Total Complication Rate Research Articles

Neoadjuvant Chemoradiotherapy vs. Neoadjuvant Chemotherapy for the Treatment of Esophageal Squamous Cell Carcinoma: A Stabilized Inverse Probability of Treatment Weighting Analysis

<h3>Purpose/Objective(s)</h3> To compare long-term survival and safety of neoadjuvant chemotherapy (nCT) and neoadjuvant chemoradiotherapy (nCRT) in patients with esophageal squamous cell carcinoma (ESCC). <h3>Materials/Methods</h3> In 2012ཞ2020, patients diagnosed with ESCC were documented in the National Cancer Center database. as follows: 1) 18-75 years old; 2) histologically proven as stage T1-2N+M0 or T3-4N0-3M0; 3) histologic subtype was ESCC; 4) R0 resection; 5) radiotherapy dose ≥ 40Gy for primary tumor and metastatic lymph nodes. Stabilized inverse probability of treatment weighting (sIPTW) were used to minimize bias due to potential confounding factors, including sex, age, tumor location, tumor length, TNM clinical stage. The outcome included overall survival (OS), disease-free survival (DFS), pathological complete responses (pCR), and perioperative mortality and morbidity. <h3>Results</h3> A total of 419 patients (male,8 7.1%; mean age, 59.7 years) were enrolled to the nCRT group (n=158) or the nCT group (n=261). median follow-up time was 26 (7ཞ113) months in the nCRT group and 24 (7ཞ101) months in the nCT group, respectively. The chemotherapy regimen of nCT group was paclitaxel combined with platinum every 21 days with a median cycle of 3 (1ཞ4). In nCRT group, paclitaxel and platinum was performed weekly with a median of 3 cycles. The median radiotherapy dose for primary tumor and metastatic lymph nodes of 45Gy (40ཞ50.4Gy), 1.8ཞ2.14Gy/fraction, was delivered by intensity-modulated radiotherapy (IMRT) or volumetric intensity modulated arc therapy (VMAT). nCRT significantly improved the pCR rate as compared to nCT group (28.5% vs 9.2%, <i>P</i><0.001). The 1, 3 and 5-year OS in the nCRT and nCT group were 96.2% vs 98.1%, 78.4% vs 70.3% and 67.9% vs 53.3%, respectively (<i>P</i> =0.140). The incidence of anastomotic leak was in 13 of 158 patients (8.2%) in the nCRT group and 4 of 261 patients (1.5%) in the nCT group (<i>P</i> The total postoperative complications rate was 10.1% in the nCRT group (16 of 158) and 7.7% in the nCT group (20 of 261). After sIPTW, the clinical and demographic characteristics of the two groups were well balanced. The nCRT group was associated with a better OS than the nCT group (96.7% vs 97.6% at 1 year; 81.0% vs 69.2% at 3 years and 72.6% vs 48.2% 5 years, <i>P</i>=0.04). <h3>Conclusion</h3> Compared to nCT, paclitaxel and platinum-based nCRT using IMRT or VMAT technique improved OS in ESCC patients. Prospective head-to-head comparison and novel strategies with advanced drug therapy and radiotherapy technique to improve the outcomes in resectable ESCC are warranted.

One-stage versus two-stage Roux-Y gastric bypass as redo surgery of failed adjustable gastric banding.

The study focussed on whether a one-stage Roux-Y gastric bypass (OS-RYGB) or a two-stage RYGB (TS-RYGB) has a significant advantage in terms of perioperative risk in patients after failed adjustable gastric banding (AGB). Data collection included patients who underwent OS-RYGB or TS-RYGB after AGB between 2005 and 2019 and whose outcomes were compared with those after primary RYGB (P-RYGB). Outcome criteria were perioperative complications, comorbidities, 30-day mortality and operating time. The study analysed data from patients who underwent OS-RYGB (N = 525), TS-RYGB (N = 382) and P-RYGB (N = 26,445). Intraoperative and postoperative complication rates were significantly lower for P-RYGB (p < 0.001). Total intraoperative and specific postoperative complication rates were significantly lower in TS-RYGB than in OS-RYGB (p = 0.048 and p < 0.001, respectively). In contrast, the total general postoperative complication rate was lower in OS-RYGB than in TS-RYGB (p < 0.001). The mean operating time differed significantly among the three groups (P-RYGB 96.5min, OS-RYGB 141.2min and TS-RYGB 190.9min; p < 0.001). The mortality rate was not significantly different between the three groups. Based on the significant difference between the two groups in revision surgery and the slight difference with the results of primary RYGB, this study concludes that removal of a failed AGB is safe and feasible with either the OS- or TS-RYGB procedure. However, we cannot directly recommend either procedure in our study. Proper patient selection and surgeon experience are critical to avoid potential adverse effects.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy.

BACKGROUNDAcute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction (PCCI). PCCI affects the structure of the posterior circulation brain, because posterior part of the brain, which has more complex anatomical structures and more prone to posterior circulation vascular variation. Therefore, improving the prognosis of PCCI patients is necessary.AIMTo explore the effect of medical care linkage-continuous management mode (MCLMM) on endovascular interventional therapy (EIT) for PCCI.METHODSSixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group, and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group. The incidence of postoperative complications, compliance and disease self-management behavior after six months of intervention, modified Rankin scale (mRS) and Barthel index (BI) scores in the acute phase and after one year of intervention, and recurrence within one year were compared between the two groups.RESULTSThe total incidence rate of postoperative complications in the observation group (7.69%) was lower than that in the control group (18.84%) (P < 0.05). The scores for medical compliance behavior (regular medication, appropriate diet, and rehabilitation cooperation rates) and disease self-management behavior (self-will, disease knowledge, and self-care ability) in the observation group were higher than those in the control group (P < 0.05). After one year of intervention, in the observation group, the mRS score was significantly lower, and the BI score was significantly higher than those in the control group (P < 0.05). The recurrence rate within one year in the observation group (3.85%) was significantly lower than that in the control group (13.04%) (P < 0.05). CONCLUSIONMCLMM can reduce the incidence of complications after EIT for PCCI, improve patient compliance behavior and disease self-management ability, and promote the recovery of neurological function.

OC-039 WHAT IS THE INFLUENCE OF FEMALE GENDER AND FEMORAL HERNIA ON PERIOPERATIVE OUTCOME IN GROIN HERNIA REPAIR?

Abstract Groin hernias are rare in women compared to men. The proportion of women in the overall collective of operated groin hernias is between 8–12%. The rate of femoral hernias in women is higher than in men. Femoral hernias account for 3% of all primary groin hernias and 18% of all groin hernias in females. Very little is known about the influence of female gender and a femoral hernia on the outcome in groin hernia repair. For this retrospective analysis of prospectively collected data from the Herniamed Registry 347.054 primary elective unilateral groin hernia repairs were selected. 42.595 (12.3%) procedures have been performed in females. 10.265 (3%) patients had a femoral hernia. A multivariable analysis was undertaken to investigate the influence of confirmatory defined patient- and procedure-related characteristics on the perioperative outcome. A significantly favorable correlation was found between the total perioperative complication rate and female gender (OR =0.886; 0.844–0.931) p&amp;lt;0.001. Other factors with positive impact on the perioperative outcome are the laparo-endoscopic approach, smaller defects, medial defects and normal weight. A significantly unfavorable relation was identified between the total perioperative complication rate and a femoral hernia (OR =1.172; 1.095–1.254)p&amp;lt;0.001. Other unfavorable influencing factors on the perioperative outcome are higher age, higher ASA score, antithromboric medication, smoking, COPD and corticosteroid medication. The risk of perioperative complications is lower in female compared to male groin hernia repair, but not in femoral hernias.

Effect of new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation on patients with pelvic organ prolapse and their postoperative quality of life.

ObjectiveThis study aims to explore the effect of new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation on patients with pelvic organ prolapse (POP) and their postoperative quality of life.MethodsA total of 88 patients with POP and elective surgery admitted to Anqing Hospital affiliated to Anhui Medical University from March 2018 to March 2021 were retrospectively analyzed. According to their surgical methods, patients were divided into an observation group [44 cases, all underwent new-style anterior and posterior vaginal wall repair combined with modified ischial spine fascia fixation (new-style APVR-modified ISFF)] and a control group [44 cases, all underwent traditional anterior and posterior vaginal wall repair combined with sacrospinous ligament fixation (traditional APVR- SLF)]. The perioperative indicators were compared between the two groups. The pelvic floor function, pelvic organ prolapse quantification (POP-Q) classification, and quality of life were observed before operation, 3 months after operation, and 6 months after operation. All patients were followed-up.ResultsCompared with the control group, the observation group had more advantages in intraoperative blood loss, operation time, urinary catheter indwelling time, postoperative anal exhaust time, and hospitalization time (P < 0.05). In terms of pelvic floor function, patients of both groups showed significant improvement at 3 months and 6 months after surgery (P < 0.05). In terms of quality of life, the two groups exhibited significant improvement at 6 months after surgery (P < 0.05). PFIQ-7, PFDI-20, and UDI-6P of the observational group were lower than those of the control group, while PISQ-12 was higher than that of the control group but all with no significant difference (P > 0.005). In addition, the total complication rate of the observation group was 2.27% (1/44), which was significantly lower than 22.73% (10/44) of the control group (P < 0.05).ConclusionNew-style APVR-modified ISFF can effectively treat POP and improve the quality of life of such patients, with less postoperative complications and high safety.

Factors associated with immediate and early extubation in pediatric living-donor liver transplant recipients.

The practice of prompt extubation after adult liver transplantation has increasingly been applied in the pediatric population. Therefore, the factors contributing to this intervention should be identified in order to minimize failures. We sought to determine the factors associated with immediate and early extubation in pediatric living-donor liver transplant recipients. The medical records of pediatric liver transplant recipients at our center from January 2013 to December 2021, a 9-year period, were retrospectively collected and divided into early or delayed extubation groups. Factors associated with early extubation were determined using univariate and multivariate analyses, as the primary outcome. Comparisons of the postoperative management and outcomes between groups were evaluated as secondary outcomes. Seventy-nine patients were included in the analysis, of whom 19 (24%) were immediately extubated in the operating room while 12 patients (15%) were extubated early, within 24 h postoperatively. These 31 patients (39%) were assigned to the early extubation group, whereas the others were assigned to the delayed extubation group. Shorter anhepatic time was the only factor associated with early extubation (adjusted odds ratio=0.52; 95% confidence interval: 0.30, 0.89 per 30-min increment; p-value=.018) in patients with the same characteristics, including diagnosis, total operative time, and intraoperative volume of albumin and packed red blood cells. The length of intensive care unit stay was shorter in the early extubation group than in the delayed extubation group (p=.001). The rates of total and early medical complications and total reintubation in 30 days were significantly higher in the delayed extubation group than in the early extubation group (p-value=.002, .044, and .006 respectively). There were no significant differences in the length of hospital stay between the groups. Our findings indicated that 39% of the pediatric living donor-liver transplantation patients tolerated early extubation and that the only associated factor was anhepatic time. Early extubation significantly reduces the number of days of intensive care unit stay but may not change the length of hospital stay.

Rates of implantable cardioverter defibrillator implantation and outcomes in octogenarians or older compared to non-octogenarians in a statewide cohort from 2009 to 2018

Abstract Background Octogenarians are underrepresented or excluded in major implantable cardioverter defibrillator (ICD) trials. The deployment of ICDs and their real-world outcomes in octogenarians is unclear. Purpose To investigate the prevalence and outcomes of ICD implantation in octogenarian or older vs non-octogenarian. Methods We extracted details of all ICD implanted statewide from 2009–2018 including patient's characteristics, in-hospital complications and mortality using the Centre-for-Health-Record-Linkage administrative datasets. Implantation rates were adjusted for the population size by sex, age-groups in decade and calendar-year. Analysis was stratified by age &amp;lt;80 vs ≥80yo. Results There were 9304 admissions (12.1% ≥80yo) for de novo ICD implantation (mean±SD implantation: 1163±122 cases per-annum). The mean age for ≥80 vs &amp;lt;80yo groups was 83.5±2.9yo vs 66.2±12.1yo respectively (overall cohort mean age 66.1±13.1yo). Total ICD implantations increased by 8.4±12.4% vs 1.8±8.4% per-annum for ≥80 vs &amp;lt;80yo groups. The mean implantation rates were 52.7±10.8 vs 22.0±2.8 per-100,000-persons in ≥80yo compared to &amp;lt;80yo, respectively, with rates increasing at 7.7±18.3% per-100,000-persons-per-annum in ≥80yo. In contrast, implantation rates declined slightly by 0.2±12.4% per-100,000-persons-per-annum in &amp;lt;80yo groups. There was a non-significant trend towards more in-hospital non-fatal complications in ≥80yo compared to &amp;lt;80yo (10.8% vs 9.0% respectively, p=0.054), with no difference in in-hospital mortality (0.6% vs 0.4% respectively, p=0.32). The 1-year mortality was 10.7% in ≥80yo compared to 4.7% in &amp;lt;80yo (p&amp;lt;0.001), and 2-year mortality was 20.2% vs 8.8% respectively (p&amp;lt;0.001). The 1-yr and 2-yr mortality hazard ratio for ≥80yo was 2.0 (95% confidence interval [CI] 1.6–2.5, p&amp;lt;0.001) and 2.2 (95% CI 1.8–2.5, p&amp;lt;0.001) respectively after adjusting for sex, year of implantation, referral source, indications for ICD, and comorbidities. Overall, the annual rates of total in-hospital non-fatal complications and mortality did not alter significantly during the study period. Conclusion Despite limited clinical trials data on efficacy of ICD use in octogenarians or older, implantation rate was more than double that of &amp;lt;80yo age-groups, with the implantation rate observed to be increasing in ≥80yo. There was no significant difference in in-hospital mortality between the two age-groups, however the 1-year and 2-year mortality rates were significantly higher in the ≥80yo. Funding Acknowledgement Type of funding sources: None.

Intracardiac echocardiographically guided permanent pacemaker implantation is a feasible imaging tool with comparable procedural efficacy and safety

Abstract Background Amongst cardiovascular interventions, pacemaker implantation procedure is one of the most hazardous in terms of radiation exposure due to its proximity and unprotected radiation exposure. In order to reduce radiation hazards, alternative imaging tool to guide pacemaker implantation should be sought. The aim of this study is to investigate the feasibility, efficacy, and safety of intracardiac echocardiographically (ICE) guided pacemaker implantation. Methods We retrospectively investigated pacemaker implantation with ICE guidance. ICE catheter was placed in right atrium (RA). Right ventricular (RV) lead was placed in RV apex within home view (low RA, 2-4 O'clock). Then RA lead was placed in RA appendage within mid RA 1-2 O'clock view. Fluoroscopy was used only for verifying lead redundancy (2 or 3 second duration before pocket closure). Other procedure steps were similarly performed as in conventional fluoroscopic method. Radiation dosage, patient safety, total procedure time, and lead parameters were assessed and compared. Results From June 2013 to March 2021, a total of 270 patients underwent pacemaker implantation either with ICE or with fluoroscopy. Amongst them, ICE guided implantation was attempted in 35 patients. In order to exclude potential bias caused by the operator's learning curve, we excluded early 5 cases out of ICE group. Radiation exposure was markedly decreased within ICE group (2.3±4.4 Gy cm2 in ICE group vs. 27.2±50.5 Gy cm2 in fluoroscopy group, P&amp;lt;0.001). The total procedure time and complication rate showed no significant difference between groups. In ICE group, atrial lead parameters were better than those of fluoroscopy group (impedance 454±57 Ω vs. 533±125 Ω, P&amp;lt;0.001). Conclusion In 30 patients with ICE guided pacemaker implantation, radiation exposure was markedly decreased without any trade-offs in terms of patients' safety and procedural success. Furthermore, operation team members' physical stress reduction also might be potentially guaranteed. Funding Acknowledgement Type of funding sources: None.

FACTORS AFFECTING THE DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY IN BIOPSY OF PERIPHERAL PULMONARY NODULES IN A COMMUNITY HOSPITAL

FACTORS AFFECTING THE DIAGNOSTIC YIELD OF ELECTROMAGNETIC NAVIGATION BRONCHOSCOPY IN BIOPSY OF PERIPHERAL PULMONARY NODULES IN A COMMUNITY HOSPITAL

S187 Percutaneous Endoscopic Colostomy: A Systematic Review of More Than Two Decades Experience

Introduction: Percutaneous endoscopic colostomy (PEC) is a minimally invasive procedure used to treat recurrent colonic pseudo-obstruction, sigmoid volvulus, chronic intracTable constipation, and neurogenic bowel. Traditional management of these conditions involving surgical colostomy or bowel resection in many cases has been replaced by percutaneous approaches under imaging or endoscopic guidance due to high rates of technical success and low morbidity rates. We conducted a systematic literature review to summarize the use, indications, and complications of PEC in adult patients. Methods: A systematic literature review was conducted using PubMed, Medline, Google Scholar, and Embase to identify patients who had undergone PEC for any indication. The search terms used were “percutaneous endoscopic colostomy”, “percutaneous endoscopic cecostomy”, “percutaneous cecostomy”, and “percutaneous colostomy”. Exclusion criteria were colostomy tubes that were not placed endoscopically. Results: A total of 11 observational studies (3 prospective, 8 retrospective), 18 case reports, and 7 case series between 1998 and 2022 were identified. A total of 318 patients who underwent PEC were identified. The mean age was 66.4 ± 23.5 and 64% were male. The most common indication was sigmoid volvulus (n= 131) followed by pseudo-obstruction (n=43), chronic intrac table constipation (n=83), neurogenic bowel (n=45), and others (n=9). The procedure was technically successful in 311 patients (97.7%). The total complication rate was 37.6%, 83.5% (n=66) of which were minor complications such as pain, bleeding, infection, leakage, and 16.4% (n=13) of which were major complications such as peritonitis, pneumoperitoneum, and sepsis. PEC-related mortality was 1.3% (n=4). The most common locations for tube placement were the left colon (59%) followed by right colon (13%), the rest of the cases the location was not reported. The number of tubes removed was 57, 8 due to symptom resolution, 3 for planned colostomy, and 1 for pain. (Figure) Conclusion: PEC is an underutilized procedure that offers a viable treatment alternative for select patients who are deemed high risk for surgical intervention and in whom conservative therapy is unsuccessful. It can lead to durable relief of symptoms with good technical success and low risk of major complications. Further prospective studies are needed to establish the optimal placement technique, long-term efficacy, and safety.Figure 1.: Percutaneous Endoscopic Colostomy tube indications

Minimally invasive procedures for hypothalamic hamartoma-related epilepsy: a systematic review and meta-analysis.

Hypothalamic hamartoma (HH) is a rare, nonmalignant, heterotopic developmental malformation that consists of a mixture of normal neurons and glial cells. Resection of HHs has been associated with high rates of mortality and morbidity. Therefore, minimally invasive ablation methods could be the best treatment option for HH. The most frequently used minimally invasive options for HH ablation are radiofrequency thermocoagulation (RFT), laser ablation (LA), and stereotactic radiosurgery. To investigate three minimally invasive procedures in the treatment of refractory seizures related to HH, the authors conducted a systematic search in March 2022 in the MEDLINE, Embase, Scopus, and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seizure freedom was the primary outcome of interest. The authors defined seizure freedom as Engel class I or International League Against Epilepsy class 1 or 2 or as the reported term "seizure freedom." The secondary outcome was long-term complications reported in studies. Both random- and fixed-effects models were used to calculate the pooled proportion of seizure freedom and complication rate with 95% confidence intervals. A modified version of the Joanna Briggs Institute (JBI) Critical Appraisal to assess the risk of bias was used. The authors included 15 studies with 422 patients (RFT, n = 190; LA, n = 171; and Gamma Knife Radiosurgery [GKRS], n = 61). Generally, the mean incidences of overall seizure freedom after minimally invasive procedures were 77% (95% CI 0.74-0.81) and 68% (95% CI 0.57-0.79) using fixed- and random-effects models, respectively. The mean incidence of overall seizure freedom after RFT was 69% (95% CI 0.63-0.75), and the mean incidences of overall seizure freedom after LA and GKRS were 87% (95% CI 0.82-0.92) and 44% (95% CI 0.32-0.57), respectively. The total complication rate with minimally invasive procedures was 13% (95% CI 0.01-0.26). The complication rate in each treatment was as follows: 5% (95% CI 0.0-0.12) for RFT, 20% (95% CI 0.0-0.47) for LA, and 22% (95% CI 0-0.65) for GKRS. Meta-regression analysis showed an association between older age and higher complication rates in the LA group. In this meta-analysis, LA showed superiority in seizure freedom over the other two methods. The complication rate associated with RFT was less than those in the other two methods; however, this difference was not statistically significant.

The Impact of Obstructive Sleep Apnea on Clinical, Perioperative, and Cost Outcomes in Patients Who Underwent Posterior Cervical Decompression and Fusion: A Single-Center Retrospective Analysis From 2008 to 2016.

Obstructive sleep apnea (OSA) is a pervasive problem that can result in diminished neurocognitive performance, increased risk of all-cause mortality, and significant cardiovascular disease. While previous studies have examined risk factors that influence outcomes following cervical fusion procedures, to our knowledge, no study has examined the cost or outcome profiles for posterior cervical decompression and fusion (PCDF) procedures in patients with OSA. All cases at a single institution between 2008 and 2016 involving a PCDF were included. The primary outcome was prolonged extubation, defined as an extubation that took place outside of the operating room. Secondary outcomes included admission to the intensive care unit (ICU), complications, extended hospitalization, nonhome discharge, readmission within 30 and 90 days, emergency room visit within 30 and 90 days, and higher total costs. We reviewed 1191 PCDF cases, of which 93 patients (7.81%) had a history of OSA. At the univariate level, patients with OSA had higher rates of ICU admissions (33.3% vs 16.8%, P < 0.0001), total complications (29.0% vs 19.0%, P = 0.0202), and respiratory complications (12.9% vs 6.6%, P = 0.0217). Multivariate regression analyses revealed no difference in the odds of a prolonged extubation (P = 0.4773) and showed that history of OSA was not predictive of higher costs. However, a significant difference was observed in the odds of having an ICU admission (P = 0.0046). While patients with sleep apnea may be more likely to be admitted to the ICU postoperatively, OSA status a lone is not a risk factor for poor primary and secondary clinical outcomes following posterior cervical fusion procedures. Various deformities of the cervical spine can exert extraluminal forces that partially collapse or obstruct the airway, thereby predisposing patients to OSA; however, no study has examined the cost or outcome profiles for PCDF procedures in patients with OSA. Therefore, this investigation highlights the ways in which OSA influences the risks, outcomes, and costs following PCDF using medical data from an institutional registry.

Comparison of SaCoVLM™ video laryngeal mask-guided intubation and i-gel combined with flexible bronchoscopy-guided intubation in airway management during general anesthesia: a non-inferiority study

BackgroundWhen a difficult airway is unanticipatedly encountered and the initial laryngoscopic intubation fails, a supraglottic airway device (SAD) may be placed to aid ventilation and oxygenation, and act as a conduit for intubation. SaCoVLM™, as new SAD, can offer a direct vision to guide intubation. However, no study has evaluated the performance of SaCoVLM™ video laryngeal mask (VLM) intubation and i-gel combined with flexible bronchoscopy (FB)-guided intubation in airway management during general anesthesia.MethodsA total of 120 adult patients were randomly allocated into the SaCoVLM™ group (Group S) and i-gel group (Group I). After induction of general anesthesia, guided tracheal intubation under direct vision of the SaCoVLM™ was conducted in Group S, while Group I received FB-guided tracheal intubation using the i-gel. The success rate of SAD placement, first-pass success rate of guided tracheal tube placement, and total success rate in both groups were recorded. The time for SAD placement, time for guided tracheal intubation, total intubation time (time for SAD placement and intubation), glottic exposure grading and postoperative intubation complications (i.e., dysphagia, hoarseness, pharyngalgia, etc.) of both groups were also compared.ResultsThe first-time success rate of SAD placement was 98% in two groups. The first-pass success rate of guided endotracheal intubation was 92% in Group S and 93% in Group I (P = 0.74 > 0.05). The total intubation time was 30.8(± 9.7) s and 57.4(± 16.6) s (95% CI = -31.5 to -21.7) in Group S and Group I, respectively (P < 0.01). The total complication rate was 8% in Group S and 22% in Group I (P < 0.05). The laryngeal inlet could be observed in the S group through the visual system of SaCoVLM™. No dysphagia or hoarseness was reported.ConclusionSaCoVLM™ can reveal the position of laryngeal inlet, thus providing direct vision for tracheal intubation. SaCoVLM™ -guided intubation is faster, and does not rely on FB, compared to i-gel combined with FB-guided intubation. Besides, SaCoVLM™ has a lower post-intubation complication rate.Trial registrationChinese Clinical Trials Registry (ChiCTR2100043443); Date of registration: 18/02/2021.

Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett's Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study.

Background Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett's procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett's procedure. Results No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett's repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.

Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: A single-center retrospective study.

BackgroundTo compare the incidence of complications and constructive effects of cranioplasty with polyetheretherketone (PEEK) and titanium mesh after decompressive craniectomy, and to further explore potential risk factors of postoperative and post-discharge complications.MethodsA retrospective study was conducted on 211 patients who underwent PEEK or titanium mesh cranioplasty in the Department of Neurosurgery of Zhujiang Hospital, Southern Medical University, between July 2017 and September 2021. Demographic data, imaging data, and postoperative complications were recorded and statistically analyzed. Long-term effects and satisfaction degree were evaluated based on following-up telephone survey. Univariate and multivariate logistic regression models were used to analyze risk factors of postoperative and post-discharge complications of PEEK and titanium cranioplasty.ResultsThe total postoperative complication rates of the PEEK and titanium mesh groups were 38.7 and 51.4% (p = 0.063), and post-discharge complication rates were 34.7 and 36.0% (p = 0.703), respectively. The incidence of pneumocephalus during hospitalization (33.3% vs. 6.6%, p < 0.001) and epidural effusion in the titanium mesh group were significantly higher than that in the PEEK group (18.0 vs. 6.6%, p = 0.011). Patients in PEEK group were less likely to occur subcutaneous effusion after discharge than in TI group (2.0 vs. 10.5%, p = 0.013). Multivariate logistic regression analysis revealed a history of ventriculoperitoneal shunt (VPS) before CP was an independent risk factor for postoperative overall complications (p = 0.023). Either superficial (p < 0.001) or intracranial infection (p = 0.001) was a risk factor for implant failure. Depressed skull defects (p = 0.024) and cranioplasty with titanium cranioplasty (p < 0.001) were associated with increased incidence of early pneumocephalus.ConclusionThere were no differences in overall postoperative and post-discharge complication rates between the titanium mesh and PEEK. A history of VPS before cranioplasty was an independent risk factor for postoperative overall complications, and infection was a risk factor for implant failure. Finally, depression skull defects and titanium mesh implants increased the incidence of postoperative pneumocephalus. Our results aim to promote a better understanding of PEEK and titanium cranioplasty and to help both clinicians and patients make better choices on implant materials.

The effect of biliary stents implanted before pancreaticoduodenectomy in periampullary tumors on postoperative results: a retrospective analysis of 106 consecutive cases at a single medical center.

The present study evaluated the potential effects of biliary drainage before pancreaticoduodenectomy on postoperative outcomes and presented the details of a surgeon's 6years of experience. All consecutive pancreatoduodenectomies performed from 2015 to 2021 were retrospectively analyzed. The study population was divided into two groups: the stented group (Group I) and the nonstented group (Group II). Patient demographic data and clinical characteristics were compared between the two groups. This study comprised 106 individuals who underwent pancreaticoduodenectomy for periampullary tumors. The median age of the patients was 64.41 ± 11.67years, and 65 (61.3%) were males. Sixty-seven patients (63.2%) received biliary drains (stented group), and 39 (36.8%) patients did not (nonstented group). Total bilirubin values (6.39mg/dl) were higher in the nonstented patient group than in the stented group. The rate of total complications was significantly higher in the stented group than in the nonstented group [please check this carefully] (p < 0.05). The length of stay, operation time and pancreatic fistula were found to be higher in the stented group than in the nonstented group. Although the total bilirubin value was higher in the nonstented patient group than in the stented group, preoperative biliary drainage increased postoperative complication rates, operation time, and hospital stay. An advanced age and the presence of stents were independent risk factors influencing morbidity development according to the multivariate analysis.

Based on the IWATE criteria: to investigate the influence of different surgical approaches on the perioperative outcomes of hepatectomy.

In terms of perioperative outcomes, compared with traditional open surgery and laparoscopic surgery, studies of robotic liver resection have been limited and must be further clarified. Clinical data from 465 patients who underwent liver resection were collected in this retrospective study, and the IWATE criteria were used to evaluate the difficulty level of each operation. We compared perioperative outcomes of open, laparoscopic, or robotic approaches for patients with uncomplicated and complex hepatectomy according to different IWATE scores. Among patients with uncomplicated hepatectomy, the median operation time was significantly longer in the robotic liver resection (RLR) group than in the open liver resection (OLR) and laparoscopic liver resection (LLR) groups; however, the RLR group had the shortest hospital stay. There were no significant differences in intraoperative blood loss, conversion rate, total complication rate, or serious complication rate among the three groups. Among patients with complex hepatectomy, the RLR group had the smallest intraoperative blood loss and shortest mean length of stay. The cases converted to open hepatectomy were lower in the RLR group than in the laparoscopic group, mainly based on the IWATE score of expert hepatectomy. The incidence of general and serious postoperative complications in the RLR group was significantly lower than that in the OLR and LLR groups. Robotic liver resection is a safe and feasible surgical method that is more advantageous than laparoscopic and open liver resection, especially in complex liver surgery.

Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis.

Backgrounds Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue. Methods Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I2 index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger's test. Results A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge (p < 0.00001). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications (p = 0.0001), but the analysis limited to randomized controlled trials did not support this result (p = 0.68). There was no significant difference in total complication rates (p = 0.08) and bleeding-related complication rates (p = 0.05) between the two groups. Patient satisfaction was higher in VCD group (p = 0.002). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.05). Conclusions Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.

Spinal Nerve Sheath Tumors: Factors Associated with Postoperative Residual and Recurrent Tumors: A Single-Center Experience

Spinal schwannomas (SSs) are usually benign tumors with a good prognosis when treated by surgical excision. However, complete resection can be complicated by factors such as the tumor location and configuration. In the present study, we sought to identify the factors associated with incomplete surgical resection (residual) and the factors associated with tumor recurrence. We performed a retrospective review of 113 cases of SSs treated surgically from 2008 to2021. Of the 113 SSs, 102 were benign and 2 were malignant nerve sheath tumors. Of the 102 benign SSs, gross total resection (GTR) was performed for 87, with 8 displaying residual and 7, recurrent tumor. We found a significantly higher ratio of cervical and sacral tumors (P= 0.008 and P= 0.004, respectively), dumbbell and foraminal configurations (P < 0.0001 and P= 0.0006, respectively), and larger tumor volumes (P= 0.003) in the residual and recurrent cohorts compared with the GTR cohort. A second operation was performed for 2 patients in the residual and 4 patients in the recurrent cohorts. The total complication rate was 6%. We found that most benign SSs will be amenable to GTR (85% of cases), with an excellent prognosis. The patients with residual or recurrent tumor were more likely to have had a cervical or sacral location, a dumbbell or foraminal configuration, and a larger tumor volume. Except for 1 new SS and 1 recurrent tumor that had necessitated a lateral approach, the remainder had been treated using a posterior approach. At surgery, ultrasonography of the canal is advisable to ensure that the intra- and extraspinal components of dumbbell lesions have both been entirely removed.

Muscle mass ratio in male gastric cancer patients as an independent predictor of postoperative complications after minimally invasive distal gastrectomy.

The current study aimed to investigate the relationship between muscle mass proportion and the incidence of total complications in male gastric cancer (GC) patients after minimally invasive distal gastrectomy (MIDG). Between March 2017 and March 2020, 152 male GC patients with clinical stage III or lower GC who underwent MIDG were enrolled in this study. The muscle mass ratio (MMR) was calculated by dividing the total muscle weight obtained from bioelectrical impedance analysis by the whole-body weight. Thereafter, the association between MMR and surgical outcomes was determined. Based on the optimal MMR cutoff value of 0.712 obtained using the receiver operating characteristic (ROC) curve, patients were divided into two groups (69 and 83 patients in the MMR-L and MMR-H groups). The MMR-L group had a significantly higher total complication rate compared to the MMR-H group (MMR-L, 24.6% vs. MMR-H, 7.2%; P = 0.005). Multivariate analysis also identified MMR-L as a significant independent risk factor for total complications and intra-abdominal infectious complications after MIDG. The MMR calculated using bioelectrical impedance analysis can be a useful predictor for postoperative complications after MIDG in male GC patients.