Vast Majority Of Complications Research Articles

Results of Thoracic Surgery in HIV-infected Patients

The objective: substantiation of the possibility of surgical treatment of various lung diseases in HIV-infected patients.Subjects and Methods. Comorbidities, medical history, bad habits, ongoing antiretroviral therapy (ARVT), viral load and CD4+count before and after lung surgery were assessed. Blood loss during the operation, intra- and postoperative complications was analyzed. Causes of postoperative lethality were analyzed.Results. According to results of the study, planned surgical treatment for chronic abscess, tuberculosis, cancer, mycotic pulmonary lesions and cicatricial stenosis of the trachea in HIV-infected patients is justified, and should be performed based on indications common for these diseases. This is confirmed by the level of postoperative complications in HIV-negative patients. The vast majority of complications were temporary, not severe, and were resolved by conservative treatment. Achievment of the best results is facilitated by ongoing ART.

Anaesthesia-Relevant Disease Manifestations and Perianaesthetic Complications in Patients with Mucolipidosis-A Retrospective Analysis of 44 Anaesthetic Cases in 12 Patients.

Mucolipidosis (ML) type II, intermediate, and III are lysosomal storage disorders with progressive multiorgan manifestations predisposing patients to a high risk of perioperative morbidity. The aims of the study were to systematically assess disease manifestations relevant to anaesthesia as well as anaesthesia-related complications. This retrospective study includes ML patients who underwent anaesthesia in two centres between 2008 and 2022. We reviewed patients’ demographics, medical history, disease manifestations, as well as procedure- and outcome-related data. A total of 12 patients (7 MLII, 2 ML intermediate, 3 MLIII) underwent 44 anaesthesia procedures (per patient: median 3, range 1–11). The median age was 3.3 years (range 0.1–19.1). At least one complication occurred in 27.3% of the anaesthesia procedures. The vast majority of complications (94%) occurred in children with MLII and ML intermediate. A predicted difficult airway was found in 100% and 80% of the MLII and ML intermediate patients, respectively. Accordingly, most complications (59%) occurred during the induction of anaesthesia. Altogether, respiratory complications were the most frequent (18%), followed by difficult airway management (14%). The risk for anaesthesia-related complications is alarmingly high in patients with ML, particularly in those with MLII and ML intermediate. Multidisciplinary risk–benefit analysis and thoughtful anaesthesia planning are crucial in these patients.

Severe Complications Following Maxillary Sinus Augmentation Using Poly L-lactide-co-ε-caprolactone-Coated Bovine Bone: A Retrospective Study.

To describe the postoperative complications following lateral wall sinus augmentation using (poly L-lactideco-ε-caprolactone; PLCL) and natural polysaccharides polymers-coated bovine bone (PBB). The secondary aims were to examine histologic findings and to propose complication management alternatives. This retrospective study included 61 subjects who underwent 67 lateral wall sinus augmentation procedures using PBB in the standard protocol. In cases that presented complications, treatment included additional antibiotic therapy, implant removal, or sinus reentry and total removal of the grafting material. In three cases, biopsy specimens were taken from the sinuses, and histologic analyses were performed. The prevalence of postoperative complications was 32.8% (22 of 67 cases) in 18 of the patients (29.5%). The most prevalent symptoms were persistent pain (68.2%), swelling (63.6%), and oroantral fistula (54.5%). Radiographic signs appeared in 45.5% of the complications. A total of 24 implants failed; thus, an overall 80.3% survival rate was established at 19 months. The vast majority of complications (86.4%) were treated eventually with reentry surgery and revealed that the sinus was full with granulation tissue surrounding pieces of a nonossified rubber-like material. In cases where implants were placed, nonosseointegrated implants were surrounded by soft tissue. The sinus was cleaned thoroughly; the graft material remnants were removed together with inflamed parts of the sinus membrane, followed by chlorhexidine and saline lavages. In the biopsy specimens taken from the sinus cavity, there were no histologic features of new bone formation around the grafted material. Lateral wall maxillary sinus augmentation using PBB was associated with an acute sinus infection histologic appearance and with a 7-times-higher failure rate compared with previous reports. This serious adverse event suggests that PBB cannot be recommended for maxillary sinus augmentations.

Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review.

Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.

Cadaveric kidney allotransplantation at Krasnoyarsk Regional Clinical Hospital

Objective: to evaluate the early and long-term outcomes of cadaveric kidney allotransplantation (CKAT) based on a retrospective analysis of 71 cases treated at Krasnoyarsk Regional Clinical Hospital (KRCH).Materials and methods. From March 2014 to June 2019, 71 kidney transplants were performed at KRCH – 42 (59.15%) men and 29 (40.85%) women. The age of the patients varied from 20 to 59 years (mean age 39.6 ± 8.14 years). The causes of end-stage chronic kidney disease which subsequently led to CKAT were chronic glomerulonephritis, chronic tubulointerstitial nephritis, hypertensive nephropathy (HN), diabetic nephropathy resulting from type I diabetes (DN), nephropathy of mixed genesis (HN + DN), vesicoureteral reflux, congenital angiodysplasia of the kidneys, and Alport syndrome. The mean number of HLA mismatches was 4.5 ± 0.9.Results. Hospitalization lasted for an average of 34.05 ± 9.56 days. Primary function was observed in 32 (45.08%) patients, while 39 (54.92%) cases had delayed function. Post-transplant complications were noted in 23 (32.39%) patients, of whom 12 (16.9%) had early post-transplant complications, while 15 (21.13%) encountered complications in the late post-transplant period. The most frequently diagnosed were immunological, infectious, and urological complications. Vascular, surgical, oncological, and other complications were less frequent. The annual graft survival rate was 87.3%. Patient survival rate was 95.77%. One (1.4%) and 2 (2.81%) patients died in the early and late post-transplant periods, respectively. Hospital mortality – 1 case (1.4%).Conclusion. Kidney transplantation is the most effective treatment for patients with irreversible chronic kidney disease. About 87.33% of transplants were found to be effective. However, 32.39% of patients had postoperative complications. The vast majority of complications were reversible and were corrected conservatively or surgically. Nevertheless, graft loss occurred in 12.67% of cases. The success of transplantation depends on a number of factors related to both the donor and the recipient, as well as the immunological status and surgical technique. A personalized approach to recipients helps to reduce postoperative complications, prevent nephrotoxicity and rejection reactions.

Reporting and grading of complications after mid-urethral sling surgeries: Could the "Clavien-Dindo Classification" be adopted?

Background:To construct a modified model for reporting and grading of postoperative complications after the mid-urethral sling (MUS) procedure based on the Clavien-Dindo classification. In addition, complications of three different types of MUS were compared.Materials and methods:A PubMed search for postoperative complication after MUS was carried out for the period between January 1990 and July 2018. Reported complications were stratified in a plate form designed in accordance with grades of the Clavien-Dindo classification. Then, the proposed model was applied on reported complications in 160 females who underwent three different procedures of MUS (transvaginal tape [TVT], transobturator tape [TOT], and autologous fascial sling) with a minimum follow-up of 24 months.Results:The mean ± SD age at time of surgery was 46 ± 7 years. TVT was carried out in 75 (47%) patients, TOT in 40 (25%), and fascial sling in 45 (28%). The total number of complications was 62 in 43 (26.8%) patients. The vast majority of complications were Grade I and Grade II 19 (12%) and 21 (13%) out of 160 patients, respectively. Transient postoperative voiding difficulty (Grade II) and de novo urgency (Grade II) were the most prevalent complications in the fascial sling method (15.4% for each), whereas transient thigh pain (Grade II) was the most frequently reported complication after TOT (10%). Life-threatening vascular injury (Grade IV-a) was a serious complication in TVT cases.Conclusions:Postoperative complications of the MUS could be graded according to Clavien's classification. The vast majority of complications were Graded I or II. TVT can cause serious life-threatening complications.

Biologic and Technical Complications of Implant-Supported Immediately Loaded Fixed Full-Arch Prostheses: An Evaluation of Up to 6 Years.

Treatment by means of implant-supported immediately loaded fixed full-arch prostheses is known to be related to biologic and technical complications. The aim of this retrospective study was to investigate the prevalence and moment of occurrence of biologic and technical complications happening in immediately loaded fixed full-arch prostheses. This study investigated patients who received treatment with immediately loaded fixed full-arch prostheses using four to six implants from 2007 to 2013. The investigation included biologic and technical complications. Complications were depicted regarding their prevalence and their first time of occurrence. Statistical analysis was performed regarding the differences of the mean complication values between the mandible and the maxilla and between technical and biologic complications. The investigation included 482 immediately loaded fixed full-arch prostheses (380 patients, mean observation period: 23.5 months). In 193 arches (40%), either technical (30.9%), biologic (6.5%), or both (3.1%) types of complications occurred. Technical complications occurred significantly more often than biologic complications (P < .000). The most frequent technical complication was "fracture of veneering material" (24.7%, arch level). The most frequent biologic complication was "marginal bone loss ≥ 2 mm" (16.3%, implant level). The median first advents of technical complications were after 23/26 months (implant-/prosthesis-related) and after 3 months for biologic complications, respectively. There was no significant difference of the mean complication rates between the maxilla and the mandible (P = .409). In 99.0% of the arches with complications, the restorations could be obtained. Within this treatment concept, biologic and technical complications may occur over time. However, the vast majority of complications (99.0%) do not affect the overall prosthesis survival. Technical complications are assumed to occur significantly more often than biologic complications. It is suggested that not only stress and material fatigue but also function is a matter concerning this treatment option and, thus, may be a factor related to complication rates.

Report on Current Experience of ASAPS Membership and Management of Cosmetic Tourism Complications.

BackgroundCosmetic tourism is an expanding industry with increasing scrutiny in the public domain of complications and patient safety issues. The health and financial implications for patients are large and deserve further investigation.ObjectivesThe aim of this study was to understand the experience of the American Society for Aesthetic Plastic Surgery (ASAPS) members treating medical tourism patients with complications who returned to the United States for secondary management.MethodsA 20-question survey was administered electronically in August 2018 to ASAPS members with voluntary participation. Questions about surgeon experience, the nature of complications, type of initial surgery, and subsequent management were asked. Responses were tabulated and percentages of response choices were calculated and reported.ResultsNinety-three responses were received from the 1611 physician ASAPS members (5.8% response rate). More than half of respondents had seen 2 to 5 patients in the last 12 months with a complication from cosmetic tourism. The most common procedure that patients had done abroad was abdominoplasty. The most common complication was infection caused by Gram-positive organisms, managed on an outpatient basis without surgical intervention. Involvement of an ASAPS member led to successful resolution of complications in the vast majority of patients. Estimated costs out of pocket for management of complications were most commonly between $1001 and 5000.ConclusionsWhile the experience of ASAPS members is as varied as the complications faced by cosmetic tourism patients, the vast majority of complications is infectious and can be managed on an outpatient basis successfully with the involvement of an ASAPS member. Further collaborative efforts both domestically and internationally can help improve patient safety for cosmetic tourism patients.

Complications associated with combined surgical hip dislocation and periacetabular osteotomy for complex hip deformities.

Surgical hip dislocation (SD) and periacetabular osteotomy (PAO) are well-described treatments for femoroacetabular impingement (FAI) and acetabular dysplasia, respectively. Occasionally, complex deformities require a combined SD/PAO; the morbidity of performing both procedures in a single stage has not been fully investigated. We performed a retrospective review of a consecutive group of patients undergoing combined SD/PAO to investigate the incidence and character of perioperative complications. Forty-five patients (46 hips) were identified. Perioperative complications were graded by the modified Clindo-Davien complication scheme. Mean follow-up was 36 months (range 12–128), and no patients were lost to follow-up. Six complications occurred in six hips (13%). Four (8.7%) complications were minor (Grades I or II): one Brooker Grade III heterotopic ossification requiring no treatment, one superior pubic ramus nonunion requiring no treatment and two superficial wound infections requiring antibiotics. Two (4.3%) complications were major (Grades III or IV): one coxa saltans interna and labral tear requiring hip arthroscopy with labral repair and iliopsoas lengthening, and one deep surgical site infection requiring irrigation and debridement followed by development of arthritis requiring conversion to arthroplasty. The average Harris hip score improved from 62 ± 13 preoperatively to 80 ± 19 at final follow-up. Except for the single joint replacement, there were no long-term disabilities. There were no major neurovascular injuries, osteonecrosis, fractures or trochanteric nonunions. Combined SD/PAO for the treatment of complex, concomitant deformities of the proximal femur and acetabulum is associated with an acceptable risk of complications. The vast majority of complications that occurred were managed without permanent disability. Level of Evidence: IV

Clinical Characteristics and Complications of Pediatric Liver Biopsy: A Single Centre Experience

IntroductionPercutaneous liver biopsy (LB) is the gold standard method for evaluation and management of patients with liver disease. The purpose of this study was to characterize pediatric patients undergoing LB at British Columbia Children's Hospital, and to determine the rate and timing of complications following the procedure. Material and methodsThe medical records of all pediat-ric patients who underwent LB during a six-year retrospective study were reviewed to collect demographic and procedure-related data. Results223 LBs were performed, and 179 of these biopsies were percutaneous or transjugular. Elevated liver enzymes and cholestasis together accounted for almost 70% of the indications for LB, and the histological analysis of liver tissue yielded a specific diagnosis in 89 % of the cases. There were no deaths and no major complications related to LB. The most frequent minor complication was pain (59% of LBs) and the other complications were bleeding-related and classified as minor. The vast majority of complications (88%) were recognized within 8 h of the LB. ConclusionsLB is a valuable and safe procedure in pediatric patients with a low rate of complications. Pediatric patients can be discharged home safely should no complications occur within the first 8-12 h after the procedure.

ESGE survey on tissue power morcellation complications other than leiomyosarcoma

The exact incidence of power morcellation complications (PMC) is unknown and probably underestimated. Medical literature mainly describes case reports and the vast majority of complications after tissue power morcellation are not reported. ESGE has run a survey among its members about complications emerging after laparoscopic electromechanical morcellation including the risk of leiomyosarcoma (LMS). The reported risk of a sarcoma after myoma or uterus morcellation is low and presented in a separate article. The Central office using the ESGE server and website, activating the ‘Survey Monkey’ programme, sent a request to 3422 ESGE members to answer, anonymously, a structured electronic questionnaire with multiple structured answer options, within 3 months. The doctors responding to the call were automatically given a serial number in an EXCEL spreadsheet, enabling statistical analysis using the SPSS v.18. The probabilities were calculated by using the raw data as reported to each individual question, dividing the number of incidence with surgeon’s lifetime experience in laparoscopic surgery. The electronic questionnaire was answered by 216 (6 %) surgeons. The majority of the respondents used the morcellator for 10 years. The overall probability of direct power morcellator injuries to internal organs is more frequent (0.12 %) than that of morcellator injuries to the abdominal and pelvic wall (0.06 %). The risk of parasitic myoma is estimated 0.08 and 0.16 % for the de novo endometriosis after myoma and adenomyoma morcellation. Furthermore, the vast majority of surgeons have never experienced bladder or ureter, aorta and vessel injuries by using the morcellator, proven by the standard deviation being close to zero. Three surgeons with morcellator experience between 1 and 5 years were involved in an injury that caused permanent damage, 1 nerve, 2 bowel and 1 port-site hernia injury due to the morcellator. According to surgeons’ answers, death has never occurred after power morcellation. Morcellator technical problems found also to be of low probability between 0.12 and 0.3 % as estimated for all endoscopic surgeries in lifetime of 188 surgeons. The average number of times per doctor where the morcellator stacked and stopped working is 2.17 with standard deviation equal to 4.4 and sum of incidents equal to 426 times for all 196 doctors. The most frequent technical problem was morcellator transient stacking and the least frequent was the morcellator stopped working and colpotomy needed to evacuate the tissue out of the abdominal cavity 0.12 % operations. The majority of surgeons 136/188 (72 %) are using reusable morcellator devices and 51 (27 %) are using disposable devices. Moreover, 97/188 (51.6 %) of surgeons are using exclusively, only reusable morcellators; 56/188 (29.8 %) are using both disposable and reusable types of morcellators. The incidence of power morcellation complications is very low reputedly. The ESGE board advises that endoscopic operations must be performed only by doctors who have had an adequate training and knowledge. It is compulsory to know the publications about dangers, contraindications and complications before performing these operations. A complete knowledge of techniques and principles of endoscopic surgery is needed to avoid and minimize complications. A training session prior to morcellator first use might decrease further PMC.

MP65-20 DETERMINANTS OF OPERATIVE TIME FOR BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY

INTRODUCTION AND OBJECTIVES: The ‘rates’ of complications following radical cystectomy (RC) are well known, however, the data regarding ‘timing’ is lacking. We sought to assess the median time-to-event for 18 principal postoperative complications within 30days following surgical intervention. Further, the complications were stratified into pre-/post-discharge and the predictors were identified; lastly, the effect of time-to-complication on secondary outcomes was evaluated. METHODS: A retrospective case-control study utilizing the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011); Patients undergoing RC were identified using CPT-codes. RESULTS: Overall, 1,118 patients underwent RC. The overall complication rate was 32.4% and the median LOS was 8 days. The majority of complications (94.4%), except for myocardial infarction, primarily occurred around week 2 post-surgery (fig. 1) at a median time of 10.4 days. With relation to discharge, almost equal number of the complications occurred pre-/post-discharge (49% vs. 51%) with infectious complications and DVT/PE tending to present post-discharge. In multivariable-analyses, increasing age (OR1⁄41.02, p<0.001), black race (OR1⁄41.67, p1⁄40.001), and creatinine 1.2mg/dl (p1⁄40.002) were significant predictors of pre-discharge complications, while, diabetes (OR1⁄41.40, p<0.001) and advanced cancer (OR1⁄41.35, p1⁄40.007) were significant predictors of post-discharge complications. BMI 30 and continent diversions both increased (p<0.01) the odds for both preand post-discharge complications. For a given complication, timing did not affect the odds for mortality or re-intervention (OR1⁄40.42, p1⁄40.115; OR1⁄41.51, p1⁄40.875, respectively). CONCLUSIONS: Vast majority of complications following RC occur during week 2 post-surgery and approximately 50% of the complications occur post-discharge; this highlights the need for rigorous observation and follow-up at both inpatient/outpatient levels during the early postoperative period to decrease the burden of these complications. Further, knowledge regarding the timing and risk-factors for complications may facilitate improved patient-physician communication, both at admission and discharge.

Complications following hip arthroscopy: a systematic review and meta-analysis

The use of hip arthroscopy to address injuries and conditions about the hip is becoming more widespread. There are several narrative reviews regarding complications of hip arthroscopy but a systematic review is currently lacking. The primary goal of this study is to determine the complication rate associated with hip arthroscopy in the literature. A search of the EMBASE and Ovid Medline databases was performed to identify articles published between 1 January 2000 and 25 November 2011 that reported a complication rate after hip arthroscopy. Appropriate inclusion and exclusion criteria were applied to identify articles, and a meta-analysis was performed to determine an overall complication rate. Complications were divided into major and minor. A total of 66 papers (n = 6,962 hip arthroscopies) were identified and deemed appropriate for analysis. The overall complication rate was found to be 4.0 % (95 % CI 2.9-5.2 %). Of the 287 complications identified in the literature, 20 were deemed major constituting a rate of 0.3 %. Hip arthroscopy appears to be safe. The vast majority of complications are minor in nature. Prospective trials looking at the complications of hip arthroscopy would aid in identifying prognostic factors. Systematic review and meta-analysis, Level III.

Juvenile angiofibroma: major and minor complications of preoperative embolization

Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.

Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM. Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. Outcomes data, including adverse events, were collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days to 2 years following surgery) were tabulated and stratified based on clinical factors. The study enrolled 302 patients (mean age 57 years, range 29-86) years. Of 332 reported adverse events, 73 were classified as perioperative complications (25 major and 48 minor) in 47 patients (overall perioperative complication rate of 15.6%). The most common perioperative complications included minor cardiopulmonary events (3.0%), dysphagia (3.0%), and superficial wound infection (2.3%). Perioperative worsening of myelopathy was reported in 4 patients (1.3%). Based on 275 patients who completed 2 years of follow-up, there were 14 delayed complications (8 minor, 6 major) in 12 patients, for an overall delayed complication rate of 4.4%. Of patients treated with anterior-only (n = 176), posterior-only (n = 107), and combined anterior-posterior (n = 19) procedures, 11%, 19%, and 37%, respectively, had 1 or more perioperative complications. Compared with anterior-only approaches, posterior-only approaches had a higher rate of wound infection (0.6% vs 4.7%, p = 0.030). Dysphagia was more common with combined anterior-posterior procedures (21.1%) compared with anterior-only procedures (2.3%) or posterior-only procedures (0.9%) (p < 0.001). The incidence of C-5 radiculopathy was not associated with the surgical approach (p = 0.8). The occurrence of perioperative complications was associated with increased age (p = 0.006), combined anterior-posterior procedures (p = 0.016), increased operative time (p = 0.009), and increased operative blood loss (p = 0.005), but it was not associated with comorbidity score, body mass index, modified Japanese Orthopaedic Association score, smoking status, anterior-only versus posterior-only approach, or specific procedures. Multivariate analysis of factors associated with minor or major complications identified age (OR 1.029, 95% CI 1.002-1.057, p = 0.035) and operative time (OR 1.005, 95% CI 1.002-1.008, p = 0.001). Multivariate analysis of factors associated with major complications identified age (OR 1.054, 95% CI 1.015-1.094, p = 0.006) and combined anterior-posterior procedures (OR 5.297, 95% CI 1.626-17.256, p = 0.006). For the surgical treatment of CSM, the vast majority of complications were treatable and without long-term impact. Multivariate factors associated with an increased risk of complications include greater age, increased operative time, and use of combined anterior-posterior procedures.

Complication of Minimally Invasive Radical Cystectomy

Introduction and Objectives: Open radical cystectomy (ORC) is the standard treatment for high-grade and muscle invasive bladder cancer, with the significant potential of early complications even in the most experienced hands and in high-volume center. Over the last decade, we have witnessed the emergence and progression of minimally invasive surgery in urology, including radical cystectomy. Any new technique applied to the treatment of invasive bladder cancer should be safe, should maintain similar oncological principles as ORC, and should provide similar options for lower urinary tract reconstruction. While many complications of radical cystectomy are shared between approaches, recognition and management in the robotic and laparoscopic surgery environment poses unique challenges. The goal of this video is to present graphic illustrations of complications during robotic or laparoscopic radical cystectomy (LRC). Methods: A multi-institutional collection of surgical videos was compiled. These videos illustrate vascular injury, rectal injury, benign ureteral strictures, and the presence of vesicovaginal fistula after surgery. Management techniques are illustrated where appropriate. Results: This video shows the possible complications and how often they are encountered, comparing the different approaches, open, laparoscopic, and robotic. In addition, short- and middle-term complications in patient after minimally invasive radical cystectomy are characterized. Conclusions: Robot-assisted radical cystectomy (RARC) and LRC must reproduce the robust oncological outcomes seen with ORC while attempting to minimize perioperative morbidity. RARC and LRC incur acceptably low postoperative morbidity, with the vast majority of complications being low grade. High-grade complications are infrequent and similar to those encountered after ORC. Complications are similar in all approaches, but may be surgeon or technique related. Early recognition and appropriate management is essential when these complications occur. No competing financial interests exist. Runtime of video: 7 mins 57 secs

Systematic review of the complications of plate fixation of clavicle fractures

BackgroundThe number of displaced midshaft clavicle fractures treated surgically is increasing and plate fixation is often the treatment modality of choice. The study quality and scientific levels of evidence at which possible complications of this treatment are presented vary greatly in literature.PurposesThe purpose of this systematic review is to assess the prevalence of complications concerning plate fixation of dislocated midshaft clavicle fractures.MethodsA computer-based search was carried out using EMBASE and PUBMED/MEDLINE. Studies included for review reported complications after plate fixation alone or in comparison to either treatment with intramedullary pin fixation and/or nonoperative treatment. Two quality assessment tools were used to assess the methodological quality of the studies. Included studies were ranked according to their levels of evidence.ResultsAfter study selection and reading of the full texts, 11 studies were eligible for final quality assessment. Nonunion and malunion rates were less than 10% in all analysed studies but one. The vast majority of complications seem to be implant related, with irritation or failure of the plate being consistently reported on in almost every study, on average ranging from 9 to 64%.ConclusionThe quantity of relevant high evidence studies is low. With low nonunion and malunion rates, plate fixation can be a safe treatment option for acute dislocated midshaft clavicle fractures, but complications related to the implant material requiring a second operation are frequent. Future prospective trials are needed to analyse the influence of various plate types and plate position on implant-related complications.

The Medical Benefits of Male Circumcision

The Medical Benefits of Male Circumcision

An Analysis of 101 Primary Cosmetic Rhinoplasties

Primary cosmetic rhinoplasty is one of the most complex of cosmetic surgical procedures in the maxillofacial area that requires precise consideration to both form and function. The complex and variable anatomy, highly visible position of the nose, and distinct patient desires contribute to the complexity of this procedure. This study reports the combined results of 101 consecutive primary cosmetic rhinoplasties at 2 centers. A retrospective chart review was completed on all patients who had primary cosmetic rhinoplasty with or without septoplasty and who were operated on by the senior authors (S.C.B. and H.M.) from June 2006 through December 2008. A standard physical examination, including photo documentation, was completed on each patient preoperatively. All patients were followed periodically after surgery for at least 12 months. Outcome was measured by both subjective and objective measures of cosmetic and functional (breathing) outcome. The following data were collected and analyzed: age of patient, gender, chief cosmetic and functional complaint, details of surgical procedure (including septoplasty, grafts, and donor sites), complications, and report of subjective outcome at final evaluation. One hundred one patients (n = 101, average age 24.4 ± 6.8 years old) were enrolled in the study. Most patients presented for consultation regarding cosmetic rhinoplasty (80%) versus septorhinoplasty (20%). Although most of the patients (63%) were treated with septorhinoplasty, the open rhinoplasty (transcollumellar) incision was used in 61% of patients versus the closed rhinoplasty (39%) technique. The most commonly performed combination of techniques used was the combination of nasal tip modification, with dorsal reduction and nasal osetotomies (54%), followed by tip modification with dorsal reduction (19%), and dorsal reduction with osteotomies (18%) and no tip modification. In the 50 patients who required a graft, in 80% the donor site was the nasal septum. Spreader grafts were used in 14% of patients, and a combination of shield/tip graft was used in 52%. The following complications were observed: unhappy patient 16%, dehiscence at incision 5%, asymmetry requiring revision 6%, and infection 1%. In the 63 patients that had septoplasty, 6 (9.5%) reported that their breathing was not improved. In this series 11 patients (11%) received a revision rhinoplasty. Primary cosmetic rhinoplasty is 1 of the more complex facial cosmetic procedures. The vast majority of complications can be avoided with careful and extensive treatment planning. In this series we found a complication and revision rate similar to that reported in the literature.

The operative treatment of pressure wounds: a 10‐year experience in flap selection

This study sought to both assist in the selection of flaps for ischial pressure wound re-construction and to evaluate the overall complication rates associated with re-construction. A retrospective medical record review was conducted for 78 patients following the surgical re-construction of an ischial pressure sore. Records were reviewed for demographics, location of sores, methods of re-construction and flap selection, as well as any complications and recurrences. Seventy-two wounds were re-constructed with an average of 1.4 flaps used per wound. An ischial flap complication rate of 16% was observed in flap follow up, with a recurrence rate of 7% recorded. The vast majority of complications went on to heal with 15% of patients requiring a second re-construction. Our relatively large sample of ischial flaps allowed for a close comparison with previously published work. Both flap selection and site of reconstruction significantly affected the success rates for pressure sore coverage. The overall complication rates by flap and re-constructive site in this review are lower than previously published reports. Our experience with ischial re-construction was extensive enough to suggest a posterior medial thigh fasciocutaneous flap combined with a biceps femoris muscle flap as a first choice in ischial pressure wound re-construction.