Type Of Repair Research Articles

A Scoping Review of Definitions of Success in Endovascular Aortic Arch Repair.

The present standard of care to treat aortic arch pathologies is open surgical repair with cardiopulmonary bypass and deep hypothermic arrest. With approaches for total endovascular and extra-anatomic cervical debranching hybrid arch repair becoming more diverse, understanding what is considered a successful operation is prerequisite for a rigorous comparison of techniques. This review describes the specific outcomes reported, the rates of success, and the definitions of technical and clinical success in total endovascular and extra-anatomic cervical debranching hybrid aortic arch repair. A comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed. Studies with patients undergoing total endovascular or hybrid extra-anatomic cervical debranching repair of the aortic arch were included. Any publications including only patients with Ishimaru zone 2 or distal repairs were excluded from this review. Studies with less than 5 patients were excluded. Data extraction was performed by one author. Data items included were study design, procedure type, procedural details, underlying pathology, type of cervical debranching, type of endograft repair, surgical outcomes, definition of cerebrovascular events, technical success, and the definition of technical success. Of 1754 studies screened for review, 85 studies with 5521 patients were included. By frequency, the included studies examined the following interventions: fenestrated devices, branched devices, parallel grafting. Most studies were retrospective single-institution studies. There were no randomized controlled trials. Short-term mortality and cerebrovascular events were nearly universally reported, present in 99% and 95% of studies reviewed, respectively. Only 27% of studies provided an explicit definition for cerebrovascular events. While 75% of studies reported a technical success rate, only 45% of those studies provided explicit criteria. Clinical success rates were infrequently reported, present in only 5.9% of studies reviewed. The definitions of technical success that were provided fell short of analogous defined reporting standards in nearly all studies, inflating technical success rates. Definitions of cerebrovascular events and technical success require stringent criteria to uniformly compare various methods of endovascular aortic arch repair. A societal consensus document for reporting standards of endovascular aortic arch repair would allow for higher-quality outcomes research. Total endovascular and extra-anatomic cervical debranching hybrid operations are being increasingly utilized for complex aortic arch repair. These techniques, however, can be associated with serious complications. Currently, there is no accepted metric to define technical or report clinical outcomes. Due to the paucity of high-quality data, use of these approaches may be limited in clinical practice. This study emphasizes the need for the development of standards for reporting outcomes in endovascular aortic arch repair. Future studies can then utilize these benchmarks, whcih will allow for improved efficacy and safety in these techniques.

The “Rocky” Factor: Minimizing Globe Injury in Subsequent Orbital Floor Fractures in Repeat Offenders

Background: Recurrent or repeat orbital floor and/or medial wall fractures may have an increased risk of globe injury and vision loss. To see if the initial orbital floor repair technique and/or chosen material for reconstruction impact the result, we studied repeat offenders who engage in: (1) repeat assaults, (2) unprotected sports injuries, or (3) seizure disorders. Methods: From 715 patients who underwent traumatic orbital floor repair over an 18-year period, 58 “repeat offenders” suffered a subsequent orbital fracture and were studied. Type of repair and outcomes including globe injuries were documented. Results: Repeat offenders who had a second orbital fracture had initial repairs with: resorbable plates (63.8%), titanium mesh (12.1%), and split cranial bone grafts (14%). More significant globe injuries occurred when initial repair was with titanium plates (86%) and bone grafts (14%) compared to resorbable plates (0%). Of the total group with initial orbital fractures and repair, 15% were categorized as “at risk” to be repeat offenders based on their medical history and activity. Of the “repeat offenders” who had an additional orbital fracture, 95% (50/58) fell into the “at risk” category for “repeat offending.” Conclusion: Resorbable plate orbital floor and/or medial wall fracture repair may offer less significant globe injury for repeat offenders at risk for subsequent orbital trauma.

NHEJ and HDR can occur simultaneously during gene integration into the genome of Aspergillus niger

Non-homologous end joining (NHEJ) and homology-directed repair (HDR) are two mechanisms in filamentous fungi to repair DNA damages. NHEJ is the dominant response pathway to rapidly join DNA double-strand breaks, but often leads to insertions or deletions. On the other hand, HDR is more precise and utilizes a homologous DNA template to restore the damaged sequence. Both types are exploited in genetic engineering approaches ranging from knock-out mutations to precise sequence modifications.In this study, we evaluated the efficiency of an HDR based gene integration system designed for the pyrG locus of Aspergillus niger. While gene integration was achieved at a rate of 91.4%, we also discovered a mixed-type repair (MTR) mechanism with simultaneous repair of a Cas9-mediated double-strand break by both NHEJ and HDR. In 20.3% of the analyzed transformants the donor DNA was integrated by NHEJ at the 3’ end and by HDR at the 5’ end of the double-strand break. Furthermore, sequencing of the locus revealed different DNA repair mechanisms at the site of the NHEJ event.Together, the results support the applicability of the genome integration system and a novel DNA repair type with implication on the diversity of genetic modifications in filamentous fungi.

Impact of operative approach and patient frailty on outcomes for aorto-iliac occlusive disease with critical limb threatening ischemia.

Multiple treatment modalities exist for the management of aorto-iliac occlusive disease (AIOD) including endovascular (endo), extra-anatomic bypass (EAB), and anatomic bypass (AB). The goal of this study was to examine the impact of revascularization strategy and patient frailty on outcomes for AIOD in patients with critical limb threatening ischemia (CLTI). Patients undergoing revascularization for CLTI and AIOD were identified from the NSQIP database over 5years. Demographics, procedural characteristics, and outcomes were recorded. Modified frailty index (mFI-5) was calculated for each patient. Patients were compared based on the type of procedure and frailty (mFi>0.6). From 2017 to 2021, 1777 patients underwent revascularization for CLTI from AIOD. Patients were majority male (56%) with a mean age of 68. A total of 1346 patients (76%) underwent an open operation of which 669 were EAB. When endo (431 patients) was compared with open repair, endo was associated with a higher incidence of tissue loss at presentation (42% vs 33%, p < 0.001), lower rates of bleeding (6.5% vs 15.5%, p < 0.001), fewer MI/stroke (1.6% vs 4.6%, p = 0.004), and fewer wound complications (2.6% vs 11.2%, p < 0.001). There was no difference in re-intervention, amputation, or death based on frailty. For frail patients (184 patients), type of repair did not impact re-intervention, major amputation, or mortality, though there was increased MI/stroke with EAB and increased wound complications with AB/EAB. AIOD revascularization strategies for patients with CLTI have similar 30-day re-intervention, major amputation, and mortality rates. Endovascular repair has less surgical wound complications and is better suited for frail patients.

Late-"de novo" paraesophageal hernia after Roux-en-Y gastric bypass (RYGB)-should it be repaired?

This study presents a case series of "de novo" paraesophageal hernia (dnPEH) in post-Roux-en-Y gastric bypass (RYGB) patients and analyzes the predisposing factors, symptoms, and outcomes after repair. This is a lesser known complication after RYGB and when symptomatic, may warrant surgery. A retrospective review of data from a single academic institution from 2002 to 2022 was performed identifying patients who developed dnPEH after RYGB and compared them to patients with primary RYGB without post-operative symptomatic dnPEH. Patient characteristics from initial RYGB were analyzed to identify predisposing factors for dnPEH development. Additional information analyzed included time to dnPEH repair, indications for surgery, types of herniation, type of surgical repair, and symptom resolution. There were 6975 RYGB in the study period of which 6619 underwent RYGB alone at index surgery, with 31 of those patients developing late stage PEH requiring repair. Patients with older age (51.8years with dnPEH vs 45.2years without, p = 0.001) and increased weight loss at 1year (33.4% vs 30.5%, p = 0.048) from index RYGB were more likely to develop dnPEH. The incidence of dnPEH was 31/6619 (0.47%). Late dnPEH after RYGB took an average of 74months (45-102months IQR) to develop symptoms and undergo repair. The most common symptoms were heartburn/reflux 19/31 (61.3%) and epigastric pain 13/31 (41.9%). Symptom resolution rate after repair was highest with 100% for globus and 89.5% heartburn/reflux. The most common form of dnPEH was pouch herniation in 25/31. Surgical repair most commonly included primary cruroplasty alone in 25/31 with additional mesh in 1 case. Recurrence rate was 2/31 (6.54%). Late dnPEH after RYGB is an emerging entity typically occurring years after index RYGB. Symptomatic patients with dnPEH warrant hernia repair and responded well to surgical repair in this case series.

Small Bowel Obstruction Following Congenital Diaphragmatic Hernia Repair-Incidence and Risk Factors.

Small bowel obstruction (SBO) is a known complication following congenital diaphragmatic hernia (CDH) repair, resulting in significant morbidity and potential mortality. Our study aims to evaluate the incidence and risk factors for SBO following CDH repair. A single-institution retrospective review evaluated all CDH births between January 2010 and September 2022 (n = 120). Risk factors for SBO were analyzed, including operative approach, type of repair, need for extracorporeal membrane oxygenation (ECMO), and additional abdominal surgeries (gastrostomy tube and fundoplication). 120 patients were included. 16 (13%) patients developed an SBO, of which 94% were due to adhesive bands. The median time to SBO was 7.5 months. 15/16 (94%) patients required operative intervention. Need for ECMO (P < 0.01), prior gastrostomy tube (P < 0.01), and prior fundoplication (P < 0.01) were associated with an increased risk of SBO, as were longer time to initial CDH repair (6 days vs 3days; P < 0.01) and longer length of initial hospitalization (63 days vs 29days; P = 0.01). Neonates with increased acuity of illness (ie, those requiring ECMO, additional abdominal operations, longer time to repair, and longer initial hospitalizations) appear to have an increased risk of developing adhesive SBO after CDH repair. More than 90% of patients who developed SBO required surgery.

Application of a Novel Mitral Valvuloplasty Strategy in Children with Mitral Regurgitation.

To retrospectively analyze the clinical efficacy of an innovative mitral valvuloplasty strategy in the treatment of mitral regurgitation in children. From January 2018 to December 2022, 140 patients undergoing surgical treatment for mitral regurgitation in our hospital were enrolled. Ninety patients underwent three-step standardized pediatric mitral valvuloplasty (group A) and 50 patients underwent simple annuloplasty (group B). The incidence of primary and secondary study endpoint was compared between the two groups, and the independent risk factors for the primary study endpoint were determined. Our primary study endpoint was a composite endpoint of postoperative functional mitral failure, postoperative heart failure, transplantation, and/or mortality. Secondary end points were defined as perioperative complications. During the follow-up period, there was no all-cause death. Primary endpoint events occurred in 22 patients, including 12 patients in group A and 10 patients in group B. There was no significant difference in the incidence of primary and secondary endpoint events between the two groups. Multivariate Cox proportional hazards regression analysis showed that younger age and residual mitral regurgitation at discharge were independent risk factors for the primary endpoint events, while type of MV repair was not an independent risk factor. Subgroup analysis based on age showed that primary endpoint events occurred in 4 patients in group A and 7 patients in group B in patients < 1year old. The incidence of primary endpoint events in group A was lower than that in group B (6.06% vs. 20.59%, P = 0.041). In patients ≥ 1year old, the primary endpoint event occurred in 8 cases in group A and 3 cases in group B. There was no significant difference in the incidence of primary endpoint events between groups A and B (33.33% vs. 18.75%, P = 0.312). The degree of mitral regurgitation at discharge was significantly improved compared with that before operation in both groups (P < 0.001), and the degree of mitral regurgitation at the last follow-up was not significantly worse than that at discharge (P = 0.090). The mid-term results of mitral valvuloplasty for mitral regurgitation in children are encouraging. The perioperative recovery and postoperative outcomes of three-step standardized mitral valvuloplasty in children are not inferior to those of annuloplasty alone. Three-step standardized pediatric mitral valvuloplasty has better postoperative outcomes than simple mitral annuloplasty, especially for patients younger than 1year old. Children with residual mitral regurgitation at discharge should be followed up regularly to be alert to the occurrence of poor prognosis.

In-hospital mortality risk after endovascular and open aortic aneurysm repairs for ruptured abdominal aortic aneurysms

ObjectiveObservational studies demonstrate reduced mortality after endovascular (EVAR) compared with open aneurysm repair (OAR) for ruptured abdominal aortic aneurysms (rAAAs). We sought to determine national trends in repair type and in-hospital mortality rates for rAAAs. MethodsWe analyzed patients with rAAAs managed with OAR or EVAR from 2002 to 2020 in the National Inpatient Sample and evaluated annual trends in volume and in-hospital mortality by repair type. Multilevel mixed effects logistic regression model was fit for patient and system-level risk adjustment. We assessed interactions between time, sex, and Elixhauser index with repair type. ResultsWe examined 13,376 patients with rAAAs. Of these, 8357 (62.5%) underwent OAR. Patients receiving EVAR were slightly older (73.7 vs 72.5 years; P < .001) with slightly higher mean Elixhauser index (4.0 vs 3.8; P < .001). Unadjusted in-hospital mortality was 37.4% vs 22.4% for OAR and EVAR, respectively. EVAR offered a risk-adjusted survival advantage (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.32-0.46). There was a statistically significant reduction of in-hospital mortality over time in the EVAR group (interaction OR, 0.96; 95% CI, 0.95-0.98). The interaction between Elixhauser index and repair was not statistically significant (interaction OR, 0.95; 95% CI, 0.87-1.05). ConclusionsSurvival rates for OAR and EVAR improved over time. EVAR persistently provided a substantial survival advantage over OAR in patients with rAAAs over the past 2 decades.

Role of endovascular management on outcomes in patients with traumatic inferior vena cava injuries

IntroductionThe aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries. MethodsThis is a retrospective analysis of the ACS-TQIP database (2017–2020), including patients with traumatic IVC injuries. Patients were stratified by injury mechanism and type of repair and compared. ResultsOut of 1334 patients, 5 ​% underwent endovascular repair while 95 ​% had an open procedure. Overall, 74.7 ​% sustained a penetrating injury. On multivariable regression analysis, the type of repair was not associated with mortality and morbidity for patients with penetrating injuries. However, among patients with blunt injuries, endovascular repair was associated with lower odds of in-hospital mortality (aOR:0.35, p ​= ​0.020) and non-venous thromboembolism (VTE) morbidity (aOR:0.41, p ​= ​0.015), and higher odds of VTE complications (aOR:6.74, p ​< ​0.001). ConclusionsAlthough the type of repair did not impact morbidity and mortality in patients with penetrating injuries, endovascular repair was identified as the only modifiable predictor of reduced non-VTE morbidity and mortality in patients with blunt injuries.

Less is more: Outcomes of surgical approaches to rectal prolapse in patients with cirrhosis

BackgroundPatients with cirrhosis have increased risk of perioperative complications, and surgical management of concomitant rectal prolapse poses a challenge in these patients. Given the paucity of data informing this, our study aimed to evaluate postoperative outcomes. MethodsThe National Surgical Quality Improvement Program database was queried for patients undergoing rectal prolapse repair from 2011 to 2019. Patients were stratified by cirrhosis (Model for End-Stage Liver Disease ≥10) and no cirrhosis. Bivariate and multivariable regression analyses were used to compare comorbidities, repair types, and identify predictors of postoperative outcomes. ResultsWe identified 2,234 patients: 332 patients with cirrhosis (Model for End-Stage Liver Disease 14 [10–34]). Patients with cirrhosis were older (76 ± 12 years vs 69 ± 17, P < .001) with increased comorbidities (eg, heart failure, lung disease), greater mortality (3.6% vs 0.8%, P < .001), and complication rates compared with patients without cirrhosis. Readmission rates and longer hospital stays also were observed in patients with cirrhosis. A total of 52% of NCPs underwent abdominal repair compared with 62% of patients with cirrhosis who received perineal repair; greater complication rates were observed for abdominal repairs in both groups (patients without cirrhosis 11.4%, patients with cirrhosis 25%). Predictors of greater complication rates in patients with cirrhosis included abdominal repair (odds ratio 2.7, 95% confidence interval 1.4–5, P = .002) and presence of ascites (odds ratio 4.6, 95% confidence interval 1.1–20, P = .04). ConclusionOverall, abdominal repairs have greater complication rates even when controlling for Model for End-Stage Liver Disease score and presence of ascites. The Delorme procedure had the lowest complication rates. Additional evidence is needed to recommend a preferred surgical approach to rectal prolapse repair in patients with cirrhosis.

166 A Retrospective Observational Study on Laparoscopic and Open Hernia Repairs at a Single Centre

Abstract Aim To compare Laparoscopic and open hernia repairs in terms of patient management and post operative complications was collected and compared against the existing standards regarding management of hernias. Method A retrospective observational study of all emergency and elective, laparoscopic and open inguinal hernia repairs that were performed during the years 2020-2021 was conducted. Demographic and outcome data were collected from electronic patient records including patient demographics, laterality, type of repair, conversion rate, peri- and postoperative complications, rates of recurrence, chronic groin pain and mortality. These were then analyzed using MS Excel and SPSS. Results 108 patients were studied in total. In the post operative period, there was zero mortality in both groups, and only one patient developed recurrence as a complication. None of the other patients had any major complications. 1 patient complained of paraesthesia in the groin, 5 had scrotal edema, 5 developed seromas. Other minor complications were inguinodynia, post operative pain, bruising and haematoma in 1 percent of patients. The single incidence of recurrence occurred in a case where open repair was done and a greater proportion of minor complications were observed in people who underwent laparoscopic repair (19% of all laparoscopic repairs), while it was lower in patients who underwent open repair (14.7% of all open repairs). These differences were of no statistical significance as Chi-square test. Conclusions The data obtained reveal that there is no significant difference between the outcomes of laparoscopic and open hernia repairs at a single Centre.

Socioeconomic and regional variations in repair modality for ruptured abdominal aortic aneurysms

BackgroundPrevious studies report that patients of racial/ethnic minorities more frequently present with ruptured abdominal aortic aneurysms (rAAAs) than their counterparts. The distribution of rAAA treatment modality, whether open aneurysm repair (OAR) or endovascular aneurysm repair (EVAR), by race/ethnicity classification remains uncertain. This study aims to investigate disparities, as represented by race/ethnic classification, median income, and insurance status, in the management of rAAA in a national cohort. MethodsWe conducted a retrospective analysis of patients admitted with rAAA managed with either OAR or EVAR from 2002 to 2020 using the National Inpatient Sample, comparing repair type by race/ethnicity group. Multilevel mixed effects logistic regression models, adjusted for patient- and system-level factors, were used to calculate difference in use of OAR or EVAR dependent on race/ethnicity classification. ResultsWe identified 10,788 admissions for rAAA repairs, of which 9506 (88.1%) were White, 605 (5.6%) were Black, 424 (3.9%) were Hispanic, and 253 (2.4%) were Asian/Native American. Asians/Native Americans underwent the highest frequency of OAR as compared with EVAR (61.7% vs 38.3%). In the adjusted model, there was no statistically significant difference in the use of OAR vs EVAR by race/ethnicity classification. In total, primary payer and median income were also not statistically significant predictors of AAA treatment modality. ConclusionsOur study found no statistical evidence of disparities with respect to race, insurance, or median income and use of OAR or EVAR for the management of rAAA.

ANALISIS LIFE CYCLE COST PERKERASAN KAKU DAN LENTUR JALAN PROVINSI (STUDI KASUS: JALAN RAYA PARE – KEDIRI)

Pare-Kediri Highway is a provincial road which is the main connecting road between Pare and Kediri City. On this road section is often bypassed by vehicles with large loads. However, in existing conditions there is damage that varies. Road planning is generally planned to be used for a certain period of time, for example 10 to 20 years depending on existing transportation needs, in the hope that the road will remain in good condition and suitable for traffic. Road maintenance measures are necessary to ensure good operating conditions throughout the planning period. Maintenance and repair of damaged roads also cost a lot. As a result evaluating road damage and choosing the right type of repair is very important. According to the results of research with the 2017 pavement Design Manual guidelines, flexible pavement thickness was obtained including AC-WC 4 cm, AC-BC 6 cm, AC-Base 16 cm and Class A aggregate foundation layer 15 cm. While the thickness of the rigid pavement using continuous concrete without reinforcement with 30 MPa quality concrete obtained plate thickness of 28.5 cm and a layer of thin concrete foundation (LMC) 10 cm. Based on data processing, the construction cost of flexible pavement amounted to Rp 12,958,812,587.00 while rigid pavement amounted to Rp 30,584,262,345. 00. The Total maintenance cost for flexible pavement is Rp 23,836,678,414.33 while for rigid pavement is Rp 3,208,462,265. 15. So that the results of life cycle cost analysis of this study obtained the total cost during the 20-year life cycle of flexible pavement of Rp 36,795,491,001.33 while rigid pavement of Rp 33,792,724,610. 15. In this case, rigid pavement has a life cycle cost (life cycle cost) which is 8.51% more efficient than flexible pavement.

Reliability analysis of multiple repairable systems under imperfect repair and unobserved heterogeneity

AbstractImperfect repairs (IRs) are widely applicable in reliability engineering since most equipment is not completely replaced after failure. In this sense, it is necessary to develop methodologies that can describe failure processes and predict the reliability of systems under this type of repair. One of the challenges in this context is to establish reliability models for multiple repairable systems considering unobserved heterogeneity associated with systems failure times and their failure intensity after performing IRs. Thus, in this work, frailty models are proposed to identify unobserved heterogeneity in these failure processes. In this context, we consider the arithmetic reduction of age (ARA) and arithmetic reduction of intensity (ARI) classes of IR models, with constant repair efficiency and a power‐law process distribution to model failure times and a univariate Gamma distributed frailty by all systems failure times. Classical inferential methods are used to estimate the parameters and reliability predictors of systems under IRs. An extensive simulation study is carried out under different scenarios to investigate the suitability of the models and the asymptotic consistency and efficiency properties of the maximum likelihood estimators. Finally, we illustrate the practical relevance of the proposed models on two real data sets.

Early and Mid-Term Outcomes of Transcaval Embolization for Type 2 Endoleak after Endovascular Aortic Repair.

Background: Among the endovascular approaches for the management of endoleak type 2 (EL 2), transcaval embolization (TCE) has shown encouraging outcomes. However, the literature is still limited. This study aimed to present the early and mid-term outcomes of TCE for EL 2 after endovascular aortic repair. Methods: A retrospective, single-center analysis of consecutive patients managed with TCE for EL 2 after standard or complex endovascular aortic repair, from August 2015 to March 2024, was conducted. The indication for TCE was the presence of an EL 2 related to ≥5 mm sac increase, compared to the first imaging after aneurysm exclusion or the smallest diameter during follow-up. Patients managed with TCE for other types of endoleaks were excluded. The primary outcomes were technical and clinical successes during follow-up. Results: Forty-three patients were included (mean age: 75.1 ± 6.0 years, 90.7% males). Technical success was 97.7%. Selective embolization was performed in 48.8% and non-selective in 51.2%. No death was recorded at 30 days. The estimated clinical success was 90.0% (standard error; SE: 6.7%) and the freedom from EL 2 was 89.0% (SE 6.4%) at 36 months. Cox regression analysis showed that the type of embolization (selective vs. non-selective), type of previous repair (f/bEVAR vs. EVAR), and use of anticoagulants did not affect follow-up outcomes. Reinterventions related to EL 2 were performed in 12.5%; three underwent an open conversion. Conclusions: TCE was related to high technical success and limited peri-operative morbidity, regardless of the type of initial endovascular aortic repair. Clinical success was encouraging with reinterventions for EL 2 affecting 12.5% of patients.

Standardized porcine integrated robotic inguinal hernia training: the SPIRIT model.

Implementing a robotic system for minimally invasive surgical procedures necessitates a comprehensive training regimen. This involves not only mastering the technological aspects of the robotic system but also enhancing surgical proficiency in manipulating robotic instruments. Furthermore, procedural expertise in specific surgeries is critical. Minimally invasive inguinal hernia repair is particularly suitable as an initial procedure for human application. The development of a comprehensive training model for this type of repair is a crucial element of such an educational pathway. Anatomical dissections were carried out on pigs to assess both the similarities and differences between pig and human anatomy. A structured minimally invasive inguinal hernia repair was performed to determine the suitability of the porcine inguinal region for training purposes. A detailed anatomical description of the porcine inguinal region is outlined, to provide a framework for assessing the critical view of the porcine myopectineal orifice. By integrating the human 'ten golden rules' for safe and effective minimally invasive inguinal hernia repair, the standardized porcine integrated robotic inguinal hernia training (SPIRIT) model describes a step-by-step approach to practice surgical techniques in a realistic setting. The SPIRIT model is designed to be a well-structured training model for minimally invasive inguinal hernia repair and incorporates the specific surgical steps as encountered in a human patient.

The Fisher Subunit Anatomical Approach for Cleft Lip Revisions

Abstract Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with nonanatomic scars and a short upper lip, creating a need for revision. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors' experience, recreating the defect and utilizing the Fisher repair for revision have led to aesthetically pleasing results and less noticeable scars. A database was collected that included all cleft lip revisions performed at a large, comprehensive children's hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons. Data collected included sex, characteristics of the cleft lip, age at initial and index repair, type of initial repair, previous revisions, type of revision with any additional tissue rearrangement, and any nose repair. Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. This study demonstrates a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons' experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

Port-site hernia recurrence at previous 5-mm laparoscopic access: case report and review of literature.

Port-site hernia (PSH) of less than 10 mm is an exceptionally rare complication of minimally invasive surgery (MIS). To date, there have been no cases in the literature reporting recurrence of PSH from a 5 mm incision. We present the first case of PSH recurrence in a woman who underwent surgery for benign gynaecological pathology via a MIS approach. Her post-operative course was complicated by an episode of symptomatic hernia arising from a 5 mm accessory trocar which was surgically managed. A few months later she re-presented with the same symptoms and had a PSH recurrence of the same port-site. Two corrective surgeries employing different techniques were performed. The first episode was managed laparoscopically using interrupted stitches. On the other hand, the PSH recurrence was managed by placement of a mesh. Ultrasound played a crucial role in diagnostics, especially in the recurrent setting. Due to the complete absence of similar cases in the literature, the decision making around the management of a PSH recurrence from a 5 mm trocar site proved to be challenging. As MIS is the current standard of care, more cases are likely to occur, however despite the increasing number of surgical procedures performed via MIS, no established guidelines for managing such complications have been proposed. Trying to bridge this gap, we present the case report of the first case of PSH recurrence from a 5 mm accessory port and a review of the most significant literature available to date. We finally summarise the reported cases of PSH and the types of surgical repair conducted to highlight the absence of a standard of care.

Unveiling pathogenesis and therapeutic targets of metastatic breast cancer through sparse modeling of genomic landscape

Breast cancer is one of the most lethal and frequently detected diseases in the world. Its heterogeneity poses significant challenges for precision therapy. To better decipher patterns in the human genome given its heterogenous nature and have them converge into common functionalities, mutational signatures are introduced to define the types of DNA damage, repair, and replicative mechanisms shaping the genomic landscape of each cancer patient. In this study, we developed a deep learning (DL) model, based on pruning technology to improve model generalization through deep sparsity. We applied it to patient-level whole genome sequencing (WGS) samples, and identified statistically significant mutational signatures associated with metastatic progression using Shapley additive explanations (SHAP). We also employed gene cumulative contribution abundance analysis to link the mutational signatures with relevant genes uncovering the shared molecular mechanisms behind tumorigenesis and metastasis of each patient which can potentially lead to novel therapeutic target identification. Our study illustrates that our approach is an effective tool for discovering clinically meaningful mutational signatures in metastatic breast cancer (MBC) and relating them directly to relevant biological functions and gene targets. These findings could facilitate the development of novel therapeutic strategies and improve the clinical outcomes for individual patients.

EVALUATION OF POSTOPERATIVE COMPLICATIONS AND REOPERATIONS IN PATIENTS UNDERGOING OPEN UMBILICAL HERNIA REPAIR

Abstract Background Umbilical hernia repair is a common surgical procedure. Open repair is recommended for small to medium size hernias, and use of mesh reduces recurrence. The primary aim was to evaluate the risk of postoperative complications and reoperations after emergency and elective open umbilical hernia repair, and secondly to evaluate whether complications and reoperations were associated to type of repair. Methods A single center retrospective cohort study of patients undergoing open umbilical hernia repair from October 2022 to September 2023. Data was extracted from the patient charts. Results A total of 151 had an umbilical hernia repair, 103 (68%) elective surgeries and 48 (32%) emergency surgeries. For the elective repairs, 37 (36%) got a suture- and 66 (64%) a mesh repair. There was no difference in complications, 5.4% versus 7.6%, p = 0.675. A higher percentage of emergency surgeries had the mesh placed in the onlay position 45.8% (22/48) compared to elective surgeries 30.1% (31/103), which more often received a preperitoneal mesh 34% (35/103). The overall complication rate tended to be higher for emergency repair compared with elective surgery, 6.8% and 14.6%, p = 0.124, with a tendency towards more complications with the use of mesh 12.1% (12/99) compared with suture repair 3.8% (2/52), p = 0.096. The most frequent complications were wound related (seroma, hematoma, wound infection). There were three (3%) reoperations in the elective group due to infection, and correspondingly two (4%) in the emergency group. Conclusion There is no difference in postoperative complication regarding suture or mesh repair of umbilical hernias.