Type Of Previous Surgery Research Articles

Post-laparoscopy Epidermal Inclusion Cyst of Umbilicus

Background: Epidermal inclusion cysts can develop in the umbilicus following trauma or surgery. In this study, we aim to report cases of epidermal inclusion cysts occurring at the umbilicus in patients with a history of previous laparoscopic surgery.Methods: A retrospective study was conducted between January 2020 and May 2023 based on the medical records of patients who developed epidermal inclusion cysts in the umbilicus following laparoscopic surgery. Information regarding age, sex, symptoms, type of previous surgery, time elapsed from previous surgery to mass discovery, and postoperative complications was collected from a total of 15 patients.Results: Out of the 15 patients, 13 were female (86.7%) and two were male (13.3%). Symptoms such as discharge, redness, and tenderness were present in 12 patients (80.0%). Obstetric and gynecologic laparoscopic surgeries were performed on 10 patients (66.7%), whereas general surgical laparoscopic surgeries were performed on five patients (33.3%). The mean time from laparoscopic surgery to discovery of the umbilical mass was 43.5 months. Wound dehiscence occurred in one patient (6.7%) and seroma developed in another patient (6.7%) out of 15 patients.Conclusion: Achieving an ideal shape of the umbilicus after removal of epidermal inclusion cysts that occur at the umbilicus following laparoscopic procedures requires significant effort. Through this study, we aim to remind laparoscopic surgeons that epidermal inclusion cysts can develop at the umbilicus through laparoscopic interventions and thereby emphasize the importance of proper wound management.

Safety of Laparoscopic Entry Points in Patients With a History of Abdominal Surgery: A Research Article.

This study aimed to assess the safety of laparoscopic entry sites in patients with previous abdominal surgery who subsequently required re-operation. This is a prospective study wherein the data of 118 patients who had undergone previous abdominal surgery and were subsequently re-operated at our center (Bakırköy Doctor Sadi Konuk Research and Study Hospital) were collected from October 2015 to October 2016. Careful attention was paid to gathering information regarding patients' age, parity, body mass index (BMI), type of previous surgery, type of incision made during previous surgery, and medical history. For this study, the abdomen was topographically divided into nine parts. During the operation, all quadrants were examined and evaluated for adhesion and the content of adhesion. Adhesions were found in 44% (55 out of 118) of the patients, while 56% (66 patients) had no adhesions in the abdomen. The majority of cases (74%) had a history of cesarean section, and 87%had a Pfannenstiel incision. Adhesions were reported in 37.5% (33 out of 88) of the patients with a previous history of cesarean section. A significant proportion of subjects with adhesion (83%) had anterior abdominal wall adhesions, including only the omentum, whereas 11.5% (six subjects) had umbilical adhesions. Subjects with a history of umbilical hernia repair had more adhesions. The present study sought to assess the safety of laparoscopic entry points in individuals with prior abdominal surgery. The rise in laparoscopic surgeries, favored for reduced wound infections and quicker recovery times, brings forth concerns about potential complications in those with previous abdominal operations. Historically, postoperative adhesions have been observed in a significant number of patients after gynecological procedures. Our research, however, found a lower adhesion rate, which could be due to the smaller size of our sample and fewer gynecological cases. Existing adhesions can complicate subsequent surgeries, increasing operational times and posing injury risks. Adhesions also elevate healthcare costs and patient morbidity and mortality. Moreover, complications like Trocar-related injuries, including damageto major organs, are pivotal. While certain trocar insertion techniques may have fewer complications, our results align with previous findings suggesting higher adhesion rates after non-gynecological surgeries. Therefore, alternative entry points or methods, such as the palmer site or direct trocar entry, are recommended for those with an abdominal surgery history. Notably, our study's limited sample size may affect its generalizability, urging future studies for broader insights. Comprehensive pre-surgery assessments are crucial to anticipate complications. Our research supports that laparoscopic surgeries are safe for many with prior abdominal surgery, but for certain patients, non-umbilical entry sites are advised to further mitigate risks. The umbilicus is one of the safest entry sites for primary trocar insertion in patients with a history of Pfannenstiel incision. However, the probability of umbilical adhesions is high in patients who have undergone umbilical mesh repair, median incision, or major abdominal surgery. In these patients, surgeons should prefer other laparoscopic entry sites, especially Palmer's point, rather than the umbilicus.

Endoscopic Ultrasound-Guided Gastrojejunostomy for Malignant Afferent Loop Syndrome Using a Fully Covered Metal Stent: A Multicenter Experience.

Endoscopic-ultrasound-guided gastrojejunostomy (EUS-GJ) can be a new alternative for patients with malignant afferent loop syndrome (MALS). However, a fully covered self-expandable metal stent (FCSEMS) has not been well investigated in this setting. This is a multicenter retrospective cohort study. Consecutive patients that underwent EUS-GJ using a FCSEMS for MALS between April 2017 and November 2022 were enrolled. Primary outcomes were technical and clinical success rates. Secondary outcomes were adverse events, recurrent symptoms, and overall survival. Twelve patients (median age: 67.5 years (interquartile range: 58-74.8); 50% male) were included. The most common primary disease and type of previous surgery were pancreatic cancer (67%) and pancreatoduodenectomy (75%), respectively. Technical success and clinical success were achieved in all patients. Procedure-related adverse events occurred in one patient (8%) with mild peritonitis. During a median follow-up of 96.5 days, one patient (8%) had recurrent symptoms due to the EUS-GJ stent dysfunction; including biliary events unrelated to the EUS-GJ stent, five patients (42%) had recurrent events. The median overall survival was 137 days. Nine patients (75%) died due to disease progression. EUS-GJ with a FCSEMS seems safe and effective for MALS with high technical and clinical success rates and an acceptable recurrence rate.

Comparison of Open vs Laparoscopic Cholecystectomy in patients of Cholelithiasis having Previous Abdominal Surgeries

Background: Most of the surgeons in our setups perform open cholecystectomy (OC) in patients of cholelithiasis having previous abdominal surgery. This is the era of laparoscopic and robotic surgery and laparoscopic cholecystectomy (LC) should be the preferred treatment for these patients as well. Aim: To observe the effect of previous abdominal surgeries on laparoscopic cholecystectomy. Study design: Randomized, controlled and multicenter experimental study. Place and duration of study: Department of Surgery, Central Park Teaching Hospital, Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021. Methodology: Fifty eight patients were allocated into 2 groups (29 in each group) not considering age and sex. Both types of surgeries were analyzed on the basis of operating time, post-operative pain (VAS) and complications. Complications were noted i.e. wound infection, bile leakage from cystic duct/CBD injury, gut injury and per operative bleeding). Type of previous surgery was also noted. Data of conversion to open cholecystectomy from laparoscopic cholecystectomy was also recorded. Results: Mean age of patients in group A was 45.99±13.42 years while mean age of patients in group B was 41.87±14.65 years and p-value 0.105. 75.2% patients in group A were female while 82.1% patients in group B were female (p-value 0.185). Operative time in group A was 45.51±8.32 minutes while operative time in group B was 70.33±13.40 minutes (p-value 0.001). VAS score was 7.34±1.80 in group A while it was 5.24±1.93 in group B (p-value 0.001). 4 patients (13.79%) in group A developed wound infection while 1 patient (3.45%) from group B developed wound infection (p-value 0.005). Bile leakage and gut injury were not seen in any of the patient from both groups. Peroperative bleeding (more than 50ml) was seen in 2 patients of group A (6.90%) while it was seen in 8 patients of group B (27.59%) p-value 0.001. Type of previous surgeries were 24 cases were of mesh hernioplasty (41.38%), 16 cases of herniorrhaphy (27.59%), 10 laparotomies for peritonitis/intestinal obstruction (17.24%) and 8 cases of laparotomies for gynecological problems (13.79%). No case of laparoscopic cholecystectomy was converted to open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a safe and excellent option in patients of cholelithiasis having previous abdominal surgery. Even though LC takes more time due to adhesions but this issue does not out weights the benefits of laparoscopic cholecystectomy over open cholecystectomy. Keywords: Laparoscopic cholecystectomy, Cholelithiasis

Data analytics and artificial intelligence in predicting length of stay, readmission, and mortality: a population-based study of surgical management of colorectal cancer

Data analytics and artificial intelligence (AI) have been used to predict patient outcomes after colorectal cancer surgery. A prospectively maintained colorectal cancer database was used, covering 4336 patients who underwent colorectal cancer surgery between 2003 and 2019. The 47 patient parameters included demographics, peri- and post-operative outcomes, surgical approaches, complications, and mortality. Data analytics were used to compare the importance of each variable and AI prediction models were built for length of stay (LOS), readmission, and mortality. Accuracies of at least 80% have been achieved. The significant predictors of LOS were age, ASA grade, operative time, presence or absence of a stoma, robotic or laparoscopic approach to surgery, and complications. The model with support vector regression (SVR) algorithms predicted the LOS with an accuracy of 83% and mean absolute error (MAE) of 9.69 days. The significant predictors of readmission were age, laparoscopic procedure, stoma performed, preoperative nodal (N) stage, operation time, operation mode, previous surgery type, LOS, and the specific procedure. A BI-LSTM model predicted readmission with 87.5% accuracy, 84% sensitivity, and 90% specificity. The significant predictors of mortality were age, ASA grade, BMI, the formation of a stoma, preoperative TNM staging, neoadjuvant chemotherapy, curative resection, and LOS. Classification predictive modelling predicted three different colorectal cancer mortality measures (overall mortality, and 31- and 91-days mortality) with 80–96% accuracy, 84–93% sensitivity, and 75–100% specificity. A model using all variables performed only slightly better than one that used just the most significant ones.

Histologic-Proven Recurrence of Endometriosis after Previous Ablation Vs. Excision Surgery

<h3>Study Objective</h3> compare incidence of recurrence of endometriosis after previous ablation or excision surgery for endometriosis. <h3>Design</h3> retrospective study. <h3>Setting</h3> academic medical center. <h3>Patients or Participants</h3> all patients who underwent excision endometriosis surgery from January 2013 to December 2020 who had history of previous ablation or excision surgery for endometriosis either at study institution or outside institution. <h3>Interventions</h3> repeat excision surgery for endometriosis. <h3>Measurements and Main Results</h3> Of the 139 patients that met inclusion criteria, 47 had previous ablation and 92 had previous excision of endometriosis. Differences in baseline characteristics at time of repeat surgery between the two groups included age < 35 (59.6% vs. 41.3%, p=0.04), historical American Society of Reproductive Medicine (ASRM) stage of endometriosis (Stage 1-2: 76.6% vs. 43.5%; Stage 3-4: 23.4% vs. 54.3%, p<0.001), and history of previous hysterectomy (2.1% vs. 14.1%, p=0.026). Overall, 80.5% of patients were found to have histologic evidence of endometriosis on repeat surgery. For those without versus with recurrence, proportion of nulliparity (59.3% vs. 72.3%, p=.21), interval since prior surgery (mean months 42 vs. 41, p=0.07), number of surgeries for endometriosis prior to surgery of interest (mean 2.5 vs. 1.7, p=0.92), previous hysterectomy (7.4% vs. 10.7%, p=0.61) and postoperative hormonal suppression (63% vs. 56.2%, p=0.73) did not differ. Overall recurrence did not vary by type of previous surgery (82.9% ablation vs. 79.3% excision). However, for those with previous ASRM stage 1-2, recurrence incidence was higher if ablation was previously performed (84.8% vs. 63%, p=0.04). <h3>Conclusion</h3> Most women pursuing repeat surgery for endometriosis are found to have histologic evidence of endometriosis recurrence. Excision surgery has lower recurrence of endometriosis for patients with lower ASRM stage. Although possible that initial surgery undertreated pre-existing disease, these findings support excision surgery as the preferred surgical approach for treatment of endometriosis.

History of previous surgery is associated with higher risk of revision after primary total knee arthroplasty: a cohort study from the Geneva Arthroplasty Registry

Background and purpose — Prior to primary total knee arthroplasty (pTKA), 6–34% of patients have undergone surgical procedure(s) of their knee. We investigated whether history of previous surgeries influences the risk of revision of pTKA, the risk according to the type of previous surgery, and how previous surgery influences specific causes of revision and the time of revision. Patients and methods — This is a prospective cohort study from the Geneva Arthroplasty Registry. All pTKA between 2000 and 2016 were included and followed until December 31, 2019. Outcomes were risk of revision, evaluated using Kaplan–Meier survival and Cox and competing risks regression, the specific causes, and time of revision. Results — Of 3,945 pTKA included (mean age 71 years, 68% women), 21% had a history of previous surgery, with 8.3% revisions vs. 4.3%, at 3–20 years’ follow-up (mean 8.6). 5- and 10-year cumulative failure by previous surgery (yes vs. no) were 6.6% (95% CI 5.1–8.5) vs. 3.3% (CI 2.7–4.0), and 8.4% (CI 6.6–10.6) vs. 4.5% (CI 3.8–5.4). Baseline differences explained only part of the higher risk (adjusted HR 1.5, CI 1.1–2.1). The risk of failure was higher for all causes of revision considered. Patients in the previous surgery group had a higher risk of an early revision. Interpretation — A history of previous surgery adversely affected the outcome with a 1.5 times higher cumulative risk of all-cause revision over the course of up to 20 years after index surgery. The increased risk was seen for all causes of revision and was highest in the first years.

Autologous rectus sheath sling for treatment of vault prolapse after hysterectomy.

Objective: Determine the duration and post-operative complications of surgery in patients who underwent rectus sheath sling for correction of vault prolapse. We started doing this novel technique and found it very safe with least side effects so wanted to study it. Study Design: Experimental study. Setting: Nishtar Hospital Multan Pakistan. Period: July 2016 to June 2018. Material &amp; Methods: Patients were applied autologous sling of rectus sheath at Nishtar Hospital Multan and were followed for 2 years. Patients with diabetes mellitus and any other chronic disease were excluded. Patients who had previous surgery for vault prolapse were also excluded from the study. Data were recorded and analyzed using IBM-SPSS version 23.0, percentages are given for previous surgery duration (how long before the previous surgery was done), duration of current surgery, post-operative fever, post -operative urinary tract infection(UTI), duration of stay in the hospital after surgery, parenteral analgesia requirement. Parameters were tested using Pearson Chi Square test with type of previous surgery. Results: The total number of patients in the study were 19.The mean age of the patients was 59.7 years (SD = ±9.7) and mean weight was 59.4kg (SD = ±12.5). The duration of surgery was less than 1 hour in 84 % of patients. Same percentage had less than 36 hours requirement of post- operative parenteral analgesia and thus less than 2 days of post-operative stay in hospital. Postoperatively 31.6 % had fever, 26.3% had Urinary tract infection. On 2 years follow-up of this surgery, no patient had any recurrence of vault prolapse and 85.7% showed no coital difficulty. Conclusion: This surgical procedure is a simple, time saving method with less complications and is best suited for low resource countries like Pakistan.

Midterm outcomes of revision shoulder arthroplasty

BackgroundSince the introduction of shoulder arthroplasty, the indications have been expanding. Because of the increasing number of arthroplasty procedures, revision surgeries are also inevitable. The purpose of our study is to delineate a large number of revision shoulder arthroplasty cases treated in different ways, including antibiotic spacer placement (ABX), hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), and reverse total shoulder arthroplasty (rTSA), and to analyze the relationship between preoperative factors and clinical outcomes. MethodsWe reviewed our institution's records of revision shoulder arthroplasty between January 1, 2000, and October 1, 2017. Preoperative information included age at the time of surgery, gender, body mass index, and infection status. Pre- and postoperatively, we gathered 6 patient-reported clinical outcomes and 3 range-of-motion parameters (elevation, abduction, and external rotation). Postoperative complications were also assessed. Then, we examined the differences between the pre- and postoperative outcomes. As a secondary analysis, we performed multivariable regression analysis on the same outcomes, accounting for age at the time of surgery, infection status, and previous surgery type. ResultsAmong the 341 revisions performed, 138 cases met inclusion criteria of at least a 2-year follow-up with pre- and postoperative functional outcome scores. The majority of our revision procedures were to a rTSA (92 cases, 67%), followed by aTSA (28 cases, 20%), and ABX/HA (18 cases, 13%). The mean age at the time of our index surgery was 66 years old. In aTSA and rTSA, all the postoperative outcomes (ie, ASES, Constant, UCLA, SST, SPADI, SF-12 scores, and 3 AROMs) were significantly improved beyond the minimal clinically important difference (MCID) except SF-12 scores in aTSA (P = .25) and active external rotation in rTSA (P = .73). None of the ABX/HA's postoperative outcomes achieve significant improvement or MCID. Multivariable regression analysis showed that older age at the time of surgery was significantly associated with better outcomes in 3 of the 6 patient-reported outcomes (ASES, SST, and SPADI; P = .023, .023, and .028, respectively). ConclusionRevision aTSA and rTSA showed statistically and clinically significant improvement postoperatively. ABX and HA did not achieve meaningful postoperative improvement. Overall, patients getting revision shoulder arthroplasty at an older age had better patient-reported outcomes. Level of evidenceLevel III; Retrospective Cohort Study

Rate of Corneal Grafting Post-Glaucoma Drainage Device Use in Pediatric and Adult Patients.

Kaplan-Meier analysis was used to compare the rate of corneal grafting after glaucoma drainage device (GDD) placement in pediatric and adult patients. Adults were at an increased risk of receiving a corneal graft after device placement. The goal of this study was to compare the rate of corneal graft implantation after GDD placement in pediatric and adult patients. Patients receiving a GDD between January 1, 1985 and December 31, 2017 were selected from the medical records. Patients receiving their first device while <18 years of age were considered children for the extent of the study. We compared the rate of receiving a corneal graft after GDD implantation using Kaplan-Meier analysis. Baseline patient characteristics and surgical characteristics were compared using a generalized estimating equation. Corneal grafting occurred in 8.6% of adults and 4.7% of children from the original cohort. The rate of receiving a corneal graft at 5, 10, and 15 years was 9.4%, 16.8%, 39.4% and 1.6%, 1.6%, 12.5% for adults and children, respectively. However, certain characteristics were different between the 2 groups. Adult patients were more likely to receive a corneal graft after GDD placement. However, pediatric and adult patients differed in the prevalence of preexisting corneal disease, glaucoma type, GDD type used, and types of previous surgeries. Elucidation of the impact of these factors on corneal graft rate requires a larger cohort size.

Ventral rectopexy with biological mesh for recurrent disorders of the posterior pelvic organ compartment

Recurrent prolapse of the posterior pelvic organ compartment presents a management challenge, with the best surgical procedure remaining unclear. We present functional outcome and patient satisfaction after laparoscopic and robotic ventral mesh rectopexy (VMR) with biological mesh in patients with recurrence. We analyzed data from 30 patients with recurrent posterior pelvic organ prolapse who underwent VMR with biological mesh from August 2012 to January 2018. Data included patient demographics and intra- and postoperative findings; functional outcome as assessed by Cleveland Clinic Constipation Score (CCCS), Obstructed Defecation Score Longo (ODS), and Cleveland Clinic Incontinence Score (CCIS); and patient satisfaction. CCCS, CCIS, and ODS were significantly improved at 6-12months postoperatively and at last follow-up. Patient satisfaction (visual analog scale [VAS] 6.7 [0 to 10]), subjective symptoms (+ 3.4 [scale - 5 to + 5]), and quality of life improvement (+ 3.0 [scale from - 5 to + 5]) were high at last follow-up. The rates of morbidity and major complications were 13% and 3%, respectively. There were no mesh-related complications or deaths. Difference in type of previous surgery (abdominal or transanal/perineal) had no significant effect on results. VMR with biological mesh is a safe and effective option for patients with recurrent posterior pelvic organ prolapse. It reduces functional symptoms, has a low complication rate, and promotes patient satisfaction.

Prótesis pulmonar porcina versus yugular bovina para reparar el tracto de salida del ventrículo derecho en menores con cardiopatía congénita

IntroductionIn some patients, in childhood, it may be necessary to recover the valve function of the right ventricular outflow tract, a sequel of the primary repair of their congenital heart disease. ObjectiveTo compare the outcomes of bovine jugular (YB) -Contegra® versus porcine prosthesis (PPP), implanted in patients under 18 years old. MethodsThe study included all patients under 18 years old and re-operated on between January 2003 and June 2015 after primary surgery right ventricle outflow tract, and in whom a YB/PPP was implanted. Prosthetic valve dysfunction criteria were, surgical/percutaneous re-intervention, and a gradient>50mmHg or severe prosthetic regurgitation. Statistical analysis was performed using SPSS 20.0. ResultsThere were 21 PPP implanted in 20 patients, and 15 YB in 15 patients. The study included 60% males. The most common primary congenital heart disease was Fallot. The groups were not exactly homogeneous. Of the 24 preoperative variables, 11 of them showed statistically significant differences (P<.05). These included a higher percentage of transannular surgery, indication of pulmonary regurgitation surgery, ventricular dilation, and dysfunction in the PPP group.Of the 15 perioperative variables, there were significant differences in, the mean age at implantation: 8.8±4.4 years YB versus 11.8±4 PPP (P=.044); valve diameter (P<.001) lower in YB. Need of aortic cross clamping (P=.015) however, higher in YB.There was no in-hospital or late mortality. Follow-up: 4.8 years YB versus 2.4 PPP (P=.046). Other postoperative variables with significant differences: transprosthetic gradient, residual prosthetic regurgitation, prosthetic dysfunction, all higher in YB group. ConclusionsWith prudence imposed by differences in follow-up time and type of previous surgery in both cohorts, it seems reasonable to choose a PPP to recover functionality of the right ventricle outflow tract.The YB could be used when a conduit is essential.

Risk factors and a prognostic model of hip periprosthetic infection recurrence after surgical treatment using articulating and non-articulating spacers.

The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence. In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI. Patients with infection recurrence had increased levels of ESR and CRP (P < 0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P < 0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50%, P < 0.01) where Gram-negative bacteria were predominant (61.5%, P < 0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2%, P < 0.01). Efficacy of the first step of two-stage revision was 64.1%. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.

Abstract 12340: Risk Model of Aortic Valve Replacement After Cardiovascular Surgery based on 2,227 Cases From a National Japanese Database: The Japan Cardiovascular Surgery Database (JACVSD)

Objective: To create a risk model to assess outcomes of aortic valve replacement after cardiovascular surgery (ReAVR) using a national Japanese database. Methods: The Japan Adult Cardiovascular Surgery Database is a web-based data system involving more than 500 hospitals. Between 2007 and 2012, 2,227 patients who underwent ReAVR for aortic stenosis were retrospectively analyzed. Patients with a previous history of AVR were also included. Results: The background of prior surgery (including overlapping cases) was: CABG, 30.9%; valve, 65.4%; and thoracic aorta, 14.7%. The mean age was 70.4. Types of prosthesis used were: bioprosthesis, 51.3%; and mechanical valve, 48.7%. The rate of isolated ReAVR was 59.5%. Concomitant procedures were: CABG, 14.6%; mitral valve surgery, 30.4%; and aortic surgery, 5.7%. The overall hospital mortality rate was 8.7%. Major complications (reoperation, prolonged ventilation, mediastinitis, stroke, and newly required dialysis) occurred in 26.0%. The incidence of stroke was 3.7%, and that of AV block was 3.5%. ORs for hospital mortality were as follows: age, 1.4 (reference ≦60, 5-year increments); male, 1.4; urgency, 1.7; EF ≦30%, 2.0; NYHA classification IV, 1.7; MR ≧2, 1.5; creatinine &gt;2.0 mg/dL, 2.7; liver dysfunction (cirrhosis, AST or ALT &gt;100 U/L, or bilirubin &gt;1.5 mg/dL), 2.3; peripheral artery disease, 1.6; and recent stroke (&lt;2 weeks), 4.8. The type of previous surgery was not a predictor for mortality. In addition to the above-mentioned risk factors, ORs for the composite outcome (mortality and major complications) were as follows: carotid stenosis, 2.5; respiratory dysfunction (FEV1.0 &lt;75%, or bronchodilator use), 1.8; prior valve surgery, 1.3; preoperative inotropic agents, 2.0; endocarditis, 1.7; concomitant CABG, 1.4; and concomitant valve surgery, 1.5. As a performance metric model, C-indexes of hospital mortality and the composite outcome were 0.77 and 0.71, respectively. Conclusions: Based on a national Japanese database, early outcomes after ReAVR were satisfactory, despite these operations being associated with a higher risk than the primary operations. The type of previous surgery was not a risk for mortality after ReAVR.

Management of recurrent stress urinary incontinence after failed midurethral sling: a survey of members of the International Urogynecological Association (IUGA).

Synthetic midurethral slings (MUS) have gained popularity in the management of stress urinary incontinence (SUI), due to their efficacy and minimally invasive nature. As there are no robust data to guide management of persistent or recurrent SUI after failed MUS, the aim of this study was to evaluate the management of these cases among IUGA members. A pretested, web-based survey designed to explore assessment, surgical management and views about future research was sent to IUGA members. A total of 385 participants opened the survey and 331 eligible responses were obtained. Conventional laboratory urodynamics were the most commonly used investigation (72.6 %). The type of previous surgery, urodynamic findings and surgeon's preference/experience were considered to be the most important factors in choosing the type of surgical management. Retropubic sling (RPS) was the preferred surgical option in most of the clinical scenarios with urethral bulking agents (UBA) being more popular in the absence of urethral hypermobility after a failed RPS. While the vast majority of the respondents (93.0 %) recognized the urgent need for good quality research, they were less willing to participate in randomized controlled trials (RCT) comparing redo MUS with autologous fascial sling or colposuspension. Members of IUGA prefer RPS in most patients and UBA in patients with absent urethral hypermobility and intrinsic sphincter deficiency. There is a recognized need for good quality research, but IUGA members are reluctant to participate in RCTs comparing minimally invasive to conventional surgical techniques.

EFFICIENCY OF THE FIRST STAGE OF TWO-STAGED REVISION SURGERY IN PATIENTS WITH PERIPROSTHETIC HIP INFECTION

Objective - to evaluate the effectiveness of the first phase of a two-stage method of surgical treatment of periprosthetic infection and to identify possible factors influencing the outcomes. Material and methods. The analysis of results of treatment of 217 patients with infection operated in 2008-2012. The mean age was 56.1 years (95% CI 48.3 to 67.4). All patients underwent surgery with removal of hip endoprosthesis and installation block or articulating spacers at different times after the primary (77%) or revision (23%) arthroplasty. Results. Relapse of infection was detected in 78 cases (35.9%). In 139 (64.1%) patients remission of infection was observed, which allowed an average of 10.2 weeks (95% CI 7.87 to 14.3) perform a full-fledged replacement for a spacer prosthesis. Relapse of infection was detected in 78 (35.9%) cases. Conclusion. The main risk factors leading to a recurrence of the infection are the combination and type of microorganism, laboratory parameters, weight of the patient and the type of previous surgery.

Management of bladder stones associated with foreign bodies following incontinence and contraception surgery.

To investigate success of endoscopic lithotripsy for bladder stone following stress urinary incontinance surgery and contraception surgery. Charts of patients admitted in two centers between January 2006 and March 2013 were retrospectively reviewed and seven women were enrolled in our study. Patients demographic parameters including age, main complaint(s), previous surgery type, time to diagnosis were analyzed. Also operative time, hospitalisation lenght, perioperative and postoperative complication( s) were evaluated. Five patients had undergone tension free vaginal tape procedure and one patient had undergone transobturator tape procedure. Median age was 62 (50-71) years. In one patient bladder stone formed around an intrauterine device. Dysuria (85%), hematuria (57%) and recurrent urinary tract infection (57%) were the main complaints. The median diagnosis time was 44.1 months. Abdominal ultrasonography and non contrast enhanced computer tomography were performed for five and two patients respectively and diagnosis was confirmed cystoscopically. Endoscopic lithotripsy using Holmium laser lithotripter or pneumatic lithotripter was used for all cases. The mean operation time was 41.2 minutes (20-70) and success was 100%. There was no intraoperative complication. Only one patient had fever higher than 38ºC postoperatively and was treated by appropriate antibiotic. The median hospitalisation time was 1.57 day. In conclusion endoscopic lithotripsy is a safe and effective approach to manage bladder stone associated with mid-urethral synthetic slings and intrauterine devices.

Persistent Structural Disease Is the Most Common Cause of Repeat Hip Preservation Surgery

Hip preservation surgery has become more commonplace, yet when it fails, it is unclear why it does so. Understanding failed procedures should lead to improved surgical results. The purposes of this study were to (1) characterize patients undergoing hip preservation surgery after prior procedures; (2) compare demographics, hip pain, and function in patients with prior procedures with those undergoing primary surgery; (3) determine the types of previous procedures and the reasons for secondary surgery; and (4) report the procedure profile of the secondary surgeries. A prospective, multicenter hip preservation database of 2263 patients (2386 surgery cases) was reviewed to identify 352 patients (359 hips, 15% of the total) who had prior surgery. Patient demographics, type of previous surgery, diagnostic categories, clinical scores, and type of secondary procedure were recorded. For patients undergoing secondary surgery, the average age was 23 years and 70% were female. Hip pain and function were similar between patients undergoing primary and secondary surgery. The previous surgical approaches were open in 52% and hip arthroscopy in 48%. In the femoroacetabular impingement and adult acetabular dysplasia subgroups, hip arthroscopy was the most common previous surgical approach (86% and 64%, respectively). Inadequately corrected structural disease was the most common reason for secondary surgery. Femoral osteochondroplasty and acetabular reorientation were the most common secondary procedures. Inadequately corrected structural disease (femoroacetabular impingement or acetabular dysplasia) was commonly associated with the need for secondary hip preservation surgery. Although we do not have data to identify other technical failures, the available data suggest primary treatments should encompass comprehensive deformity correction when indicated.

Role of persistent processus vaginalis in hydroceles found in a tropical population

Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of para site eradication programs. We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. From January to March 2010, 4922 patients were seen, none of whom had elephantiasis. Of the 64 patients who collectively underwent 69 inguino-scrotal procedures, 5 patients had inguinal hernia repair several years after hydrocele excision via the scrotum, 19 patients with bilateral hydroceles underwent a scrotum-only approach, and 45 patients had an inguinal approach (33 unilateral and 12 bilateral) to repair 57 hydroceles. A patent processus vaginalis was present in 50 of 57 (88%) hydroceles where the groin was explored. Hydroceles remain common in Léogâne despite successful eradication of filariasis with mass drug administration using diethylcarbamazine-fortified cooking salt. Persistent patent processus vaginalis is a more likely cause than persistent filariasis. There is probably little difference between hydrocele in developed countries and tropical hydrocele other than neglect. Hydrocele prevalence is not a measure of the effectiveness of parasite eradication programs.

Management of the axilla for ipsilateral breast cancer recurrence after previous sentinel lymph node biopsy and breast conserving therapy

The sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in patients with primary breast cancer. Of these patients, 10–15% will develop local breast cancer recurrence. Optimal management of the axilla for these patients is still not established. The aim of this review is to assess the role of secondary lymph node biopsy in patients with ipsilateral breast cancer recurrence. The MEDLINE–PubMed databases were searched from 2006 to 2010 for publications addressing the role of secondary SLNB for ipsilateral breast cancer recurrence. Following terms were used: breast cancer recurrence, sentinel node biopsy, lymphatic drainage, follow-up lymphatic mapping. Twenty-two publications reporting a second SLNB at the time of ipsilateral relapse were identified. The detection rate of a new sentinel node (SN) was 45–97%. The detection rate varied depending on the type of previous surgery. A high rate of extra-axillary re-SN was reported (32%). In 8–35% cases, a histologically positive re-SN was diagnosed. The optimal management of the axilla in the setting of local recurrence is still not established. Prospective trials are needed to facilitate evidence-based recommendations for this situation.