Type Of Repair Research Articles

Occult Urinary Incontinence, Diabetes, Obesity, Prolapse Severity, and Type of Surgical Repair as Risk Factors for De Novo Stress Urinary Incontinence in Women Undergoing Surgical Repair of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis.

The International Continence Society and the International Urogynecological Association have not yet standardized the definition of de novo stress urinary incontinence. Recent studies define the development of stress urinary incontinence as occurring after surgical repair of pelvic organ prolapse in previously continent women. The mechanisms that cause de novo stress urinary incontinence are not yet clear. Knowledge of the predictive factors for this outcome after surgical correction of pelvic organ prolapse would be useful for assessing whether a concomitant anti-incontinence procedure should be performed. The aim of this systematic review and meta-analysis was to identify some of the risk factors for de novo stress urinary incontinence: high body mass index, pelvic organ prolapse stage before surgery, presence of occult urinary incontinence, type of surgery, and the presence of diabetes mellitus. The present study was registered in the PROSPERO database under number CRD42021293764, and the systematic review was carried out according to the MOOSE recommendations and with the PRISMA 2020 guidelines. A total of 2429 articles were identified. Nine cohort studies were included in the systematic review and seven in the meta-analysis. The risk of bias was assessed via the Newcastle-Ottawa scale and the certainty of evidence was assessed using the GRADE approach for each outcome. In the meta-analysis, associations were identified between de novo stress urinary incontinence and occult urinary incontinence (n: 422; OR: 2.01; 95% CI: 1.26-3.22; p = 0.004), diabetes (n: 1213; OR: 2.35; 95% CI: 1.30-4.26; p = 0.005), and advanced pelvic organ prolapse (n: 1003; OR: 1.94; 95% CI: 1.14-3.30; p = 0.01). Consulting a meta-analysis for the type of surgery was deemed impossible. A previous study comparing abdominal sacrocolpopexy with minimally invasive sacrocolpopexy revealed that women who underwent abdominal sacrocolpopexy were more likely to develop de novo stress urinary incontinence (n: 77; OR: 4.73; 95% CI: 1.56-14.34; p = 0.005). Another study found that pelvic organ prolapse repair using a transvaginal mesh was associated with higher levels of de novo stress urinary incontinence compared to robot-assisted sacrocolpopexy (n: 76; OR: 6.74; 95% CI: 1.35-33.75; p = 0.02). A meta-analysis of overweight or obesity was not possible due to the different assessment methods used in the studies. This meta-analysis revealed that occult incontinence, diabetes, and advanced pelvic organ prolapse before repair were associated with de novo stress urinary incontinence and these groups may therefore benefit from for anti-incontinence procedures concomitant with pelvic organ prolapse repair.

Dorsolateral Transdural Surgical Management of Spontaneous Intracranial Hypotension From Ventral Dural Cerebrospinal Fluid Leaks: Case Series and Technical Report

BACKGROUND and OBJECTIVES: Spontaneous intracranial hypotension is an uncommon but debilitating condition that commonly involves positional headaches and vertigo. One cause is cerebrospinal fluid (CSF) leakage from ventral dural defects from calcified spinal discs. Patients can undergo epidural blood or fibrin glue patches as treatment; however, in cases where the leak does not resolve, surgical repair of the dural tear may be warranted. We aim to describe a case series and technical notes for these patients. METHODS: Patients with spontaneous intracranial hypotension because of myelography-confirmed ventral dural defect from calcified thoracic disc, who were treated surgically between June 2020 and March 2024, were included in the study cohort. Demographic information, clinical course, and postoperative outcomes were collected. The surgical technique was also described based on an illustrative case. RESULTS: Twelve consecutive patients underwent surgery between June 2020 and March 2024 with postoperative records. The median age at the time of surgery was 41.5 years (range: 28-58 years). Male patients comprised 50% of the cohort. Dural defects were spread throughout the thoracic spine in the cohort. While all patients reported positional headaches, other symptoms included vertigo, pulsatile tinnitus, and neck pain. Median length of follow-up time was 6.5 weeks. There were no surgical complications or permanent neurologic deficits. All patients had radiologic cure of their leaks with absence of extradural CSF on postoperative MR imaging. Ten patients (83.3%) had complete resolution of spontaneous intracranial hypotension-related symptoms. Two patients did suffer from rebound headaches postoperatively. CONCLUSION: The dorsolateral transdural surgical approach is a safe and effective method to repair type 1 CSF leaks caused by ventral dural defects. Our case series of 12 patients did not involve any surgical or immediate postoperative complications, and all patients had radiologic resolution of their leaks with relief of positional headaches. Two patients experienced continued headaches after treatment.

Hemostatic derangements associated with cardiopulmonary bypass predict outcomes in pediatric patients undergoing corrective heart surgery

BackgroundUnderstanding of the hemostatic and complement alterations associated with cardiopulmonary bypass (CPB) in pediatric patients and the impact of these alterations on outcome is limited. ObjectivesThe present study prospectively characterized these alterations and their association with postoperative outcomes in pediatric CPB. Patients/MethodsAll patients <21 years undergoing CPB at the authors’ institution between 2020 and 2021 that weighed >3 kg, were >36 weeks gestational age, and had no known prothrombotic or hemorrhagic disorders were eligible. Blood samples were analyzed for multiple hemostatic and complement biomarkers pre-, intra-, and 24 hours post-CPB. Biomarker levels were compared to clinical outcomes, including chest tube output (CTO). ResultsFifty consecutive patients were enrolled. CPB resulted in multiple significant alterations in hemostatic and complement components. Lower platelet counts (<80 x 109 platelets/L) at CPB termination were associated with increased postoperative CTO (p=0.003). Lower factor VIII levels (<60 IU/dl) at the end of CPB were associated with a longer hospital stay (p<0.001) and increased postoperative CTO (p<0.001). Patients undergoing staged single ventricle reconstruction were more likely to have lower platelet counts at CPB termination (p=0.009) and higher CTO postoperatively (p=0.001) than patients undergoing other types of surgical repair. These differences were not due to different preoperative platelet counts, increased incidences of circulatory arrest, or longer CPB times. ConclusionsThese data suggest that intraoperative alterations in hemostatic system components may predict postoperative outcomes in pediatric CPB. Further study is needed to determine if interventions targeting platelets or factor VIII could improve outcomes in pediatric CPB.

Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment Outcomes: IRIS® Registry (Intelligent Research in Sight) Analysis

PurposeTo determine treatment patterns and outcomes of pneumatic retinopexy (PnR) for rhegmatogenous retinal detachments (RRD). DesignRetrospective cohort analysis using IRIS® Registry (Intelligent Research in Sight) database. ParticipantsPatients with RRD treated by PnR from 2013-2022. MethodsCases were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9, ICD-10) diagnostic codes. Surgical procedures were identified using Current Procedural Terminology (CPT) codes for type of RRD repair. Baseline demographic information included age, sex, race and ethnicity, geographic region, smoking status, and health insurance type. Main Outcome MeasuresPrimary outcomes for PnR included single-operation success (SOS) and failure (SOF), change in visual acuity at 9-12 months, rates of complications, rates of secondary procedure following SOF, and outcome by phakic status. Results13,302 unique eyes were analyzed (median age, 64 years, 61.56% male). Overall SOS for primary PnR was 59.82%. The mean BCVA at 9-12 months following PR was LogMAR 0.44 (95% CI: 0.42, 0.46) for SOF eyes, compared to 0.23 (95% CI: 0.22, 0.25) for SOS eyes (P < 0.001). Complications of PR included vitreous hemorrhage (9.1%), ERM (45.17%), proliferative vitreoretinopathy (0.98%), and endophthalmitis (0.14%). Of the 40.18% of eyes with SOF, 81% required either secondary PnR, scleral buckle (SB), vitrectomy (VTX), or complex detachment repair (CDR), whereas the remaining eyes required more than one of these secondary procedures. SOS for phakic eyes was 64.50% versus 53.93% for pseudophakic eyes (P < 0.001). ConclusionsIRIS Registry data reveal real-world outcomes and utilization patterns of PnR for RRD. Overall SOS for primary PnR was 59.82%, which is lower than other cited rates in the literature. Pseudophakic eyes were more likely to fail primary PnR. It is important to counsel patients on risks of the procedure when obtaining informed consent.

Management of post-iliac crest bone harvesting hernias: Insights from a case series and systematic review

IntroductionHernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repairing these hernias is challenging. Appropriate repair techniques are needed to minimise morbidity and recurrence. We present our experience with three cases of post-iliac graft hernia repair with mesh anchored to titanium mini-plates and a systematic review of current literature. MethodWe conducted a systematic review of the literature in February 2024 on two online databases, PubMed®/MEDLINE and EMBASE, in accordance with PRISMA guidelines. Keywords used were “Hernia,” “Iliac,” and “Graft.” Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded. ResultsWe included 30 studies out of 751 results, spanning from 1975 to 2023. There were 40 reported cases of hernias post iliac bone grafting. The age distribution ranged from 37 to 88 years, with a median age of 60. The majority of patients (40 %) presented within one year. Fracture management, accounting for 19 cases (47.5 %), was the main indication for bone grafting. Mesh repair was performed in 31 cases (77.5 %). Seven cases (17.5 %) of recurrence were reported. ConclusionRecurrence is a common complication in patients with post-iliac graft hernias. Open mesh repair is the most frequently performed surgery and involves various techniques. While titanium mini-plates as anchors enable a pre-peritoneal plane mesh repair, long-term follow-up and comparative studies are needed to evaluate its efficacy compared to simple mesh.

Unusual Surgical Repair of Bronchoesophageal Fistula Following Esophagectomy.

Radical esophagectomy remains the only potentially curative option in the treatment of esophageal cancer. However, this procedure is burdened with high morbidity and mortality rates, even in high-volume centers. A tracheo- or bronchoesophageal fistula (TBF) is rare but is one of the most difficult life-threatening complications following an esophagectomy for cancer treatment. Several classifications have been proposed regarding the localization of a TBF, its etiology, and the timing of its occurrence; hence, no classification is universally accepted. However, one of the most common etiological explanations for the formation of a TBF is a prior esophagogastric anastomotic leak. Treatment options include a conservative approach, which usually combines several endoscopic methods. Surgical treatment is directed towards fistula closure with direct suturing or, more often, the usage of pediculated flaps. Here, we present a patient with late TBF following a minimally invasive esophagectomy, which was surgically solved in an atypical way. We believe that this type of repair may be useful in patients in whom pedunculated flaps are not an option.

Pengaruh Pemahaman dan Kesiapan terhadap Penerapan Standar Akuntansi Keuangan Entitas Mikro Kecil dan Menengah (SAK EMKM) pada UMKM Jenis Perdagangan dan Reparasi di Kabupaten Ponorogo

Micro, Small and Medium Enterprises (MSMEs) in Indonesia are one of the priorities in national economic development. Therefore, reporting in this type of MSME business activity must be able to make systematic reports with the recording process following the applicable Financial Accounting Standards. So, there needs to be an understanding and readiness factor in preparing the report, so that SAK EMKM can be implemented in the management of MSMEs. This research aims to determine the effect of understanding and readiness for SAK EMKM on Trade and Repair MSMEs in Ponorogo Regency. This type of research uses primary data in the form of data on the number of trade and repair type MSMEs in 2021. This research method is a quantitative descriptive approach. Meanwhile, the data analysis method uses data quality testing, regression analysis, and hypothesis testing, while data collection is by distributing questionnaires and interviews. The results of this research show that there is a significant influence of understanding and readiness factors on the implementation of SAK EMKM in Ponorogo Regency. This means that the government needs to pay more attention or provide outreach/direction regarding the preparation of financial reports to MSME actors in Ponorogo Regency in accordance with applicable financial standards.

Single-Port Robotic Ureteroenteric Stricture Repair: A Retrospective Cohort Review.

Introduction The objective of this study is to present a series of 16 cases utilizing single-port robot-assisted repair for ureteroenteric anastomosis stricture (UES). To our knowledge, this is the first case series recorded detailing successful single-port UES revision. Methods A retrospective review of all patients under a single surgeon undergoing single-port robotic revision of ureteroenteric stricture following radical cystectomy with urinary diversion at our institutions from September 2020 through July 2024 was performed. Patient demographics and perioperative outcomes were assessed. Results The study consisted of 3 bilateral ureteroenteric strictures and 13 unilateral strictures, more commonly on the left. Stricture length averaged 2.2 cm on the left and 2.1 cm on the right. Surgeries were performed by a single surgeon using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, California, US). The type of stricture repair included excision and primary anastomosis (EPA) with Bricker or Wallace reconstruction or Heineke-Mikulicz (HM) repair, although one case involved the necessity of revision ileocalycostomy. Two of the 16 cases were converted from robotic to open due to extensive adhesions. The average procedure length was 265 minutes (148-440). Length of stay (LOS) ranged from 0-46 days, averaging 4.9 days. There were five postoperative complications encountered including two seromas, two incisional hernias, and an episode of urosepsis. Pre- and postoperative changes in creatinine level ranged from -0.26 to 0.3 mg/dL. No renal units were lost.No patients were readmitted following initial surgical discharge. All patientsreturned for follow-up; none required repeat intervention. Conclusion SP robotic repair of ureteroenteric anastomoses is safe and feasible. The risk of complications is low with a high chance of success and possibly a lower length of stay;more research is warranted.

Agelessness is possible under the disposable soma theory but system complexity makes it unlikely

Although demographic studies have failed to find evidence of aging in certain animal species, classic evolutionary theories of aging struggle to explain how evolution could favor agelessness in such cases. Here, we develop mathematical models of the disposable soma theory to identify conditions in which agelessness would be evolutionarily favored. For any given type of damage that could accumulate and cause age-accelerating mortality risk, we find that evolution could select for its complete removal if the mortality risk it poses is severe enough and its repair does not pose too large of a penalty to reproduction. Environmental factors such as extrinsic mortality and the form of population density-dependent regulation also play a large role in determining the optimal rate of aging and whether agelessness should be evolutionarily favored. However, in a system with multiple sources of damage and multiple independent repair processes, avoiding aging is rarely evolutionarily favorable. Pleiotropic repair processes, such as those that could be present in asexual fissioning organisms, make agelessness more likely but do not guarantee it. Our results indicate that agelessness could be favored by evolution in narrow contexts but that multiple types of damage and repair make agelessness unlikely to arise in sufficiently complex organisms.

DNA polymerase ζ has robust reverse transcriptase activity relative to other cellular DNA polymerases

Cell biology and genetic studies have demonstrated that DNA double strand break (DSB) repair can be performed using an RNA transcript that spans the site of the DNA break as a template for repair. This type of DSB repair requires a reverse transcriptase to convert an RNA sequence into DNA to facilitate repair of the break, rather than copying from a DNA template as in canonical DSB repair. Translesion synthesis (TLS) DNA polymerases (Pol) are often more promiscuous than DNA Pols, raising the notion that reverse transcription could be performed by a TLS Pol. Indeed, several studies have demonstrated that human Pol η has reverse transcriptase activity, while others have suggested that the yeast TLS Pol ζ is involved. Here, we purify all seven known nuclear DNA Pols of Saccharomyces cerevisiae and compare their reverse transcriptase activities. The comparison shows that Pol ζ far surpasses Pol η and all other DNA Pols in reverse transcriptase activity. We find that Pol ζ reverse transcriptase activity is not affected by RPA or RFC/PCNA and acts distributively to make DNA complementary to an RNA template strand. Consistent with prior S. cerevisiae studies performed in vivo, we propose that Pol ζ is the major DNA Pol that functions in the RNA templated DSB repair pathway.

DNA polymerase ζ is a robust reverse transcriptase.

Cell biology and genetic studies have demonstrated that DNA double strand break (DSB) repair can be performed using an RNA transcript that spans the site of the DNA break as a template for repair. This type of DSB repair requires a reverse transcriptase to convert an RNA sequence into DNA to facilitate repair of the break, rather than copying from a DNA template as in canonical DSB repair. Translesion synthesis (TLS) DNA polymerases (Pol) are often more promiscuous than DNA Pols, raising the notion that reverse transcription could be performed by a TLS Pol. Indeed, several studies have demonstrated that human Pol η has reverse transcriptase activity, while others have suggested that the yeast TLS Pol ζ is involved. Here, we purify all seven known nuclear DNA Pols of Saccharomyces cerevisiae and compare their reverse transcriptase activities. The comparison shows that Pol ζ far surpasses Pol η and all other DNA Pols in reverse transcriptase activity. We find that Pol ζ reverse transcriptase activity is not affected by RPA or RFC/PCNA and acts distributively to make DNA complementary to an RNA template strand. Consistent with prior S. cerevisiae studies performed in vivo, we propose that Pol ζ is the major DNA Pol that functions in the RNA templated DSB repair pathway.

Alternative double strand break repair pathways shape the evolution of high recombination in the honey bee, Apis mellifera.

Social insects, particularly honey bees, have exceptionally high genomic frequencies of genetic recombination. This phenomenon and underlying mechanisms are poorly understood. To characterise the patterns of crossovers and gene conversion in the honey bee genome, a recombination map of 187 honey bee brothers was generated by whole-genome resequencing. Recombination events were heterogeneously distributed without many true hotspots. The tract lengths between phase shifts were bimodally distributed, indicating distinct crossover and gene conversion events. While crossovers predominantly occurred in G/C-rich regions and seemed to cause G/C enrichment, the gene conversions were found predominantly in A/T-rich regions. The nucleotide composition of sequences involved in gene conversions that were associated with or distant from crossovers corresponded to the differences between crossovers and gene conversions. These combined results suggest two types of DNA double-strand break repair during honey bee meiosis: non-canonical homologous recombination, leading to gene conversion and A/T enrichment of the genome, and the canonical homologous recombination based on completed double Holliday Junctions, which can result in gene conversion or crossover and is associated with G/C bias. This G/C bias may be selected for to balance the A/T-rich base composition of eusocial hymenopteran genomes. The lack of evidence for a preference of the canonical homologous recombination for double-strand break repair suggests that the high genomic recombination rate of honey bees is mainly the consequence of a high rate of double-strand breaks, which could in turn result from the life history of honey bees and their A/T-rich genome.

Pathogenesis and Surgical Treatment of Congenitally Corrected Transposition of the Great Arteries (ccTGA): Part III.

Congenitally corrected transposition of the great arteries (ccTGA) is an infrequent and complex congenital malformation, which accounts for approximately 0.5% of all congenital heart defects. This defect is characterized by both atrioventricular and ventriculoarterial discordance, with the right atrium connected to the morphological left ventricle (LV), ejecting blood into the pulmonary artery, while the left atrium is connected to the morphological right ventricle (RV), ejecting blood into the aorta. Due to this double discordance, the blood flow is physiologically normal. Most patients have coexisting cardiac abnormalities that require further treatment. Untreated natural course is often associated with progressive failure of the systemic right ventricle (RV), tricuspid valve (TV) regurgitation, arrhythmia, and sudden cardiac death, which occurs in approximately 50% of patients below the age of 40. Some patients do not require surgical intervention, but most undergo physiological repair leaving the right ventricle in the systemic position, anatomical surgery which restores the left ventricle as the systemic ventricle, or univentricular palliation. Various types of anatomic repair have been proposed for the correction of double discordance. They combine an atrial switch (Senning or Mustard procedure) with either an arterial switch operation (ASO) as a double-switch operation or, in the cases of relevant left ventricular outflow tract obstruction (LVOTO) and ventricular septal defect (VSD), intra-ventricular rerouting by a Rastelli procedure. More recently implemented procedures, variations of aortic root translocations such as the Nikaidoh or the half-turned truncal switch/en bloc rotation, improve left ventricular outflow tract (LVOT) geometry and supposedly prevent the recurrence of LVOTO. Anatomic repair for congenitally corrected ccTGA has been shown to enable patients to survive into adulthood.

WP1.4 - Iliac Crest Bone Grafts and Hernia Formation: Insights from a Case Series And Review of Literature

Abstract Introduction Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repair of these hernia is challenging. There is a need for appropriate repair techniques to minimize morbidity and recurrence. We present our experience with 3 cases of post-iliac graft hernia repair and a systematic review of current literature. Method We conducted a systematic review of literature in two online databases, PubMed®/ MEDLINE and EMBASE) February 2024, following PRISMA guidelines. Keywords used were “Hernia”, “iliac”, and “Graft”. Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded. Results 31 studies, spanning from 1975-2023, were included of 751 results. There were 41 reported cases of hernias post iliac bone grafting. Age distribution ranged from 37-88 years, with an average age of 59 years. Average time of presentation was 4 years. 8 cases (25.8%) of recurrence were reported. The main indication for bone grafting was fracture with delayed/ non-union in 20 cases (64.5%). Mesh repair was performed in 70% of cases. Average follow-up period was approximately 17 months. Conclusion Hernias post iliac bone grafting should be suspected as a probable complication. If identified, most can be managed with mesh, however patients need to be followed up due to risk of recurrence.

Impact of surgical strategy and postrepair transverse aortic arch size on late hypertension after coarctation repair during infancy

BackgroundLate hypertension (HTN) after coarctation of the aorta (CoA) repair contributes to higher morbidity and mortality. An association between transverse aortic arch (TAA) hypoplasia and HTN has been found, but its relationship with surgical strategy is unclear. We studied the association between late HTN and initial surgical strategy pertaining to the TAA. MethodsWe retrospectively reviewed patients who underwent surgical repair of CoA during infancy with at least 10 years of follow-up, excluding those with atypical coarctation, major associated heart defects, and residual isthmic narrowing. TAA diameter z-score immediately postrepair was measured as a marker of surgical strategy. Systemic HTN at latest follow-up was assessed using standard criteria. ResultsA total of 130 patients underwent surgical repair of CoA (76% via thoracotomy, 24% via sternotomy) with resection and end-to-end anastomosis (62%), extended end-to-end anastomosis (30%), subclavian flap (5%), or arch repair with patch (4%), at a median age of 14 days (interquartile range [IQR], 7-62 days). The median postrepair TAA diameter z-score was −2.04 (IQR, −2.69 to 1.24). At a mean follow-up of 17.3 years, 43 of the 130 patients (33%) developed HTN. After controlling for age at repair, sex, and presence of a genetic syndrome, HTN was not associated with immediate postrepair TAA diameter z-score (P = .41), type of surgical incision (P = .99), or type of surgical repair (P = .66). ConclusionsIn patients undergoing surgical repair of CoA during infancy, late HTN was not associated with immediate postrepair TAA size or surgical strategy pertaining to the TAA. These results suggest that factors other than surgical strategy, such as differential growth of the TAA during childhood, may be important.

Martius Labial Fat Pad Use in the Treatment of Complications Associated With Prior Surgery for Urinary Incontinence or Pelvic Organ Prolapse

ObjectiveTo evaluate the outcomes of Martius Labial Fat Pad (MLFP) in the treatment of complications related to surgery for urinary incontinence (UI) and/or pelvic organ prolapse (POP) and to assess the influence of mesh presence. MethodsFollowing institutional review board approval (n° STU 2023 1280), a review of all women who underwent a MLFP procedure at our tertiary center after UI and/or POP repair was performed by an independent investigator. The primary outcome was the rate of post-operative complications classified according to the Clavien-Dindo classification. Secondary outcomes were based on indications and functional results. A subgroup analysis was performed according to the type of prior repair: mesh or native tissue repair. ResultsFrom 2006-2022, 26 patients underwent a MLFP procedure, with a median follow-up duration of 30 (12-67.5) months. Bladder outlet obstruction and fistulae were the two most frequent indications. Post-operative complications occurred in 15 patients (58%): grade I in 6 (43%), grade 2 in 3 (21%), grade 3b in 4 (29%) and grade 4b in 1 (7%). Four of the grade ≥ 3 complications occurred in the mesh group. Median operative time was longer in the mesh group: 200 minutes (177.5-229.5) versus 146 minutes (128-190) (p=0.03) and the success rate was lower: 61% versus 85% (p=0.06). Overall, surgery was successful in 19 patients (73.8%). ConclusionMFLP is a reliable flap in specialized indications after UI and/or POP repair procedures with a higher risk of major complications and a lower success rate in women previously operated with mesh.

Intraperitoneal Onlay Mesh Repair (IPOM) versus Intraperitoneal Onlay Mesh Repair with Closure of Fascia Defect (IPOM Plus) for Ventral Hernias: Retrospective Analysis of Postoperative Outcomes

Background: Intra-peritoneal onlay mesh (IPOM) repair, a type of Laparoscopic Ventral Hernia Repair (LVHR), comprises bridging the defect from the peritoneal side with a composite mesh. Recently, IPOMPlus has become the recommended type of LVHR in which the defect in the fascia is sutured before placing the mesh. Materials and Methods: This study is a retrospective cohort study conducted at Dharan Hospital, Salem. Patients who had undergone IPOM-Plus or IPOM during January 2020 to June 2021 were selected. Data regarding demographics, intra-operative and post-operative outcomes were collected from medical record section. Patients were followed up for 6 months. Data analysis was performed using SPSS version 26.0 taking a p-value of &lt;0.05 as statistically significant. Results: A total of 74 patients were included in this study, out of which 34 patients had undergone IPOM (Group A) and 40 patients underwent IPOM-Plus (Group B). In both the groups, there was no statistical difference in demographic variables except more number of umbilical hernia in both the groups compared to epigastric and paraumbilical hernia. Hernia defect size and mean operative time were varied significantly (p-value &lt; 0.05) in both groups. More number of seroma formation (p=0.021), pseudosac at first OPD visit (p=0.020) and pseudosac at 6 months (p=0.027) in Group A compared to Group B. Conclusions: IPOM plus repair is safe with possible advantages over a standard IPOM repair in patients with ventral hernia in term of postoperative outcomes. Keywords: Ventral hernia, IPOM, IPOM Plus, Laparoscopy

The types of repairs, categories of repairs, repairs in doctor-patient communication, and repair strategies from the perspective of psycholinguistics

The nature of human spontaneous speech brings about speech errors and typical disfluencies such as hesitation, pause, silence, repetition, and repair. Recent studies in spoken dialects across many countries reported that speakers produce speech errors or unclear expressions in daily verbal communication. When speakers realize their utterances are erroneous or inappropriate, they frequently make pervasive, highly systematic, and measurable repairs in conversation. Some researchers claim that the repairs in conversation are ubiquitous. This occurrence reflects that individuals make great efforts to ensure their utterances are understandable and acceptable to the listeners. This also triggered the question of what role do speech repairs play in building mutual understanding and enhancing therapeutic relationships between doctors and patients during clinical interactions. Most of these studies have predominantly focused on first (L1) and second language (L2) acquisition, while limited studies have investigated repairs in clinical settings. Repair is a key mechanism for building mutual understanding in clinical interactions and contributes to better therapeutic relationships and treatment adherence. Doctors and patients attempt to make their utterances understandable and acceptable to attain their purposes in the clinical encounter. Nevertheless, some studies do not describe the categories of repair strategies and the trouble source, while only limited research mentioned the types of repair. This gives no insights into the specific strategies and trouble sources in the communication. This study, therefore, sets out to review the types of repairs, categories of repairs, repairs in doctor-patient communication, and repair strategies in attempting to explain the repair mechanism that works in the communication setting between doctor-patient interactions from the perspective of epistemic, pragmatics, conversation analysis, and psycholinguistics.

Trends in Duodenal Injury Severity, Repair, and Mortality Over Time

IntroductionOutcomes for patients with traumatic duodenal injury are determined by the location of the injury, injury severity, and associated injuries. We hypothesized that there is an association among the increased frequency of firearm injuries, the severity of duodenal injuries, trends in repair techniques, and mortality. MethodsDuodenal injuries managed at an adult level 1 hospital from 2000 to 2022 were identified. Demographics, injury type, the American Association for the Surgery of Trauma (AAST) grade, type of surgical repair, and mortality data were obtained and aggregated into two periods (2000 to June 2011 and July 2011 to 2022) to evaluate trends over time. P values < 0.05 were considered significant. ResultsOne hundred eighty eight cases were identified. Duodenal injuries due to firearms increased over time (30% versus 55%, P < 0.001). The distribution of AAST injury grade shifted over time with fewer grade 1 and more grade 2 to 4 injuries in the later period (P = 0.002). AAST grade 2 injuries or higher were more likely due to firearms (P < 0.001). Despite more high-grade injuries, there was no change in the use of primary repair with or without tube drainage (61% versus 70%, P = 0.35) and there was no change in mortality (15% versus 17%, P value 0.62) between the time periods. ConclusionsThere was a proportional increase in the number of duodenal injuries caused by firearms. Higher grade duodenal injuries were more common with firearm injuries and were predominately repaired with simple techniques with no increase in mortality.

Endovascular Versus Open Repair in Adolescent Patients With Difficult-to-Access Vascular Injuries

IntroductionManagement of subclavian artery injuries (SAI) and iliac artery injuries (IAI) in adolescent trauma patients poses a considerable challenge due to their complex anatomical locations. The aim of our study was to determine the association between the injury mechanism and type of repair with the outcomes of patients with traumatic SAI and IAI. MethodsIn this retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database2017-2020, adolescent (<18 y) patients with SAI and IAI undergoing either endovascular or open repair were included. Patients were stratified by mechanism (blunt versus penetrating) and type of repair (endovascular [E] versus open [O]) and compared. Outcomes measured were mortality and major complications. Multivariable logistic regression analyses were performed. ResultsOver 4 y, 170 pediatric patients were identified, of which 73 (43%) sustained an SAI and 97 (57%) had IAI. The mean age was 15 and 79% were male. Overall, 39% were managed endovascularly. Both groups had comparable median injury severity score (E: 23 versus O: 25, P = 0.278). For patients with blunt injury (n = 60), the type of repair was neither associated with major complications (E: 39% versus O: 33%, P = 0.694) nor mortality (E: 2.6% versus O: 4.8%, P = 0.651). For patients with penetrating injuries (n = 110), the endovascular repair had significantly lower morbidity (19% versus 41%, P = 0.034) and mortality (3.7% versus 21%, P = 0.041). On multivariable logistic regression, endovascular repair was identified as the only modifiable risk factor associated with reduced mortality (adjusted odds ratio: 0.201, 95% confidence interval [0.14-0.76], P = 0.038). ConclusionsDifficult-to-access vascular injuries result in significant morbidity and mortality. Endovascular repair was found to be the only modifiable factor associated with decreased mortality of patients with penetrating injury, whereas the type of repair was not associated with mortality in those with blunt injury.