow-up, reaching below the preoperative values (mean 109.38). On the contrary, the fasting blood glucose levels in Frey’s procedure revealed a significant spike in the early postoperative period (two weeks) with a mean sugar value of 148 mg/dl and a p-value of 0.01. The levels stayed well above the preoperative values over 18 months of follow-up. The trends in HbA1c showed marginal improvement in the LPJ group in a six-month follow-up period (p-value 0.008) from the preoperative levels. In Frey’s procedure group, postoperative HbA1c levels at three months revealed an increase, which can be attributed to the minor but significant loss of pancreatic tissue from the head, which continued to be on the higher side at the six-month follow-up. Trends in mean insulin dosage showed a significant spike in the early postoperative period (two weeks) both in the LPJ (p-value 0.01) and Frey’s procedure group (0.01); however, in the LPJ group, the insulin dose showed a reduction over the 18-month follow-up, reaching below the mean preoperative insulin dose. While in the Frey’s procedure group, the postoperative insulin dose remained higher throughout the 18-month follow-up period (p-value <0.05).ConclusionsLPJ has got a little effect on the diabetic status of nondiabetic patients. Frey’s procedure leads to marginal deterioration of the diabetic status and increases in insulin dosage in both diabetic and nondiabetic patients.

Surgical management of postoperative bleeding after pancreatic resection

Background: One of the most severe (although not the most common) complications after pancreatic surgery is bleeding. The aim of this study was to examine and estimate the incidence, types, risk factors, time of onset, management, and outcomes of hemorrhage after pancreatic resections, performed by a team of surgeons at high volume center.

Acute cholecystitis in pregnancy

Acute cholecystitis is the most common non-obstetric abdominal emergency in pregnant patients. It is a consequence of increased formation of cholelithiasis, and occurs due to inflammation of the gallbladder, usually caused by the blockage of the cystic duct. There is also described the appearance of cholecystitis without the presence of gallstones, and this is named as acalculous cholecystitis. Elevated levels of estrogen and progesterone are thought to be a cause of women’s increased predisposition to this condition. In pregnancy, literature describe the appearance of gallstones in 1% to almost 3% pregnancies, and it is known that pregnancy by itself affects the contractility of gallbladder. For sludge and gallstones, even if there is a large range of symptoms, almost up to 50% of patients are asymptomatic. Acute cholecystitis is suspected in a patient with continuous pain in the right upper quadrant, alongside anorexia, vomiting, and fever. Laboratory findings in acute cholecystitis show leukocytosis, an elevated level of bilirubin, up to 4 mg/dl and elevated liver tests. The most useful imaging tool in diagnosing gallstones and further acute cholecystitis is an abdominal ultrasound. Any pregnant women with upper right quadrant pain should be hospitalized to exclude other differential diagnoses and for pain management, usually done with acetaminophen. Supportive care treatment includes administration of intravenous fluids and when necessary antibiotic therapy. Recent studies have showed that interventional surgery by itself brings some associated risks during pregnancy, but with an experienced team of surgeon, anesthesia specialist, and obstetrician, outcomes are better, no matter the trimester of pregnancy.

A Modified Anastomosis Technique for Esophagojejunostomy after Laparoscopy-Assisted Total Gastrectomy: A Single Team Preliminary Experience.

Results There were no significant differences between the cRY group and pRY group regarding age, sex, BMI, neoadjuvant therapy, preoperative comorbidities, history of laparotomy, ASA score, tumor location, pathological stage, total operative time, incision length, blood loss, time-to-first flatus, time-to-first soft diet, and postoperative hospital stays. The proportions of patients who received a 21 mm stapler were higher in the cRY group (7/44) than that in the pRY group (0/68) (P = 0.003). 7 anastomotic complications were reported (6 in the cRY group versus 1 in pRY group; P = 0.028) of which five (83.3%) in the cRY were anastomotic stenosis versus none in the pRY group (P = 0.044). Conclusions The application of pant-shaped anastomosis for esophagojejunostomy after LTG is a safe and feasible procedure and has an advantage when the jejunum diameter is small.

Limberg Flap Versus Primary Midline Wound Closure in Treatment of Chronic Pilonidal Sinus Disease

Objective: Current study aims to compare the Limberg flap technique with primary midline wound closure to treat the chronic pilonidal sinus disease. Study design: A comparative study was done in Surgery Department Sir Ganga Ram Hospital Lahore from January 2020 to September 2021 Method: The sample size for the study is 60 patients who were regularly visiting the hospital due to PS disease. All the patients were divided into two groups A and B. Group A had 30 patients treated with the Limberg flap method and group B had 30 patients treated with primary midline wound closure. Before starting the treatment a brief description of the treatment was given to all patients and consent was signed from all participants. The final decision for treatment was decided by the team of senior surgeons as well as with help of the patient's own choice. Limberg flap and primary midline wound closure (PMC) were applied to patients who regularly followed the instruction for chronic pilonidal sinus treatment. Primary midline closure was applied on patients who had a cosmetic concern and did not have a recurrence problem. Results: Total 60 patients were divided into two groups, Group A (Limberg flap) had 30 patients in which 25 (83%) were males and 5 (16.6%) females. The mean age for this group was 25 ± 5.00 years. The patients without a previous history of pilonidal sinus disease (primary case) was 17 (56.6%) and the recurrence case was 13 (14.3%). Group B (primary midline wound closure) had 30 patients in which 18 (60%) were males and 12 (40%) females. The mean age for this group was 28 ± 3.00 years. The patient without a previous history of pilonidal sinus disease (primary case) was 28 (93.3%) and the recurrence case was 2 (6.6%). The comparison of 3rd-week outcomes shows that in group A 25 (83,3%) patients had painless walking, 23 (76.6%) patients start their routine work and 26 (86.6%) patients had treatment satisfaction. In group B 21 (70%) patients reported painless walking, 18 (60%) patients started their routine activity and 22 (73.3%) patients shows satisfaction with treatment. Conclusion: Hence we concluded that a better improvement percentage was measured high in group A (Limberg flap) than group B (PMC). Therefore limberg flap is better technique to treat the chronic pilonidal sinus disease. Keywords: chronic Pilonidal Sinus, primary midline wound closure (PMC), Limberg flap

Two-Year Experiences of 500 Appendectomies in Lahore General Hospital, Lahore.

IntroductionAcute appendicitis is a leading cause of abdominal conditions in emergency departments. Evidence from research studies has indicated the efficacies of surgical procedures involving appendectomies. However, in Pakistan, there is a paucity of information regarding the epidemiology, clinical presentations, and surgical management of acute appendicitis.ObjectiveThis paper aims to report the epidemiologic data and findings of surgical management of acute appendicitis in Lahore General Hospital (LGH). The data was based on our two-year experiences of appendectomies in the hospital.Materials and methodologyData were collected retrospectively. The patients underwent appendectomies performed by the team of surgeons of Surgical Unit 1 of LGH in the Accident and Emergency (A&E) Department from July 2019 to October 2021.ResultsThe total number of patients was 506, and the mean age was 26.8. Males (67.29%) and young adults aged 18-34 years were at higher risk of appendicitis. Compared to other surgical procedures performed, open appendectomy and laparoscopic appendectomy operative times were significantly shorter. Histopathology of all the cases showed acute inflammation of the appendix.DiscussionSimilar to findings from other research studies, the operative time of open appendectomies was shorter (70.6 minutes) in the hospital than the operative time of laparoscopic appendectomies (77 minutes). However, the overall operative times were longer than the operative times reported in some other research studies. Also, contrary to other research findings, open appendectomy (1.22 days) was associated with a longer length of hospital stay than laparoscopic appendectomy (≈1 day). Simple acute appendicitis was the most predominant operation findings (289, 57.1%).ConclusionCompared to other hospitals, the shorter hospital stays/recovery time indicated the high surgical skill of performing open and laparoscopic appendectomies in Lahore General Hospital, Lahore, Pakistan.

Efficacy and Safety of Preoperative vs. Intraoperative Computed Tomography-Guided Lung Tumor Localization: A Randomized Controlled Trial

Background: Thoracoscopic removal of small pulmonary nodules is traditionally accomplished through a two-step approach—with lesion localization in a CT suite as the first step followed by lesion removal in an operating room as the second step. While the advent of hybrid operating rooms (HORs) has fostered our ability to offer a more patient-tailored approach that allows simultaneous localization and removal of small pulmonary nodules within a single-step, randomized controlled trials (RCTs) that compared the two techniques (two- vs. single-step) are still lacking.Methods: This is a RCT conducted in an academic hospital in Taiwan between October 2018 and December 2019. To compare the outcomes of traditional two-step preoperative CT-guided small pulmonary nodule localization followed by lesion removal vs. single-step intraoperative CT-guided lesion localization with simultaneous removal performed by a dedicated team of thoracic surgeons. The analysis was conducted in an intention-to-treat fashion. The primary study endpoint was the time required for lesion localization. Secondary endpoints included radiation doses, other procedural time indices, and complication rates.Results: A total of 24 and 25 patients who received the single- and two-step approach, respectively, were included in the final analysis. The time required for lesion localization was significantly shorter for patients who underwent the single-step procedure (median: 13 min) compared with the two step-procedure (median: 32 min, p < 0.001). Similarly, the radiation dose was significantly lower for the former than the latter (median: 5.64 vs. 10.65 mSv, respectively, p = 0.001).Conclusions: The single-step procedure performed in a hybrid operating room resulted in a simultaneous reduction of both localization procedural time and radiation exposure.

Sacral Resections for Primary Sacral Tumor - an Experience from a Tertiary Care Cancer Center in India.

Primary sacral tumors are uncommon and sacrectomy is a complex surgical procedure with substantial risk of morbidity. We conducted a retrospective study of patients who had undergone sacral resections for primary sacral tumors between 2010 and 2020. Ten sacral resections including five type 1 sacrectomy (S1 resected), four type 2 (S1 spared), and one type 3 (S3 spared) were performed during the above period. The median age was 47years and the most common histologic diagnosis was chordoma (50%). The median operating time was 705min (range 180-960min) with a median blood loss of 3400ml (range 500-7000ml) and a median duration of hospital stay of 13.5days (range 7-68days). All patients who underwent type 1 sacrectomy experienced major complications (Clavien-Dindo grade 3 or above) including one death in the immediate perioperative period. Microscopically positive margins (R1) were noted in two patients (20%). All patients with type 1 sacrectomy had R0 resection. The median follow-up period was 31months. The median MSTS score was 12 (range 4-27). A total of seven patients (70%) had a minimum follow-up of 2years without disease recurrence. Sacral resection for primary tumors of the sacrum with oncologically safe margins is feasible. Although associated with substantial perioperative morbidity, a detailed preoperative planning and execution of the surgery by a team of orthopedic oncosurgeon, surgical oncologist, and plastic surgeon offer a hope for survival in patients with acceptable functional outcome.

Learning Curve of Laparoscopic Kasai Portoenterostomy in a Tertiary Hospital with Low Caseload of Biliary Atresia.

Background: Laparoscopic Kasai portoenterostomy (KPE) is generally considered to be technically challenging. A scarcity of studies has particularly focused on the learning curve (LC) of this technique. The present study was aimed to objectively evaluate the LC of laparoscopic KPE in a medical center with relatively low caseload of biliary atresia (BA). Materials and Methods: Thirty-five consecutive pediatric patients treated with laparoscopic KPE for BA by the same surgeon team between 2012 and 2018 were retrospectively enrolled in the present study. Operative time (OT) was selected as the surrogate marker. Cumulative sum (CUSUM) analysis was applied to describe the LC of laparoscopic KPE. Results: The turning point of the CUSUM curve occurred at the 21st case, which divided the curve into two distinct phases, phase 1 (the initial 21 cases) and phase 2 (the remaining 14 cases). The curve was best modeled as a second-order polynomial with equation CUSUM in minutes equal to -0.9161 × case number2 + 32.097 × case number + 7.8217 (R2 = 0.981). Age at surgery, sex, weight, and preoperative liver function were well balanced between the two phases (each P > .05). The OT was significantly decreased in phase 2 compared with phase 1 (P < .0001). Furthermore, the rates of early jaundice clearance and 2-year native liver survival were higher in phase 2. The rate of postoperative cholangitis was comparable between the two phases. Conclusions: Two characteristic phases of the LC for laparoscopic KPE were identified using CUSUM analysis and represented the initial learning period and the subsequent period of technical mastery, respectively. Surgeons are possible to acquire competency of laparoscopic KPE in relatively low-case centers.

Cholecystectomy 7 days vs 4 weeks after mild biliary pancreatitis; looking a decrease the incidence of persistent choledocholithiasis and ERCP: A multicentric randomized clinical trial

BackgroundMild acute biliary pancreatitis (MABP) requires definitive treatment of the cholelithiasis to avoid recurrent biliary events. Recent publications recommend performing early surgery to prevent readmissions. However, an exceedingly early cholecystectomy could imply missing the presence of persistent choledocholithiasis or requiring a significant number of preoperative endoscopic retrograde cholangiopancreatographies (ERCP). This multicentre randomized clinical trial compares early surgery performed a week after MABP with delayed surgery (at 4 weeks), to compare readmission rates for recurrent biliary events and the incidence of residual choledocholithiasis between the two groups. Materials and methodsA total of 198 patients with a first episode of MABP defined by the Atlanta 2012 criteria were enrolled. Randomization was done by a central study coordinator: 98 to early surgery and 100 to delayed surgery. All of them had preoperative or intraoperative imaging to exclude persistent choledocholithiasis. Laparoscopic cholecystectomy was performed by dedicated teams of experienced surgeons. ResultsEarly surgery reduced the rate of readmissions for biliary events before cholecystectomy by half (7.2% vs 15.8%, p = 0,058). There were no differences in the type of surgery, postoperative stay, or complications compared with delayed surgery. Choledocholithiasis was observed in 9.0% of patients in the early group and 7.7% in the delayed group (p 0,719). The preoperative or intraoperative imaging study avoided unnecessary ERCP, which was performed in only 6 (3%) patients. ConclusionsEarly cholecystectomy performed seven days after resolution of MABP had a low incidence of recurrent biliary events and complications, and was not associated with an increase in residual choledocholithiasis or need for unnecessary ERCP.

Surgical Management of Postoperative Bleeding after Pancreatic Resection

Background: The aim of this study was to examine and estimate the incidence, types, risk factors, time of onset, management, and outcomes of hemorrhage after pancreatic resections, performed by a team of surgeons at high volume center.

COMPLICATIONS AND LATE FOLLOW-UP OF SCOPINARO'S SURGERY WITH GASTRIC PRESERVATION: 1570 PATIENTS OPERATED IN 20 YEARS.

ABSTRACT - BACKGROUND:Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the surgeries that offer the best immediate results in weight loss and regain in the late follow-up. It has a high rate of immediate complications and demands control with frequent laboratory tests.AIMS: The aim of this study was to analyze the late postoperative complications of 1570 patients operated by biliopancreatic diversion with gastric preservation laparoscopic video with up to 20 years of postoperative follow-up.METHODS: In a follow-up period of up to 20 years, the clinical and surgical complications of 1570 patients with grade II or III obesity were evaluated who were operated on from 2001 to 2014 with the same team of surgeons. Clavien Dindo 11 classification was used for analysis and comparison. Laboratory tests and body mass index (BMI) were used in the analysis of late metabolic outcomes.RESULTS: On the one hand, complications in 204 patients were recorded (13%), and 143 patients (9.1%) were reoperated. On the other hand, 61 patients (29.9%), who had postoperative complications were clinically treated with good evolution in 9.2 years (95%CI 8.2-10.3), with a median of 9.5 years (95%CI 6.1-12.9). Gastroileal anastomosis ulcers occurred in 44 patients (2.8%). Patients with malnutrition, severe anemia, or chronic diarrhea were operated on with common loop elongation (n=64 - 4%), conversion to gastric diversion (n=29 - 5%), or reversal of surgery (n=10 - 0.6%). One death was registered throughout casuistry (0.06%).CONCLUSIONS: Metabolic result of DBP-S was considered excellent in most patients, even referring to changes in the frequency of bowel movements, loose stools, and unpleasant odor. Complications are usually serious and most of the patients require surgical treatment. Therefore, the biliopancreatic diversion of Scopinaro should be reserved for exceptional cases, as there are safer surgical alternatives with less serious side effects.

Nasal deformity correction with nasal prosthesis

Nasal deformities can vary in the form of severity. Several different factors such as congenital, burn and traumatic nasal fractures or soft-tissue injury/loss, neoplastic: defects resulting from surgery for the treatment of cancers causing compromise the structural architecture and functional framework of the nose. This case report describes the prosthetic rehabilitation of two female patients, one who was reported with congenital arrhinia and another one who had accidental electrical burns of the face. The surgeon's team as well as the maxillofacial prosthetics team discussed the treatment options with the parents and decided to rehabilitate with a nasal prosthesis. This clinical report is imparting an accessible and economic method for prosthetic rehabilitation of a patient.

Peritoneal Rupture of Hematocolpos in Distal Vaginal Atresia

An adolescent girl with vaginal atresia, massive hematocolpos and bilateral hydroureteronephrosis presented with an acute abdomen secondary to spontaneous rupture of the hematocolpos into the cul-de-sac. Diagnosis, treatment, postoperative course and complications of this unique case are briefly summarized. Spontaneous rupture of hematocolpos into the abdominal cavity is an extremely rare manifestation of vaginal atresia. Tertiary care management, which involves a multidisciplinary team of experienced gynecologists, plastic surgeons, urosurgeons, and critical care physicians, is recommended for optimal management of these patients. Patient education is also crucial; regular follow-ups visits and strict adherence to the postoperative vaginal dilatation schedule can reduce risk of stenosis after vaginoplasty.

Плексиформная нейрофиброма наружных гениталий и промежности у девочки

We report a case of plexiform neurofibroma of the external genitalia and perineum in a 11-year-old girl with no family history of this disease. The patient was diagnosed with neurofibromatosis type 1 upon admission to the clinic. Surgery was performed by a team of a pediatric surgeon and gynecologist after the examination. The postoperative period was uneventful. No signs of neurofibroma recurrence were observed 2 years postoperatively. The description of the diagnostic and treatment stages in this case resulting from a primary genetic mutation is of interest to pediatricians and pediatric surgeons. Key words: neurofibromatosis, perineum, child

A Retrospective analysis of the profile of trauma victims presenting to an emergency department in South India

ABSTRACTBackground:Trauma is a leading cause of morbidity and mortality in both developed and developing countries.Methodology:This retrospective observational study was done in the Emergency Department (ED) of a tertiary care trauma center in Southern India in 2018 (January to December).Results:During the study period of 1 year, the ED attended 74,466 patients which included 7675 (10.3%) trauma patients. The mean age was 35.3 (SD: 18.5) years with three-fourth (76.6%) being males. Pediatric/adolescents (age ≤18 years) and geriatric age groups (age ≥60 years) comprised 16.7% and 11.8% cases, respectively. Road traffic accidents (RTA) (66%) were the predominant mode of injury followed by falls (fall from height: 8.6% and fall on level ground: 7.8%). Among the RTAs, the majority were two-wheelers related (73.8%), followed by pedestrian injuries (9.4%) and four-wheelers injuries (7.2%). Bivariate and multivariate logistic regression analysis showed pedestrian injuries, low Glasgow Coma Scale (GCS), and hypotension at arrival as independent predictors of hospital mortality. The in-hospital mortality rate was 0.7%. A quarter (24%; n = 1841) of the patient’s population was solely managed by the ED team and discharged stable, while 2179 (28.4%) victims required hospital admission.Conclusion:Trauma is a major cause of mortality especially among the breadwinners of families in India with almost half being due to two-wheeler accidents. Efficient ED professionals and a multispecialty team of trauma surgeons, neurosurgeons, and orthopedics handle the major load of acute trauma. Pedestrian injuries, low GCS, and hypotension at arrival are independent predictors of in-hospital mortality.

COMPLICATIONS AND EVALUATION OF QUALITY OF LIFE IN PATIENTS AFTER LESS-INVASIVE TREATMENT OF VARICOSE VEINS OF THE LOWER EXTREMITIES.

The aim: To analyze the occurrence of complications and evaluate the quality of life in patients who got less-invasive treatment methods using endovenous laser ablation of varicose veins of the lower extremities in the early and late postoperative periods. Materials and methods: The study was conducted with the participation of 100 patients treated in 2019-2020 by one team of surgeons for varicose veins of the lower extremities with symptoms of chronic venous insufficiency C2-C4 (CEAP classification). Depending on the performance of endovenous surgical interventions, all patients were divided into two study groups. Results: In assessing the quality of life associated with health, according to the CIVIQ 2 questionnaire, it was found that in the presence of varicose veins in the superficial veins of the lower extremities, indicators decrease both in general and on all studied scales (pain, physical, psychological and social). However, when using endovenous laser ablation without miniphlebectomy, after 6 months of observation, recurrence of varicose veins of the lower extremities was noted, which was not observed in patients of the first group. Conclusions: The use of less-invasive interventions with ultrasound guidance positively affects patients' quality of life with varicose veins of the lower extremities, both in the early and prolonged postoperative periods.

Feasibility of pectoralis major myocutaneous flap for primary reconstruction of near-total glossectomy defects: A report of 2 cases

The aim of tongue cancer surgery is to restore speech and swallowing. Smaller defects have a plethora of options, including local and distant flaps to restore volume and function may not be compromised. Large tumours of the tongue require extensive resection - near total or total glossectomy, which creates large volume defects. Free flaps using microvascular reconstruction techniques are the ideal method of reconstruction in such defects. Regional flaps like pectoralis major myocutaneous (PMMC) flaps are used only as salvage flaps when the free flaps fail and they are not used as the primary method of reconstruction. The disadvantage with free flaps is that it requires a team of surgeons with microvascular expertise, which may not be feasible in low-resource settings. Hence, the workhorse flap of head–neck reconstruction, the PMMC flap, has a lot to offer in the primary reconstruction of large tongue defects. There is always a risk of lifelong dependence on feeding tubes and tracheostomy tubes following these surgeries despite free flap reconstruction. The outcomes of the reconstruction methods are validated by the absence of dependence on these tubes. We report 2 cases of near glossectomy defects reconstructed primarily by PMMC flap and the functional outcomes of speech and swallowing and the absence of dependence on tubes for feeding and breathing.

Two-Attending Surgeon Teams Improve Outcomes of Single-Level Anterior Cervical Discectomy and Fusion.

Given the shift toward value-based healthcare, strategies that decrease risk in commonly performed procedures such as anterior cervical discectomy and fusion (ACDF) are of interest. The objective of this study was to analyze the effect of a two-attending surgeon team on the outcomes of patients undergoing single-level ACDF. A retrospective matched-cohort study of patients undergoing single-level ACDF for degenerative cervical spondylosis, with minimum 2-year follow-up was performed. Patients were subdivided into two cohorts: cases with procedures performed by one attending surgeon assisted by a resident physician and cases with procedures performed by an attending surgeon with another attending surgeon as first-assist. Patients were matched by age, sex, body mass index, smoking status, American Society of Anesthesia grade and Charlson Comorbidity Index. Perioperative data and complications were compared. Standard binomial and categorical comparative analysis were performed. Forty-two patients were included (21 in each group). There were 22 males and 20 females, with a mean age of 47.7 years and mean follow-up of 43.4 months. There were no differences in any demographic variable between groups, indicating successful matching. Cohort B had decreased anesthesia time (114.9 vs. 157.1 minutes, P < 0.001), operative time (58.1 vs. 98.9 minutes, P < 0.001) and blood loss (14.8 vs. 24.3 mL, P = 0.012). There were no significant differences in terms of post-operative complications including dysphagia, wound infection, neurologic or cardiovascular related complications. A two-attending surgeon team significantly reduces anesthesia time, surgical time, and blood loss in single-level ACDF procedures without an increase in complications or a decrease in fusion rates.