Surgical Technique For Management Research Articles

Surgical Correction of Adult Congenital Penile Curvature: A Systematic Review

Congenital penile curvature (CPC) is corrected surgically by various corporoplasty or tunica albuginea plication techniques, but the optimal surgical approach is not well-defined. To provide a comprehensive evaluation of the published literature pertaining to outcomes with penile plication and corporoplasty techniques for surgical management of CPC. To determine if plication or corporoplasty offers superior outcomes in surgical correction of CPC. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist. The following databases were queried from inception to March 18, 2020 to search for studies describing surgical treatment of CPC: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Objective and subjective postoperative outcomes including penile straightening, shortening, penile sensory changes, and reoperation rates for both corporoplasty and tunica albuginea plication were summarized. Fifty-five articles comprising 2,956 patients with CPC who underwent a plication procedure (n = 1,375) or corporoplasty (n = 1,580) were included. The definition of "treatment success" varied widely and most often involved subjective patient reporting (22 studies; 40%) or objective assessment (15 studies; 27%). We considered curvature correction to be satisfactory if there was self-reported patient satisfaction or residual curvature after correction of <20˚. Reported rates of successful straightening ranged from 75 to 100% and 73 to 100% for plication and corporoplasty, respectively. A comprehensive and accurate assessment of surgical outcomes for CPC correction, such as satisfactory penile straightening, reoperation rates, glans sensory changes, and other complications was limited by significant inter-study heterogeneity with respect to the reporting of treatment outcomes. While both plication and corporoplasty appear to be safe and effective options in the treatment of CPC, definitive conclusions cannot be drawn with respect to treatment superiority due to low-quality study design, methodology flaws, and significant heterogeneity in reporting. This report represents the most comprehensive review of CPC surgical management. However, there is a significant lack of standardization in the reporting of treatment outcomes for CPC, thereby limiting the reliability of the published data summarization encompassed by our review. Both plication and corporoplasty demonstrate high success rates and relatively low complication rates in the treatment of CPC, albeit with low-level evidence available in most research publications. Robust comparison of the surgical techniques used to correct CPC is limited by significant variation in reporting methods used in the literature.

Antibiotic cement-coated plate is a viable and efficient technique for the definitive management of metaphyseal septic nonunions of the femur and tibia.

the management of septic metaphyseal nonunions is challenging, with inconsistent outcomes. Antibiotic cement-coated implants have been demonstrated good outcome for diaphyseal infected nonunions, however there is no data in metaphyseal infected nonunions. fifteen adult patients with septic metaphyseal nonunions of the femur or tibia were treated with antibiotic cement-coated plates. The antibiotic cement-coated plate was prepared with either gentamicin or vancomycin. Outcome measures were infection control, bone healing, return to pre-injury level on daily activities, and quality of life at the last follow-up visit. A p value of <5% was considered significant. Methicillin-susceptible S. aureus was isolated in 53.3% cases. Average postoperative follow-up time was 18 months. Local infection control and radiographic bone healing were adequately achieved in 93.3% patients. No patient presented recurrent symptoms of surgical site infection. Fourteen patients reported to be either able, or on the same level as before injury, with 73.3% reporting no problems in all five dimensions of the EQ-5D-3L. Persistent infection was the only variable associated with a reduced long-term quality of life. antibiotic cement-coated plate is a viable and efficient surgical technique for the definitive management of juxta-articular metaphyseal septic nonunions of the femur and tibia.

Oral Mucocele- A Literature Review of Management Alternatives

Oral Mucocele is a common lesion seen in oral cavity which is a benign disease of minor salivary glands. It clinically presents as single, painless, soft, smooth, spherical, translucent and fluctuant nodule with pink to transclucent blue observed in reflected light.The lesion may resolve spontaneously or traumatically with the rupture of the lining, with the release of a characteristic viscous, mucoid fluid. There has been continuous research with an aim to find ways for management having least recurrence rates in various types of oral mucocele. Multiple treatment options have been trialled for eradication of the lesion, including surgical and non-surgical management techniques. The non-invasive methods also comprised of different intra-lesional injections. Many other invasive procedures with added advantages and few shortcomings have also been researched by the Clinicians.

Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2017 to January 2018

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment. Level of EvidenceLevel V, expert opinion

Pain versus Gain: Multiport versus single-port thoracoscopic surgery for pediatric pneumothorax a case series

BackgroundThe indications for single-incision thoracoscopic surgery in children are expanding. We present outcome comparisons in single versus multi-port surgical technique for management of Primary Spontaneous Pneumothorax (PSP) in seven children. MethodsThis retrospective chart review of the outcomes from a single-surgeon's experience in thoracoscopic technique over a two-year period includes seven cases, divided into two groups: traditional multiport video assisted thoracoscopic surgery (MP-VATS) (n = 3) versus single-port VATS (SP-VATS) (n = 4). Data for patient demographics, chest tube placement, operation details, opioids usage, and postoperative course were recorded and analyzed. ResultsSeven patients had a median age of 14.88 years [range 12–17 years] with a male predominance 67% MP-VATS and 75% SP-VATS (p = 0.41). Average time to surgery: 3.6 days (p = 0.21) operating time: 1.2 hours (p = 0.09). Estimated blood loss was higher for MP-VATS 5.33 ml vs SP-VATS 2.25 ml but not statistically significant (p = 0.11). Opioids given in the post-operative period until chest tube removal were similar: MP 0.19 vs SP 0.12 mg/kg (p = 0.17). Time to chest tube removal was significantly longer at 5.54 vs 3.59 days for MP-VATS vs SP-VATS (p < 0.05). Length of stay was 10.46 vs 8.33 days for MP-VATS vs SP-VATS (p = 0.30). One SP patient had recurrent pneumothorax after chest tube removal, requiring replacement of chest tube, one MP patient required an additional surgery for contralateral PSP. ConclusionIn this small case series, outcomes were similar for MP-VATS and SP-VATS for PSP, but chest tube removal was earlier in SP. This provides a convincing basis to expand the usage for this technique.

A comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia

Background: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously, especially following tension-free surgeries. The present study was planned to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair.Methods: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomised into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa's repair.Results: The operative time was significantly shorter in group 2 patients as compared to group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. Post-operative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups.Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.

TP10.2.1Lessons Learnt in the Management of Acute Appendicitis During the Sars Covid-19 [Cv 19] First Wave

AimsTo evaluate the impact of CV19 on surgical technique and patient outcome in management of acute appendicitis during the 1st wave.MethodData was collected on patients presenting with appendicitis to ED. Group A: Jan-March 2020, pre COVID and Group B: April-June 2020: peri COVIDResultsThere was no difference in sex, age and length of stay between groups. In group A [n = 194], 88% had lap appendicectomy vs Group B [n = 98], 97% had an open operation. Group A had a complication rate of 6% [wound infection] with no readmissions. Group B had 31% complication rate [intra-abdominal collection, bleeding, and ileus] requiring readmission.685 surgical patients attended ED in the first half of 2020 of which 4 % had an appendicectomy. However the method of surgical access in the 1st wave significantly impacted on patient outcome, resource and re-admission rates.ConclusionIn our study open appendicectomy undertaken due to concerns around COVID transmission during laparoscopic surgery during the 1st wave, increased rates of complications and readmission thus raising hospital costs and chances of COVID 19 infection in these patients.As a result of this and due to greater confidence in laparoscopic surgery as a whole we have returned to undertaking laparoscopic appendicectomy in the current wave. Further analysis is underway assessing the impact of COVID on all emergency operations undertaken in the 1st wave.

Share the Airway: An Interdisciplinary Course for Management of the Unexpected Difficult Airway

IntroductionWithin the scope of practice of oral and maxillofacial surgery, the unexpected difficult airway may occur in the trauma bay, operating theater, postoperative, or office-based setting. Oral and maxillofacial surgeons must be trained to diagnose and intervene in anatomically or anesthetically compromised airways. An interdisciplinary training course hosted by an anesthesiology airway expert and oral and maxillofacial surgeon is a novel resident training opportunity. Materials and methodsIn August 2019 and October 2020, the department of anesthesiology and the division of oral and maxillofacial surgery at Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, NY, co-hosted interdisciplinary educational sessions focused on management of the unexpected difficult airway, taught to residents and faculty. A SurveyMonkey (San Mateo, CA) questionnaire was taken 2 weeks before and after the course, with 10 questions assessing fund of knowledge in airway anatomy and physiology, etiology of difficult airway scenarios, difficult airway algorithm, and performance of emergency surgical airways. An interactive lecture on likely scenarios, airway algorithms, relevant surgical anatomy, routine and emergency airway management, airway devices, and emergency surgical airway techniques was conducted. A hands-on cricothyroidotomy tutorial using Crico-Trainer “Pig” (VBM, Sulz, DE) anatomic models with fresh porcine tracheas to simulate human airway anatomy were used. A post-course test consisted of a timed, filmed performance followed by a debriefing session. ResultsIncreased fund of knowledge and comfort with airway anatomy, difficult airway diagnosis and management, and emergency surgical airway techniques was evident between pre-and post-course surveys and was clearly demonstrated across multiple years. The sample size (n = 10, 2019; n = 7, 2020) was insufficient for statistical analysis. ConclusionInterdisciplinary didactic and clinical training in emergency airway management are of paramount importance to the oral and maxillofacial surgeon. Between years, a drop-off in knowledge base and technical skills occurred, even among senior staff, and all attendees agreed that periodic repetition is worthwhile. This course is now offered as part of the core curriculum on an annual basis and may be expanded to additional specialties for whom airway management is important.

Surgical Management of Lisfranc Injuries and Variants in the Athlete

Injuries to the tarsometatarsal joint (Lisfranc injuries) are an important and common injury in the athlete. Vigilant evaluation and diagnosis are critical to assure good outcomes. In general, surgical management is indicated in cases where instability is confirmed or strongly suspected. The focus of this chapter is on surgical management and rehabilitation techniques for Lisfranc injuries in the athletic population.

Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature

Background: Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. Purpose: To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. Results: Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. Conclusion: PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.

V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-08 TRUE DIPHALLIA: EVALUATION AND SURGICAL CORRECTION OF A RARE CASE OF COMPLETE DUPLICATED PENIS Amr A. Elbakry, Chad Crigger, and Osama Al-Omar Amr A. ElbakryAmr A. Elbakry More articles by this author , Chad CriggerChad Crigger More articles by this author , and Osama Al-OmarOsama Al-Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We are presenting a rare case of true diphallia. In this video, we will present our evaluation and demonstrate the surgical technique for management of a patient with complete duplicated penis. METHODS: Our patient is an 11-month-old male who presented initially as 28-day-old that was referred for evaluation of abnormal male genitalia. Physical examination showed duplicated penis with penoscrotal transposition and large scrotal lipoma. VCUG was done and showed Y-shaped duplicated urethra, with normal right urethra and atretic narrow left urethra. Diagnosis was confirmed with US and MRI, that showed complete duplication of the penis with separate two corpora cavernous and a corpus spongiosum and urethra in each penis. We decided to proceed with surgical correction with amputation of the left penis as right penis has the normal urethra evidenced by the VCUG. We started our procedure with performing a cystourethroscopy that confirmed normal right urethra that in continuation with prostatic urethra and bladder neck. Next, bilateral sub-coronal circumferential incisions were made, and complete deglovig of both penises was completed. The lipoma of the scrotum was dissected excised. The left penis was amputated, and the stump was oversewn. Next, we turned our attention to correction of pent-scrotal transposition. The two hemiscrotums were mobilized at the level of the peso-scrotal junction, paying attention to maintain penile skin attached at peno-pubic junction to maintain blood supply. The scrotal flaps were brought ventrally and approximated in the midline in 3 layers. penile skin was trimmed and redistributed for penile coverage. penile skin was approximated ventrally in the midline and was sutured to the foreskin of the left penis. A catheter was left place and dressing was applied. RESULTS: Our procedure was successful with total operative time of 4 hours, minimal blood loss and the patient was discharged home on the same day. Urethral catheter was removed at POD7. There was no reported Complications, no fistula, no wound dehiscence or discharge. Pathology confirmed the diagnosis of accessory penis with normal left and right corpora cavernosum and atretic urethra. CONCLUSIONS: We showed a case of a complete duplicated penis which is a rare congenital anomaly of the genitalia. We demonstrated a surgical technique for correction and reconstruction of the male genitalia in this rare case. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e224-e224 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amr A. Elbakry More articles by this author Chad Crigger More articles by this author Osama Al-Omar More articles by this author Expand All Advertisement Loading ...

Modified Z-Palatoplasty for Correction of Acquired Nasopharyngeal Stenosis Following Palatal Surgery: A Case Series.

To evaluate the efficacy of a novel surgical technique in management of nasopharyngeal stenosis (NPS), describing its steps and results. Study Design: Prospective clinical trial. This study was conducted at the Otolaryngology, Head and Neck Surgery Department, Zagazig University. This prospective study was conducted on patients with snoring ± obstructive sleep apnea due to acquired postsurgical NPS of grade Ι and ΙΙ. New surgical repair was employed on the patients and the pre and postoperative results were statistically compared. The grade of NPS improved significantly postoperatively (P = .00136) throughout a follow-up of 1 year. Postoperatively, there was statistically significant improvement of apnea hypopnea index (P = .0005), Visual Analog Scale (VAS) of nasal obstruction (P < .0001) and VAS of snoring (P < .0001). Dysphagia showed early worsening, but it improved completely at 3 months postoperatively. The utilized novel procedure appears effective, low cost, and easily applicable, and it does not require implants, special tools, or suture materials. Furthermore, it gives excellent results, with negligible pain, and rapid recovery without significant complications. 4.

Comparative Study between Open Surgical Drainage and Closed Technique of Percutaneous Aspiration under Image Guidance for Management of Breast Abscess

Background: The conventional surgical management of breast abscesses consists of an incision taken over the point at which there is maximum fluctuation (or pain) and breaking of the abscess septa by digits. Now antibiotics and repeated abscess aspiration under USG guidance is new minimally invasive method which is on rise&#x0D; Objectives:&#x0D; &#x0D; To study the outcome of open technique of breast abscess management.&#x0D; To study the outcome of closed technique of breast abscess management.&#x0D; To compare the outcome of open v/s closed technique of surgical management of breast abscess.&#x0D; &#x0D; Methodology: Sample will be divided into two groups and type of treatment i.e open incision and drainage or percutaneous aspiration under guidance will be decided randomly by chit system.&#x0D; Expected Results: Feasibility and outcome of Percutaneous drainage is better than incision and drainage&#x0D; Conclusion: First line management of Breast abscess will soon be percutaneous drainage under USG guidance.

Hysteroscopy-assisted laparoscopic salpingectomy for interstitial pregnancy without cornual resection

To illustrate a novel surgical management technique for interstitial ectopic pregnancies (IP). Video description of the case, demonstration of the surgical technique, reevaluation at the 6-week postoperative follow-up, and review of the advantages of this surgical technique for IP. Tertiary referral center. A 42-year-old gravida 2 para 1-0-0-1, underwent a successful invitro fertilization (IVF) cycle with a single embryo transfer and had an early ultrasound diagnosis of IP with cardiac activity. After failed medical management with a single dose of methotrexate, she was referred to us for surgical management. Transvaginal ultrasound revealed fluid in the cul-de-sac and confirmed a right interstitial ectopic pregnancy with an estimated gestational age of 6 weeks. The myometrium at the periphery of the implantation site was 1-1.5 mm, and the "interstitial line sign" was seen. After counseling for possible treatment modalities, the patient opted for surgical management, planning for further IVF treatment. Her preoperative β-human chorionic gonadotropin level (β-hCG) was 3241 IU/L. Her surgical history was significant for a previous myomectomy via laparotomy and an elective lower transverse C-section. Hysteroscopy assisted by multipuncture video laparoscopy surgery was performed. Hysteroscopic resection was not feasible as the ectopic was not visualized as described previously. Using normal saline as the distension media and with the hysteroscope aimed at the right ostium, the hydrostatic pressure was increased transiently to dissect the ectopic pregnancy and facilitate the next surgical step. Laparoscopically, the ectopic pregnancy was milked with atraumatic graspers and mobilized from the cornua into the tube creating enough proximal length for salpingectomy. Right salpingectomy was achieved using high-frequency bipolar with no complications. Hysteroscopy-assisted laparoscopy technique allows for several advantages, including a short operative time and minimal blood loss. No sutures were required and the myometrial architecture was left undisrupted. The postoperative course was uncomplicated, and the patient was discharged on the same day of surgery. The patient's β-hCG level dropped from 3,241 to 139 IU/L after 48 hours. Two weeks later, the β-hCG level was 3 IU/L. A follow-up ultrasound was performed six weeks postoperatively confirming the integrity of the myometrium without defects and proportional wall thickness on both sides. The patient was referred back to her infertility specialist to resume IVF treatment with no remarkable delay. In select cases and the presence of a proficient laparoscopic surgeon, early diagnosed IP can be removed safely using the described novel technique. While an interval conception of 3-6 months is recommended after conventional surgical procedures for IP, this technique can be comparable to salpingectomy.

An Update on the Outcomes of Patients Treated with Urolift for Benign Prostatic Hyperplasia.

Benign prostatic hyperplasia (BPH) is a ubiquitous urologic disease affecting aging men. Patients often experience bothersome lower urinary tract symptoms (LUTS) that warrant urologic evaluation and management. Routinely, patients are initially treated with medical therapies with the goal of both relaxing the bladder neck and shrinking the prostate in order to relieve obstruction secondary to prostatic enlargement. Transurethral resection of the prostate (TURP) serves as a first-line surgical intervention in those who fail medical therapy. Recently, novel minimally invasive surgical techniques for BPH management have emerged. Of these, prostatic urethral lift (PUL or Urolift) has gained attention given its presumed effectiveness and minimal risk of sexual side effects when compared to the standard TURP. The purpose of this review is to describe past and current trends in the implementation of PUL for BPH and to highlight important outcomes.

Oliverio O. Segura, MD (1933-2021) Through A Son’s Eyes – A Tribute to Dad

Oliverio O. Segura, MD (1933-2021) Through A Son’s Eyes – A Tribute to Dad

14 Surgical management of mid- and upper-vaginal constriction rings

To review the diagnosis of mid- and upper-vaginal constriction rings and describe our technique for surgically correcting vaginal constriction rings. Causes of vaginal constriction include surgery, vaginal atrophy, conditions of the vulvovaginal skin, and radiation. It is imperative for the pelvic surgeon to be able to identify and adequately address vaginal constriction. In this video, we discuss the diagnosis and management of mid- and upper-vaginal constriction rings, an entity with an undefined etiology. Initial medical management may include vaginal dilation with use of vaginal estrogen. We present three techniques for surgical management: lysis of the constriction band, lysis of the band with use of a flap, and lysis of the band with use of a biologic graft. In our experience, lysis of the constriction ring perpendicular to its axis with immediate use of vaginal estrogen and vaginal dilators is sufficient for most cases. Cases of severe stenosis, prior failed surgical management, or a combination of stenosis and foreshortening may necessitate the use of a biologic graft or local flap. Pelvic surgeons should be familiar with the diagnosis and management of vaginal constriction rings. In this video, we review diagnosis and medical management and present 3 techniques for surgical correction of this condition.

Surgical management of the orbit in thyroid eye disease: lateral orbital decompression.

Lateral orbital wall decompression is one of many well established techniques available to surgeons in management of patients with clinically significant thyroid eye disease (TED). Several different surgical approaches have been described in the literature and are reviewed herein. Lateral orbital wall decompression remains a popular technique for surgical management of TED, with a recent American Society of Ophthalmic Plastic and Reconstructive Surgery survey showing that 22.6% of respondents preferred a single-wall procedure, with 36.8% of that subset preferring lateral wall decompression alone. Surgical techniques for lateral orbital wall decompression differ based on several steps, such as the incisional approach, whether to take an ab-interno versus ab-externo approach, and whether to remove orbital fat to achieve further decompression. In addition, technological advances have produced an array of tools available to the orbital surgeon to achieve efficient and accurate bone removal. Lateral orbital wall decompression for TED, despite being an older technique, remains a popular and well established procedure for orbital decompression. Though no randomized controlled clinical trial supports one decompression technique over another for TED, lateral orbital wall decompression offers many benefits such as its ease of access and visualization of the orbital space.

Early modified primary closure for treatment of cardiac implantable electronic device pocket infections.

Guidance for wound management of the vacated generator pocket in cardiac implantable electronic device (CIED) pocket infections after removal of all hardware and tissue debridement is limited. The typical surgical technique for management of a purulent wound is to allow healing by secondary intention. An alternative approach uses negative pressure wound therapy with or without delayed primary closure. While effective in managing infection, these approaches increase hospital length of stay and costs. We present our experience with a third option: modified early primary wound closure over a suction device. All patients with CIED pocket infections who presented to our institution between September 2018 and October 2020 underwent extraction of hardware and modified primary wound closure over a negative pressure Jackson-Pratt drain. Length of hospital and postoperative stay, complications, and recurrent infections were recorded. During the study period, 14 patients underwent modified primary wound closure for CIED pocket infections. Mean length of hospital stay was 6.64 days ± 4.01 days (standard deviation [SD]). Mean postoperative length of stay was 3.92 ± 2.21 days (SD). Two patients (both on intravenous heparin for mechanical valve prostheses) required re-exploration for bleeding. No patients developed recurrent infection at a mean follow up of 363 ± 245 days (SD). Based on our experience, early modified primary wound closure for CIED pocket infections appears to be safe and allows for prompt discharge with no observed re-infections.