Operative Time Research Articles

Meta-analysis of the efficacy of plate fixation and external fixator fixation in the treatment of AO-C type distal radius fractures

Meta-analysis of the clinical efficacy of plate and external fixator fixation in the treatment of AO-C type distal radius fractures. PubMed, Embase, Cochrane Medical Library, Web of Science, CNKI, Wanfang, VIP and SinoMed databases were searched for all literature on randomized controlled clinical trials of AO-C distal radius fractures. The search time limits were from each database. The database will be established until June 30, 2023. The included studies were extracted according to the Cochrane Handbook (Version 6.3, 2022) for information extraction and literature quality evaluation. RevMan 5.4 was used to evaluate the risk of Publication bias, test heterogeneity and Perform Meta-analysis. The outcome indicators were:imaging anatomy indicators (volar inclination angle, ulnar deviation angle, radial height), wrist joint mobility (flexion, extension, rotation, ulnar deviation), complication rate, and comparison of surgical treatments (operative blood loss, operation time, hospitalization time, fracture healing time) and wrist joint function scores and related scales. (1) A total of 28 studies were included, with a total of 2 192 patients, including 1 096 cases in the plate internal fixation group and 1 096 cases in the external fixation group.(2) Meta analysis results showed:the surgical treatment situation of the external fixation group:surgical blood loss MD=-37.93, 95%CI(-48.54, -27.31), P<0.000 01;operation time MD=-31.58, 95%CI(-48.96, -14.20), P<0.000 4;hospitalization time MD=-4.58, 95%CI(-5.44, -3.71), P<0.000 01;the fracture healing time MD=-0.88, 95%CI(-1.35, -0.41), P<0.000 2, which were significantly better than that of the plate internal fixation group(P<0.05).(3) The two groups:palmar inclination angle MD=-0.17, 95%CI(-0.95, 0.61), P=0.68;ulnar declination MD=0.22, 95%CI(-0.73, 1.17), P=0.65, radial height MD=-0.24, 95%CI(-1.15, 0.67), P=0.60;flexion and extension MD=-5.63, 95%CI(-11.85, 0.58), P=0.08;rotation MD=-5.80, 95%CI(-12.77, 1.17), P=0.10, radioulnar deviation MD=-2.86, 95%CI(-10.87, 5.15), P=0.48;complication rate RR=0.96, 95%CI(0.63, 1.46), P=0.83;Gartland-Werley clinical wrist score MD=0.13, 95%CI(-0.80, 1.06), P=0.78;excellent and good rate of Gartland-Werley wrist clinical score RR=0.93, 95%CI(0.87, 1.01), P=0.08;excellent and good rate of Cooney wrist score RR=0.99, 95%CI(0.62, 1.59), P=0.98;wrist DASH score MD=-4.67, 95%CI(-14.96, 5.62), P=0.37;the differences were not significant (P>0.05). Compared with internal fixation with plate, external fixation can significantly reduce the amount of surgical bleeding, shorten the operation time, hospitalization time and fracture healing time, and its imaging anatomical indicators, wrist mobility, and complications can be significantly reduced in treating AO-C distal radius fractures. Rates and wrist function scores were equivalent.

Outcomes and Challenges of Transumbilical Single-Port Sleeve Gastrectomy: A Retrospective Analysis Based on Height and BMI.

Transumbilical single-port sleeve gastrectomy (SPSG) is a minimally invasive bariatric surgery that offers cosmetic benefits. However, the procedure's feasibility in patients with higher BMI or taller stature remains debated. This study evaluates the outcomes of SPSG based on patient height and BMI. We conducted a retrospective analysis of 753 patients who underwent stand-alone SPSG at our hospital between January 2021 and August 2024. Patients' preoperative characteristics, intraoperative data, and postoperative outcomes were collected. We compared operative times, complication rates, and postoperative length of stay between patients with different height and BMI categories. The mean operative time was significantly longer for patients with a height ≥ 1.8m (77.5 ± 32.5min) compared to those < 1.8m (63.1 ± 26.0min) (p < 0.05). Similarly, patients with a BMI ≥ 50kg/m2 had a longer operative time (79.2 ± 32.0min) than those with a BMI < 50kg/m2 (62.9 ± 25.9min) (p < 0.005). No significant difference was observed in the postoperative complications rate and length of stay between the height and BMI groups. The mean 1year percentage of total weight loss (%TWL) was 31.1 ± 7.1%. SPSG is a feasible procedure for patients with varying heights and BMIs, though it may require longer operative times for certain groups. The procedure's success hinges on the surgeon's expertise and a thorough understanding of patient anatomy. Further research is necessary to optimize single-port techniques and assess long-term outcomes.

Balloon-assisted placement of rib graft in endoscopic posterior cricoid split; a new technique.

This study aims to compare the outcomes of balloon-assisted rib graft placement with traditional graft placement in Endoscopic Posterior Cricoid Split with Rib Graft Placement (EPCS/RG). We conducted a retrospective analysis of 23 patients who underwent EPCS/RG by a single senior surgeon at King Saud University Medical City from 2017 to 2024. Data were collected on demographics, surgical approach, and operative time. Statistical analyses included Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, with significance set at p-value < 0.05. Univariate binary regression was reported as Odds Ratio (OR) with 95% Confidence Interval (CI). Of the 23 cases, 16 (69.5%) utilized the balloon-assisted technique. Age ranged from 8 months to 19 years (median age 10 years). Older age was significantly associated with the balloon-assisted technique (OR 1.627, p-value 0.022). Balloon-assisted cases demonstrated longer split lengths and graft widths, though data limitations hindered definitive conclusions. Tracheostomy was avoided in 65.2% of cases. The operative duration averaged 240min, showing no significant difference between balloon-assisted or the standard techniques (OR 1.015, CI 0.993-1.038, p-value 0.177). Balloon-assisted rib graft placement in EPCS/RG facilitates surgical approach, particularly in older patients. It does not extend operative duration, offering a promising advancement in airway surgery. Level 3.

Efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures

To analyze the clinical efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures. A total of 64 patients with Gustilo ⅢC open fractures who were admitted to the hospital bewteen September 2018 and March 2022 were included, and divided into the observation group and the control group, with 32 cases in each one. In the observation group, there were 24 males and 8 females, aged from 29 to 42 years with an average of (36.59±3.24) years. The tibial defect ranged from 2 to 5 cm with an average of (3.41±0.61) cm, and the soft tissue defect area ranged from 34 to 76 cm2 with an average of (58.50±9.44) cm2. This group received microsurgical treatment. In the control group, there were 25 males and 7 females, aged from 27 to 44 years with an average of (37.59±3.21) years. The tibial defect ranged from 2 to 6 cm with an average of (3.59±0.80) cm, and the soft tissue defect area ranged from 36 to 78 cm2 with an average of (59.09±9.53) cm2. This group received conventional staged surgery, with plaster or brace fixation after initial debridement and appropriate internal fixation at a later stage. The Anderson scores, motor ability Fugl-Meyer scale, perioperative indicators, rehabilitation outcomes, and complications were compared between the two groups. The patients were followed up for a duration from 2.5 to 5.5 months with an average of (3.15±1.11) months. In the observation group, 19 patients were rated as excellent, 12 patients as good, 1 patient as fair, and no patients as poor. In the control group, 11 patients were rated as excellent, 13 patients as good, 6 patients as fair, and 2 patients as poor. The difference in outcomes between the two groups was statistically significant (P<0.05). The operation time, the hospitalization time, and the hospitalization cost in the observation group(4.39±0.69) h, (30.22±4.58) d, and (23, 500±3, 300) yuan, respectively were significantly lower than those in the control group(5.01±0.75) h, (33.28±3.74) d, and(30, 200±5, 200) yuan, respectively (P<0.05). Revascularization time(134.25±14.76) h, wound healing time(11.34±1.56) d, and fracture healing time(3.09±0.42) months in the observation group were significantly shorter than those in the control group(P<0.05) which were (189.36±22.17) h, (13.22±2.03) d and (4.02±0.57) months respectively. The motor ability(42.91±5.51) points, sensory function(46.19±3.53) points, and total Fugl-Meyer score(89.09±6.08) in the observation group were significantly higher than those in the control group(P<0.05) which were(35.19±4.27), (34.03±3.79), (69.22±6.32) points respectivdy. In the observation group, there were 1 case of refractory wound and 3 cases of complete nerve injury, which were lower than those in the control group (8 cases and 10 cases, respectively, P<0.05). The number of complications in the observation group was lower than that in the control group (P<0.05). Microsurgical technique can effectively shorten the wound and fracture healing time in patients with Gustilo Ⅲ C open fracture, improve limb movement ability, and reduce the risk of poor prognosis and complications.

Clinical efficacy of open reduction and internal fixation with plates versus minimally invasive Kirschner wire fixation for osteoporotic Colles' fractures

To compare the short-term clinical efficacy and safety of closed reduction with Kirschner wire fixation versus open reduction with plate fixation for treating osteoporotic Colles' fractures in middle-aged and elderly patients. Between January 2018 and January 2023, 119 patients with Colles fractures were retrospectively analyzed, including 39 males and 80 females, aged from 48 to 74 years old with an average of(60.58±6.71) years old. The time from injury to operation ranged 1 to 13 days with an average of (5.29±2.52) days. According to the surgical method, they were divided into Kirschner wire fixation group (Kirschner wire group) and plate internal fixation group (plate group). In Kirschner wire group, there were a total of 68 patients, comprising 21 males and 47 females. The average age was (61.15±6.24) years old, ranged from 49 to 74 years old. Among them, 41 cases involved the left side while 27 cases involved the right side. In the plate group, there were a total of 51 patients, including 18 males and 33 females. The average age was (59.78±5.71) years old ranged from 48 to 72 years old. Among them, there were 31 cases on the left side and 20 cases on the right side. The following parameters were recorded before and after the operation:operation time, intraoperative blood loss, hospitalization days, hospitalization expenses, postoperative complications, and radiographic parameters of distal radius (distal radius height, ulnar deviation angle, palmar tilt angle). The clinical efficacy was evaluated at 3 and 12 months after the operation using Gartland-Werley and disabilites of the arm shoulder and hand (DASH) scores. The patients in both groups were followed up for a duration from 12 to 19 months with an average of(13.32±2.02) months. The Kirschner wire group exhibited significantly shorter operation time compared to the plate group 27.91(13.00, 42.00) min vs 67.52(29.72, 105.32) min, Z=-8.74, P=0.00. Intraoperative blood loss was also significantly lower in the Kirschner wire group than in the plate group 3.24(1.08, 5.40) ml vs 21.91(17.38, 26.44) ml, Z=-9.31, P=0.00. Furthermore, patients in the Kirschner wire group had a shorter length of hospital stay compared to those in the plate group (8.38±2.63) days vs (11.40±2.78) days, t=-3.12, P=0.00. Additionally, hospitalization cost was significantly lower in the Kirschner wire group than in the plate group 10 111.29(6 738.98, 13 483.60) yuan vs 15 871.11(11 690.40, 20 051.82) yuan, Z=-5.62, P=0.00. The incidence of complications was 2 cases in the Kirschner wire group and 1 case in the plate group, with no statistically significant difference(P>0.05). At 3 months postoprative, the radial height of the Kirschner wire group was found to be significantly smaller than that of the plate group, with measurements of (11.45±1.69) mm and (12.11±1.78) mm respectively (t=-2.06, P=0.04). However, there were no statistically significant differences observed in ulnar deviation angle and palmar tilt angle between the two groups (P>0.05). The DASH score and Gartland-Werley score in the Kirschner group were significantly higher than those in the plate group at 3 months post-operation (19.10±9.89) vs (13.47±3.51), t=4.34, P=0.00;(11.15±3.61) vs (6.41±2.75), t=8.13, P=0.00). However, there was no significant difference between the two groups at 12 months post-operation (P>0.05). Compared to plate internal fixation, closed reduction with Kirschner wire support fixation yields a slightly inferior recovery of radial height;however, there is no significant disparity in the functional score of the affected limb at 12 months post-operation. Nonetheless, this technique offers advantages such as shorter operation time, reduced intraoperative blood loss, decreased hospitalization duration, and lower cost.

High Modified 5 Factor Frailty Index is Associated With Worse PROMs and Decreased Return to Activities After 1 or 2 Level MI-TLIF.

Retrospective cohort study. Frailty is defined as a state of minimal "physiologic reserve." The modified 5 factor frailty index (mFI-5) is a recently proposed metric for assessing frailty and has been previously studied as a predictor of morbidity and mortality. However, its utility in predicting postoperative patient reported outcomes (PROMs) and return to activities remains understudied. This is a retrospective cohort study of patients undergoing 1 or 2 level minimally invasive transforaminal lumbar interbody fusion queried from a prospectively maintained multi-surgeon registry. Comorbidities including hypertension, congestive heart failure, diabetes, chronic obstructive pulmonary disease, and functional status were utilized to calculate the mFI-5. Patients were separated into 3 cohorts, "non-frail," "moderately frail" or "severely frail" based on their mFI-5. Patient outcomes were compared between the cohorts. 392 patients were included of which 227 patients were non-frail, 134 were moderately frail, and 31 were severely frail. Frail patients had longer operative time (P = 0.002), greater estimated blood loss (P = 0.038). Despite similar preoperative PROMs, at a longer term follow up, frail patients also had worse PROM scores for ODI (P = 0.009), VAS-back (P = 0.028), and VAS-leg (P = 0.004). Frail patients had worse preoperative (P = 0.017) and postoperative (P < 0.001) SF-12 PCS. At 1-year, frail patients had lower rates of fusion (P = 0.002). Frail patients also demonstrated lower rates of returning to work (P = 0.018), returning to driving (P = 0.027), and discontinuation of narcotics (P = 0.004). Frail patients as measured by the mFI-5 index demonstrated worse postoperative outcomes following 1 or 2 level MI-TLIF. Careful patient selection and preoperative optimization may be especially important in frail patients.

Development of a nomogram model to predict postoperative urinary retention risk after transabdominal preperitoneal inguinal hernia repair.

To explore independent risk factors and to establish a predictive model for postoperative urinary retention (POUR) following transabdominal preperitoneal inguinal hernia repair (TAPP). Between January 2017 and December 2023, 598 patients with inguinal hernia who underwent TAPP at the General Surgery Department of Zunyi Medical University Affiliated Liupanshui Hospital were enrolled in the study. Participants were randomly divided into training and validation sets (7:3 ratio). The training set was further divided into POUR and non-POUR groups (38 and 381 cases, respectively). Independent risk factors for POUR were screened by logistic regression analysis. A nomogram predictive model was established based on the independent risk factors. The model's predictive ability was evaluated. Logistic regression revealed recurrent hernia (P = 0.013, OR = 0.279, 95% confidence interval [CI]: 0.105-0.805), BPH (P = 0.002, OR = 5.09, 95% CI: 2.658-96.282), preoperative catheterization (P = 0.004, OR = 0.087, 95% CI: 0.012-0.370), operation time (P < 0.001, OR = 0.015, 95% CI: 1.006-1.023), and use of narcotic analgesics (P = 0.042, OR = 2.224, 95% CI: 1.021-5.222) as independent risk factors for POUR after TAPP. Discriminant analysis showed the training set AUC was 0.763 (95% CI: 0.684-0.842, P < 0.001) while that for the validation set was 0.812 (95% CI: 0.677-0.947, P < 0.001). The Hosmer-Lemeshow test was performed to assess calibration of the training (P = 0.696) and validation (P = 0.194) sets. Recurrent hernia, BPH, preoperative catheterization, operation time, and use of narcotic analgesics were identified as independent risk factors for POUR after TAPP. The nomogram model for risk prediction based on these factors has strong predictive performance and application prospect.

Upper Blepharoplasty for Dermatochalasis With or Without Resection of the Orbicularis Oculi Muscle, Preaponeurotic and Nasal Fat Pads: A Comparative Study.

Upper blepharoplasty is the gold standard procedure for upper eyelid dermatochalasis. Upper blepharoplasties procedures include removing the skin, orbicularis oculi muscle, preaponeurotic, or nasal fat pad. The purpose of this study is to report surgical outcomes and compare them to the most common techniques. A retrospective review of 386 consecutive patients who underwent upper blepharoplasty at Turku University Hospital from January 1st, 2015 to June 30th, 2017 was conducted. Data collected include patient demographics, surgical details, and details regarding the type and frequency of complications. During the study period, 51 upper blepharoplasties with orbicularis oculi muscle excision, skin, preaponeurotic and nasal fat pads removal (study group) and 335 upper blepharoplasties with skin only removal (control group) were performed. Non-parametric tests showed that operative time (M=60.2min; SD=11.7min) and return to work (M=8.0days; SD=3.1days) were significantly shorter in the control group. No significant differences in the total amount of complications were detected (7.8% vs 2.4%, p=0.075). Subjective patients' satisfaction was significantly higher in the study group (from 0-10, mean 8.3 vs 7.0, p=0.034). When compared to skin-only blepharoplasty, upper blepharoplasty with orbicularis oculi muscle excision, removal of skin, preaponeurotic and nasal fat pad appears to be a safe surgery with improved patient satisfaction and without carrying on additional complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Woven EndoBridge and stent-assisted coiling for treatment of acutely ruptured wide-neck bifurcation aneurysms: Single-center experience.

Treating wide-necked bifurcation aneurysms (WNBA) is challenging. Nevertheless, recent progress in endovascular techniques is promising. Woven EndoBridge devices (WEB) have exhibited outcomes comparable to conventional treatments like stent-assisted coiling (SAC) in treating aneurysms. However, their safety and efficacy in managing acutely ruptured aneurysms remain a topic of interest. This study focuses on this issue. We searched our database from 2020 to 2023 and found 38 patients with acutely (< a week) ruptured WNBA. We extracted radiologic and clinical data from the available medical reports. Favorable functional and radiologic outcomes were assessed using the modified Rankin scale (mRS) and modified Raymond-Roy occlusion classification (MRRC). Our study population comprised 15 aneurysms treated with WEB and 25 treated with SAC. Operational time was significantly lower in the WEB compared to the SAC group (39.3 vs 66.2 minutes, p value: < 0.001). Immediate (p value=0.64) and the 18th-month (p value=0.42) occlusion rates were comparable between the two groups. Favorable mRS scores in the 3rd month were seen in 100% of SAC patients and 93.3% of WEB patients (p value=0.79). Retreatment (p value=1.0) and complication (p value=0.39) rates were comparable. Vasospasms after the procedure were the most common complication. WEB demonstrated comparable safety and efficacy to SAC in patients with acutely ruptured WNBA. Notably, WEB had a shorter procedure duration. Additional studies with extended follow-up periods are necessary for comprehensive evaluation.

A novel posterior decompression technique (anterior sliding decompression osteotomy) for beak-type ossification of the posterior longitudinal ligament in the thoracic spine.

Conventional decompression surgery for beak-type ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine, whether approached anteriorly or posteriorly, poses several challenges, including technical complexity, cerebrospinal fluid leakage, incomplete decompression, and potential neurological deterioration. Therefore, the authors introduce a novel technique, anterior sliding decompression osteotomy (ASDO), for thoracic myelopathy caused by OPLL and evaluate the efficacy and safety of this technique. Six patients (4 men and 2 women) who underwent ASDO surgery for beak-type OPLL in the thoracic spine with a follow-up period of at least 2 years were included in the cohort. Clinical and surgical outcomes, including modified Japanese Orthopaedic Association (mJOA) score, neurological recovery rate, canal occupying ratio, operation time, and blood loss, were evaluated. The mean ± SD follow-up period was 26.5 ± 2.0 months. The mean mJOA score improved from 6.0 to 9.7, with the mean recovery rate reaching 63.6% at 6 weeks postoperatively to 73.9% at 2 years after surgery. Neural decompression was effective in all patients, reducing the mean canal occupying ratio from 70.8% to 29.1% without complications. ASDO surgery achieves sufficient spinal cord decompression for beak-type OPLL in the thoracic spine. It represents an effective, feasible technique, offering surgeons a familiar view from the conventional posterior approach.

Increased stiffness with medial column screw supplementation of lateral locking plate for distal femur fractures: a biomechanical study.

We propose and assess the biomechanical stability of medial column screw supplementation in a synthetic distal femur fracture model. Twenty-four low density synthetic femora modeling osteoporotic, intraarticular distal femur fractures with medial metaphyseal comminution were split into two fixation groups: (1) lateral locking distal femur plate (PA- plate alone) and (2) lateral locking distal femur plate with a 6.5mm fully threaded medial cannulated screw (PWS- plate with screw). Cyclic biomechanical testing included 5 steps of 10,000 cycles with each step increasing axial loads starting at 0.5xBW (BW = 80kg) up to 2.5xBW. Discrete stiffness was calculated for each step and cumulative stiffness was calculated across the entire protocol. Outcomes of interest included cumulative stiffness, discrete stiffness, and instrumentation failure. Seven of the PA models had failure during testing. No failures were seen in the PWS group. PWS had 19.8% higher cumulative stiffness compared to PA (676.3 N/mm vs 809.8 N/mm; P = 0.014). Discrete stiffness showed < 1% differences at lower loads, but increasing loads found the PWS group with 12% greater discrete stiffness than the PA group (879.1 N/mm vs 983.8 N/mm; P = 0.028). This is the first study to evaluate the contribution of a medial column screw in a distal femur fracture model. PWS had superior stiffness and few failures compared to PA. Applied clinically, a medial column screw can increase construct stability in the setting of complex distal femur fractures with minimal increase in operative time, patient morbidity and cost.

Effects of abdominal, vaginal, and laparoscopic hysterectomies on total oxidant/antioxidant levels: A prospective observational study.

This prospective observational study aimed to compare abdominal hysterectomy (AH), vaginal hysterectomy (VH), and total laparoscopic hysterectomy (TLH) in terms of oxidative stress (OS) by measuring serum levels of total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). Of the 3 groups, namely, AH, VH, and TLH, 22 patients were enrolled in each to investigate the aim of the study mentioned above. Patient demographics, clinical and surgical characteristics, and preoperative and postoperative (0th and 24th hours) serum TAS, TOS, and OSI levels were investigated. The groups differed significantly based on surgical indications (P < .001). While abnormal uterine bleeding was more prevalent in the AH (95.5%) and TLH (77.3%) groups, pelvic organ prolapse (POP) was more prevalent in the VH group (90.1%). The mean age and menopausal patient rates were significantly higher in the VH group than in the AH and TLH groups (P < .001). The groups did not differ significantly in terms of simultaneous bilateral salpingo-oophorectomy rates (P = .10). However, additional POP surgery was performed in 14 patients in the VH group. The mean operative time was significantly shorter in the AH group than in the VH and TLH groups (P = .001). The groups did not differ significantly based on either the preoperative or postoperative serum TAS levels (P > .05). Furthermore, the change in serum TAS levels over time was not significant in any of the groups (P > .05). In contrast, preoperative serum TOS and OSI levels were significantly higher in the VH group than in the AH and TLH groups (P < .05). The groups did not differ significantly in terms of serum TOS and OSI levels at 0th and 24th hours postoperatively (P > .05). Serum TOS and OSI levels increased dramatically over time in the AH and TLH groups (P < .05), but not in the VH group (P > .05). post hoc analysis showed that the changes in serum TOS and OSI values in the AH and TLH groups were between the preoperative and postoperative 0th hour levels (P < .001). Our results indicated that the total antioxidant capacity was preserved in all 3 techniques. However, VH causes less OS than the other hysterectomy techniques.

Cost and outcomes of side-to-side versus end-to-end anastomosis in right colectomy: a retrospective cohort study.

The optimal anastomotic configuration for right-sided colectomies remains controversial, with comparable postoperative outcomes across techniques. Thus, economic considerations may play a larger role in decision-making within cost-constrained healthcare settings. This retrospective cohort study evaluated right-sided colectomies with ileocolic anastomosis at a Swiss tertiary center between 2016 and 2021. We compared costs and outcomes among three anastomotic techniques: end-to-end (EE), side-to-side stapled (SSS), and side-to-side hand-sewn (SSH). Out of 468 patients (mean age 67.7 ± 16.2years; 51.7% female), EE was used in 95 cases (20.3%), SSS in 191 (40.8%), and SSH in 182 (38.9%). The majority (72.0%) underwent elective surgery. Insurance coverage included basic (62.2%), semi-private (24.2%), and private (13.7%). Mean operation times were shortest for EE (173.6 ± 72.3min), followed by SSS (188.0 ± 65.4min) and SSH (195.1 ± 61.5min). The median total costs were 26,449€. The SSS group had the lowest median total costs, 2424€ less than SSH and 2095€ less than EE, with no significant differences (p = 0.1657). Significant differences were observed in operating room (OR) costs, with EE being the lowest and SSH the highest (p < 0.0001). Adjusted OR costs in SSH were 23% more than EE and 21% more than SSS. No significant difference was found between EE and SSS OR costs. For mean OR material costs, EE had the lowest, followed by SSS and SSH. Adjusted costs for EE were 52% lower than SSS (p = 0.0005) and 65% lower than SSH (p = 0.0191). Clavien-Dindo Grade ≥ III complication rates were 2.1% for EE, 1.9% for SSH, and 3.0% for SSS. Anastomotic leakage occurred in 12 cases (2.6%), and in-hospital mortality was 0.9% (no deaths in EE; two in SSS and SSH each). EE anastomosis was associated with the lowest OR and material costs in this retrospective analysis while no disadvantages concerning postoperative outcomes could be identified.

Prediction of implant failure risk due to periprosthetic femoral fracture after primary elective total hip arthroplasty : a simplified and validated model based on 154,519 total hip arthroplasties from the Swedish Arthroplasty Register.

While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA). We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm. The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral heads increased both revision and reoperation risks. This is the first study to develop machine-learning models to forecast the risk of PPFF necessitating secondary surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice.

Clinical and Radiological Comparison of Unilateral Biportal Endoscopic and Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Spinal Degenerative Disease.

Unilateral biportal endoscopic discectomy (UBE) is an emerging and minimally invasive surgeryfor lumbar spinal degenerative disease. However, the efficacy, safety and the radiological changes of dural sac and paraspinal muscle of UBE compared with the conventional percutaneous transforaminal endoscopic discectomy (PTED) remains to be determined. The purpose of the study was to comprehensively compare the clinical efficacy between UBE and PTED in the surgical treatment of lumbar spinal degenerative disease. The clinical and radiological data of patients who underwent single-segment endoscopic surgery for lumbar spinal degenerative disease in our hospital from January 2021 to June 2022 were collected in the retrospective study. The visual analogue score (VAS) for back and leg pain, Oswestry disability index (ODI) before and 3, 6, and 12 months postoperative, changes of the cross-sectional area of the dural sac area and paraspinal muscles on axial T2-weighted MRI, operation time, intraoperative complications, MacNab criteria for evaluating efficacy at 12 months postoperatively, and recurrence rate of symptoms within 12 months were compared between patients undergoing PTED and UBE surgeries. A total of 142 patients were included. Among them 74 patients underwent PTED surgery, and 68 patients underwent UBE surgery. No statistically significant differences were identified between the groups in demographic variables. The average VAS and ODI scores in both groups showed significant improvement during the follow-up but without statistically significant difference between the groups. The average operation time in the PTED group was 74.82 ± 19.49 min shorter than the 81.36 ± 21.37 min in the UBE group, exhibiting no statistically significant difference. Although the incidence of complications and recurrence was lower in the UBE group (4.05% vs. 1.47%, p = 0.354; 4.05% vs. 1.47%, p = 0.354, respectively), these differences did not reach statistical significance. The dural sac area in the PTED group increased byan average of 43.16 ± 14.62 cm2, and it was 68.53 ± 16.42 cm2 in the UBE group. Despite the dural sac area increased in both groups, the UBE group had a statistically significant greater improvement than the PTED group (p = 0.000). The area of the paraspinal muscle in the UBE group was significantly greater postoperatively (34.54 ± 2.75 cm2 vs. 36.22 ± 2.96 cm2, p = 0.001) and significantly less than in the PTED group at 12 months postoperatively (31.17 ± 2.59 cm2 vs. 29.46 ± 3.11 cm2, p = 0.001). Both PTED and UBE surgeries can achieve satisfactory improvement in symptoms and function for patients with lumbar spinal degenerative disease and can be well-maintained as a first-line minimally invasive treatment. However, the UBE technique can achieve a better decompression area to restore the normal shape of the dural sac but may lead to greater paraspinal muscle damage and atrophy.

Different sides of craniotomy for anteriorly superiorly projecting anterior communicating artery aneurysm clipping: outcome and long-term cognitive function: A single-center retrospective study.

We explored the impact of various craniotomy approaches on the outcomes and long-term cognitive function of microsurgical clipping for superiorly projecting anterior communicating artery (ACoA) aneurysms. We retrospectively analyzed 127 superiorly projected ACoA aneurysms underwent microsurgical clipping between January 2014 and January 2022. Patients were categorized into two types: type 1 (70 patients), characterized by the posterior positioning of the ipsilateral A2 segment (open A2 plane side), and type 2 (57 patients), characterized by the anterior positioning of the ipsilateral A2 segment (closed A2 plane side). The analysis focused on clinical outcomes (modified Rankin Scale score, mRS) and long-term cognitive function (Montreal Cognitive Assessment, MoCA). No significant differences in initial attributes were observed between the two groups. No differences in mRS (P = 0.483), cognitive impairment (P = 0.190), or severe cognitive impairment (P = 0.332) between the two groups. Furthermore, no significant differences in delayed cerebral ischemia (P = 0.852), delayed bleeding (P = 0.912), or intraoperative rupture (P = 0.141) between the two groups. However, the occurrence of MoCA subcategories of postponed memory items (P < 0.05) and conceptualization items (P < 0.05) demonstrated a significant decrease on the accessible A2 plane side during a shorter operative time (P = 0.03) and reduced gyrus rectus aspiration frequency (P = 0.000). The anterior position of the A2 segment can offer better visualization of the aneurysm dome, bilateral A2, and AcoA, leading to reduced operative time and gyrus rectus aspiration frequency, potentially enhancing long-term cognitive function.

Delirium after deep brain stimulation for Parkinson's disease: a meta-analysis of incidence and risk factors.

Deep brain stimulation (DBS) is a valuable treatment for Parkinson's disease (PD), but postoperative delirium (POD) is a common complication. Understanding the risk factors for POD is crucial for optimizing patient selection and developing preventative measures. This systematic review and meta-analysis aims to identify predictors of POD in PD patients undergoing DBS surgery. We conducted a comprehensive search of four major databases for cohort studies on POD in patients undergoing DBS for PD, up to June 2024. Two reviewers independently screened studies, assessed the risk of bias using the Newcastle-Ottawa Scale, and extracted data. Meta-analysis was conducted using Review Manager, with heterogeneity assessed the I2 statistic and chi-square p value. Subgroup and sensitivity analyses were also performed to explore the consistency of findings. Eleven studies, including 1,368 patients, were analyzed to determine the incidence of POD in PD patients undergoing DBS. The incidence of POD in PD patients undergoing DBS, which was found to be 21% (95% CI: [14.6%, 27.4%]). Age, Mini-Mental State Examination (MMSE), and Non-Motor Symptom Scale (NMSS) were significant predictors, with effect sizes of (OR = 1.10, 95% CI: [1.06, 1.15], P < 0.00001), (OR = 0.85, 95% CI: [0.72, 1.00], P = 0.05), and (OR = 1.01, 95% CI: [1.00, 1.02], P = 0.04), respectively. However, gender, UPDRS-III ON score, brain atrophy, diabetes, Hamilton Anxiety Score (HAMA), operation time, disease duration, BMI, and cerebral infarction were not significant predictors. This meta-analysis suggests that age, cognitive function, and non-motor symptoms are important factors associated with POD patients undergoing DBS surgery. Further research with larger sample sizes and diverse populations is needed to confirm these findings and identify more specific predictors.

Robotic extended total extraperitoneal transversus abdominus release for traumatic flank and abdominal intercostal hernias.

Traumatic abdominal intercostal/flank hernias present a perplexing challenge for surgeons seeking to repair them. There has been a paucity of studies describing robotic repairs of such hernias. We aim to evaluate the effectiveness of the Robotic-assisted Extended Total Extraperitoneal/Transversus Abdominus Release (rETEP/TAR) method in repairing traumatic abdominal intercostal and flank hernias. Patients with traumatic abdominal intercostal hernias at a high-volume hernia center between 2019 and 2022 were identified and retrospective data including patient demographics, perioperative parameters, postoperative complications and up to a three-year follow-up were collected for those undergoing rETEP/TAR. Robotic ETEP access was gained through the retro-rectus space ipsilateral to the hernia, using a transversus abdominis release performed laterally to the level of the posterior axillary line. Dissection was completed from the pelvis to the central tendon as necessary. A total of 8 patients were analyzed. All patients suffered traumatic or Valsalvainduced hernias. The average age was 54 +/-15yrs. The mean defect size was 11x17cm. Heavyweight uncoated polypropylene mesh was placed in the retromuscular space and secured with transfascial suture. Mean mesh size was 34x30cm and mean operative time was 216 +/- 69 minutes. The median length of stay was 1 day. All patients reported improvement in pain without any evidence of recurrence at postoperative follow-up. This study demonstrates that the Robotic-assisted ETEP/TAR technique is an effective way of repairing abdominal intercostal and flank hernias.

Efficacy and Safety of Endovenous Microwave Ablation versus Endovenous Laser Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency: A Meta-Analysis.

Although guidelines have established endovenous laser ablation (EVLA) as the first-line option for patients with varicose veins (VVs) in chronic Great saphenous vein (GSV) insufficiency, however, Chronic Vein Insufficiency (CVI) remains a significant healthcare burden. Endovenous microwave ablation (EMA) is a promising alternative. This review aims to analyze the Endovenous Microwave Ablation versus Endovenous Laser Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency METHODS: Randomized controlled trials (RCTs) and cohort studies across PubMed, Scopus, Science Direct, and the Cochrane Library up to November 11, 2024 was searched. Risk of bias was evaluated using Cochrane Risk of Bias Tool for RCT and Newcastle-Ottawa Scale (NOS) for Cohort studies. Meta-analysis was done using RevMan 5.4.0 using an inverse-variance random-effects model with Duval and Tweedie trim-and-fill sensitivity analysis. Overall, a total of 2 RCTs and 1 cohort study included. In treating GSV VVs, EMA has proven to have shorter duration of operation significantly compared to EVLA (MD: -6.62 [95% CI: -11.91, -1.32, p = 0.01]) although heterogeneity is high. EMA have similar profiles in efficacy compared to EVLA (Aberdeen score of QoL, VAS Score, length of hospital stays, and recanalization rate in 6-months). In terms of safety, the incidence of ecchymosis was found to be lower in the EMA group compared to the EVLA group significantly (OR: 0.58). Other safety profiles were found to be similar. EMA might lower operating time, potentially reducing procedure risks, and is equally effective as EVLA in treating VVs in chronic GSV insufficiency. Further research comparing these techniques with extended follow-up periods (over 12 months) and standardized study methodologies are still needed.

Staged thoracoscopic internal traction approach for early repair of long-gap esophageal atresia (LGEA) with distal tracheoesophageal fistula (TEF)

BackgroundLong-gap esophageal atresia (LGEA) can complicate the management of esophageal atresia (EA) with or without a tracheoesophageal fistula (TEF). This series describes a short interval, staged, thoracoscopic internal traction approach for LGEA with distal TEF to manage complex anastomotic tension or an anatomically impossible esophageal anastomosis.MethodsA retrospective review (2018–2024) was performed across four tertiary centers to identify patients with LGEA and distal TEF, managed with a staged, thoracoscopic internal traction approach. In the first stage, the TEF was ligated and internal traction sutures were placed between esophageal pouches. In the second stage, patients underwent primary anastomosis. Short and long-term complications and outcomes were measured.ResultsIn total, seven patients were treated with this approach. Gestational ages ranged from 33 to 39 weeks. The average age at the initial surgery was 2.3 days, and the average age at definitive anastomosis was 15.9 days. There were no cases of leak or esophageal dehiscence. Gastroesophageal reflux was a common post-operative complication, occurring in 85.7% of patients.ConclusionsTemporary internal traction sutures allow for a minimally invasive, safe repair of LGEA with distal TEF, under decreased tension. This technique reduces operative time, and potential complications associated with other long-gap anastomotic techniques.Level of evidenceIV.