Search

Since the early 1990's, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs. [ABSTRACT FROM AUTHOR]

Aims Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others. The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardiac surgery. Methods and results Eight bibliographic databases were searched (January 2005 to March 2021) in relation to cardiac surgery and cognition. Studies including adult patients who had undergone open cardiac surgery and using a validated measurement of cognitive function were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors. A total of 2870 papers were identified, of which 36 papers met the inclusion criteria and were included in the review. The majority were prospective observational studies [ n  = 28 (75.7%)]. In total, 61 independent predictors (45 preoperative and 16 postoperative) were identified as significant in at least one study; advancing age and education level appear important. Age has emerged as the most common predictor of cognitive outcome. Conclusion Although a number of predictors of POCD have been identified, they have inconsistently been reported as significantly affecting cognitive outcome. Consistent with previous research, our findings indicate that older patients and those with lower educational levels should be prioritized when developing and trialling interventions to improve cognitive function. These findings are less than surprising if we consider the methodological shortcomings of included studies. It is evident that further high-quality research exploring predictors of POCD is required. Registration This review was registered on Prospero, CRD42020167037 [ABSTRACT FROM AUTHOR]

Minimally invasive Ivor-Lewis Esophagectomy (MIE) is widely accepted as a surgical treatment of resectable esophageal cancer. Aim of this paper is to describe the surgical details of our standardized MIE technique and its safety. We also evaluate the esophageal mobilization in semiprone compared to the left lateral position. A retrospective analysis of 141 consecutive patients who underwent Ivor-Lewis esophagectomy for cancer, from February 2016 to September 2021, was conducted. All the procedures were performed by totally thoraco-laparoscopic with an intrathoracic end-to-side circular stapled anastomosis. Thoracic phase was performed in left lateral position (LLP-group, n =47) followed by a semiprone position (SP-group, n =94). The intraoperative and postoperative outcomes were prospectively collected and analyzed. The procedure was completed without intraoperative complication in 94.68% of cases in SP-group and in 93.62% of cases in LLP-group (P =0.99). The total operative time and thoracic operative time were significantly shorter in SP-group (P =0.0096; P =0.009). No statistically significant differences were detected in postoperative outcomes between the groups, except for anastomotic strictures (higher in LLP-group, P =0.02) and intensive care unit stay (longer in LLP-group, P =00.1). No reoperation was needed in any cases. Surgical radicality was comparable; the median of harvested lymph nodes was significantly higher in SP-group (P <0.0001). The present semiprone technique of thoraco-laparoscopic Ivor-Lewis esophagectomy is safe and feasible but may also provide some advantages in terms of lymph nodes harvested and total operation time. [ABSTRACT FROM AUTHOR]

Background: Hip arthroplasty is the most frequently performed adult reconstructive hip procedure. Total hip arthroplasty (THA) is one of the most successful procedures performed in modern orthopedics. The primary indication for THA in a patient with endstage arthropathy is pain resulting in significant limitation of physical activity. Important factors to be considered in the decision to recommend or undergo THA are patient age, diagnosis, and medical comorbidities. Aim of the Work: This review pursues to systematically review the current evidence in the literature to determine whether previous hip arthroscopy would direct to inferior results in patients undergoing succeeding hip arthroplasty. Patients and Methods: The first literature search identified 412 studies in total. After removing duplicates, 307 articles were deemed irrelevant based on their title and Abstract screening. Eighty- two papers were eliminated from the remaining 105 research based on their title and Abstract. After carefully reviewing the entire text of all remaining publications, 11 studies were eliminated for reasons such as conference Abstracts, reviews, and lack of comparison between intervention and control groups. Additionally, one cohort research that compared THA results in patients who had previously undergone hip salvage surgery to those who had not previously undergone hip salvage surgery was removed. Finally, eleven studies spanning the years 2012 to 2019 were available for meta-analysis. Results: Of these citations could result from the studies' varying designs and sample sizes. Estimated blood loss, on the other hand, was deemed a reasonable indicator of operating time. The consistency in blood loss between the groups may reflect a similar operative time. Conclusion: Patients who have previously undergone hip arthroscopy are more likely to experience postoperative complications such as dislocation, revision, and reoperation following subsequent hip arthroplasty. On the other hand, prior hip arthroscopy did not appear to affect functional or intraoperative results. [ABSTRACT FROM AUTHOR]

Introduction: Erectile Dysfunction (ED) is a common male sexual disorder that is caused by various conditions including vascular dysfunction. Different treatment options can be implemented, like lifestyle modifications, pharmacological intervention, or surgical procedures. In select ED cases, vascular procedures such as penile revascularization and venous ligation could be an alternative option. Objective: We herein evaluated the current evidence and outcomes of penile revascularization, venous ligation and other vascular surgery with specific emphasis on complications and patients' satisfaction. Methods: A literature search was conducted using PubMed and Google Scholar to examine papers from 1993 to present day. Keywords, such as, "Erectile dysfunction", "ED vascular surgery", "Penile venous ligation", "Penile revascularization", and "Arterial bypass surgery", were used in this search. All the papers were in the English language. Results: A total of four studies met inclusion criteria for penile arterial bypass and dorsal penile venous ligation procedures with erectile function, clinical outcomes, satisfaction rates and post operative complications. Regarding penile arterial bypass, two studies identified. First study reported inferior epigastric artery (IEA) to the penile dorsal artery of 1500 patients reported success rates of erectile function were 67% and satisfaction rates of 89%. Postoperative complications were anastomotic disruption, penile skin sensation loss and pain. Regarding venous ligation of penile dorsal vein, two studies identified. First study of 100 patients reported success rates of erectile function were 62% at 1 year. Second study of 26 patients reported success rates of erectile function were 42.3% and satisfaction rates of 57.7% at 3.7 years. Postoperative complications were painful erections, skin necrosis, and penile shortening (Table 1). Conclusions: Vascular therapies including penile arterial bypass and penile dorsal venous ligation for ED could provide improved clinical outcomes and satisfactions in select patients' population. Future studies are warranted to further evaluate its surgical outcomes and long-term safety and efficiency. Disclosure: No. [ABSTRACT FROM AUTHOR]

Background: GERD is a very common disease nowadays. When medications like Proton Pump Inhibitors fail, Surgery becomes the treatment of choice. Objective: To review and study the most common causes responsible for failure of Fundoplication and development of the most common postoperative complications (recurrence of reflux, dysphagia and gas-bloat syndrome). Patients and Methods: Types of studies Published studies about the complications of Laparoscopic Fundoplication (carried out in the period between 2000 - 2021). Types of participants Patients with clinically proven complications like GERD, belching, dysphagia or unintentional slipping after Fundoplication. Results: A copy of each paper identified was obtained, and relevant data was Abstracted for a quantitative overview. In case of discrepancies or when the information presented in a study is unclear, Abstraction by a second reviewer was sought to resolve the discrepancy. All included articles was assessed for quality regarding methodological strength as per the 2009 Cochrane collaboration updated guidelines for systematic reviews. Conclusion: According to our results, paraesophageal hernia in addition to, disruption and tight wrap are significant causes of failure of Nissen fundoplication. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Non-Banded Sleeve Gastrectomy (NBSG) is a widely popular weight loss procedure that has been around since the start of the millennium. Another variant, the Laparoscopic Banded Sleeve Gastrectomy (LBSG) started to emerge later. Questions have arisen on whether NBSG or BSG have better outcomes on the long run regarding weight loss, weight regain and reflux disease. This study aims to analyse previous studies performed on this subject and devise a conclusion regarding this matter. Obesity is a worldwide health issue with an unfortunate impact on an individual's quality of life. As of 2016, 39% of the world population suffered from obesity. Bariatric surgery is currently considered to be an effective and sustainable solution with increasing worldwide prevalence. Laparoscopic sleeve gastrectomy was first performed as the first step in biliopancreatic diversion with duodenal switch. Objective: To scrutinize all English language papers written on the subject of comparing NBSG and LBSG as primary bariatric procedures and furthermore seeks to determine the superior surgery between them regarding weight loss, post-operative morbidity and complications like regurgitation, vomiting, reflux, dysphagia, and finally resolution of comorbidities like T2DM and HTN. Methodology: This systematic review was carried out according to the updated PRISMA 2020 statement. A thorough search was executed in the Medline (PubMed) database, Elsevier's Scopus, Web of Science and the Cochrane Library in December 2022. Search was restricted to articles written in English. Search terms will be broad to encompass Banded Sleeve procedures. Results: Our review revealed that the existing literature suggests increased weight loss following LBSG compared to NBSG; however, there's an increased risk of regular regurgitation episodes and of device related complications leading to revision surgeries (such as band removal). Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023. Conclusion: Laparoscopic banded sleeve gastrectomy provides apparent better outcomes than non-banded sleeve gastrectomy regarding sustainable weight loss results through 3-5 years of follow up as the studies we reviewed had demonstrated. Nonetheless, it poses a definite increase in the risk of regurgitation, vomiting and ring related complications that might require revision surgeries. More RCTs with longer follow up periods (>5 years) will significantly add to our understanding of the matter. Larger LBSG sample sizes are needed to further enhance our impression on efficacy and safety of the banded sleeve gastrectomy. Finally, larger T2DM and HTN patients' sample size is needed to form a conclusion on the relationship between band-ing and the resolution of these diseases. [ABSTRACT FROM AUTHOR]

Objective: Thyroid surgery may lead to postoperative complications. The a im of this paper was to determine whether the rate of postoperative hypoparathyroidism (HPT) is influenced by whether surgery is staged. Design: Single-institution retrospective observational study. Methods: The clinical records of 786 patients treated at the Otolaryngo logy Unit of the Azienda USL-IRCCS di Reggio Emilia between January 1990 and December 2015 were reviewed. Pa tients were divided into two groups according to the surgical treatment received: group TT (637 patients, 81.04%) underwent single-stage total thyroidectomy; Group cT (149 patients, 18.96%) underwent loboisthmusectomy and delay ed completion total thyroidectomy. Transient and permanent HPT, assessed after 6 months of follow-up, were the p rimary endpoints. Risk factors of postoperative HPT were also analysed as secondary outcomes. Results: Rates of transient HPT in group TT were higher than those obse rved in group cT, (P = 0.0057). Analysis of risk factors identified sex as an independent risk factor for transie nt HPT only for group TT (P = 0.0012) and the number of parathyroid glands remaining in situ (PGRIS) as an independent risk factor for transient and perman ent HPT for group TT (P < 0.0001 and P = 0.0002, respectively). Conclusions: This study suggests that the risk of transient postoperative H PT is lower in patients that undergo completion thyroidectomy. Further independent risk factors for postoperative HPT are female sex and PGRIS score. In light of the growing use of conservative surgery for thyroid ne oplasms, these findings could help to adequately plan surgery in order to reduce endocrine complications. [ABSTRACT FROM AUTHOR]

Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.g. EarWell and Ear Buddy) can be costly, and their alternatives have limited customizability. We present a technique using cost-effective and customizable materials for moulding common anomalies (Stahl's ear, constricted ear, and prominent ear). DuoDERM Extra-thin, Steri-strips, and 3M Kind Removal Silicone tape are used to splint the ear in a preferred position. The DuoDERM is rolled into a putty, placed in the ear, and secured with tapes. This treatment is initiated in the clinic, with weekly splint changes carried out at home by caregivers, and intermittent follow-up appointments. DuoDERM moulding is a safe, inexpensive, highly customizable, and simple way to correct auricular deformities. Primary physicians/paediatricians should embed moulding into their practice, starting treatment as early as possible in the neonatal period. [ABSTRACT FROM AUTHOR]

Objectives: Vasectomy is a common method of male sterilization. However, it is less popular worldwide than tubal ligation in women. Vasectomy is also a potential cause of lawsuits related to its complications. This paper summarizes the early and late complications of this surgical procedure. Methods: Data from the Medline database were used and the search terms used were "vasectomy complications", "vasectomy + infection", "vasectomy + endocarditis", "vasectomy + failure", vasectomy + cancer" and "vasectomy + death". Results: According to the Guidelines of the European Urological Society, vasectomy is evaluated as a safe and effective method and is recommended as one of the methods of male contraception. The recommended vasectomy procedure is a scalpel-free approach to the fallopian tube, followed by dissection with fascia interposition or coagulation of the fallopian tube lumen. This method has fewer complications immediately after surgery and a higher long-term success rate than the method with a scalpel approach and without coagulation or fascial interposition. Furthermore, it is generally recommended to perform the procedure under local anaesthesia only, which again has fewer complications than general anaesthesia. Conclusions: Vasectomy is a safe and relatively simple method of male contraception. It has a lower morbidity and mortality rate than tubal ligation in women. No relationship between vasectomy and the development of immunological, cardiovascular or cancer diseases has been confirmed. The possible complications are summarized in Table 1. Patients must always be informed before the procedure about the possible complications and the possibility of irreversibility of the procedure. Conflicts of Interest: None. [ABSTRACT FROM AUTHOR]

As the age of our surgical population continues to rise, there is an increased need for adequate preoperative evaluation and risk stratification to ensure the best possible surgical outcomes for patients. We sought to describe the 3 main models currently used to evaluate patient frailty and explore how they are being utilized in the field of surgery and sexual medicine. We reviewed online resources including Pubmed with relevant search criteria centered around frailty, surgery, sexual medicine, and prosthetics. All relevant studies were reviewed and several models for patient frailty emerged; the Phenotype Model, the Frailty Index, the Clinical Frailty Scale, and the modified Frailty Index. Worse frailty indices were seen to be linked to higher rates of complications and mortalities postoperatively. Although the adoption of patient frailty in the field of sexual medicine has been sluggish, few studies have shown that its use could help predict which patients are at increased risk of complications and may require more support when it comes to postoperative care and teaching. Overall there is a paucity of literature as it relates to sexual medicine and patient frailty and this paper provides a limited look at the usage of patient frailty in sexual medicine. We implore all sexual health providers to begin to incorporate frailty metrics when caring for this population to help reduce postoperative complications and help better predict surgical success. Burns RT and Bernie HL, Frailty in Surgical Patients: Is it Relevant to Sexual Medicine?. J Sex Med 2022;19:401–403. [ABSTRACT FROM AUTHOR]

Background: The benefit and harm of three‐field lymphadenectomy for oesophageal cancer are still unknown. The aim of this study was to compare overall survival and morbidity and mortality between three‐ and two‐field lymphadenectomy in patients with oesophageal squamous cell carcinoma. Methods: Between March 2013 and November 2016, patients with squamous cell carcinoma of the middle or distal oesophagus were assigned randomly to open oesophagectomy with three‐field (cervical–thoracic–abdominal) or two‐field (thoracic–abdominal) lymphadenectomy. No chemo(radio) therapy was given before surgery. This paper reports on the secondary outcomes of the study: pathology and surgical complications. Results: Some 400 patients were randomized, 200 in each group. A median of 37 (i.q.r. 30–49) lymph nodes were dissected in the three‐field group, compared with 24 (18–30) in the two‐field group (P < 0·001). Some 43 of 200 patients (21·5 per cent) in the three‐field group had cervical lymph node metastasis. More patients in the three‐field group had pN3 disease: 21 of 200 (10·5 per cent) versus 10 of 200 (5·0 per cent) (P = 0·040). The rate and severity of postoperative complications were comparable between the two groups, except that six patients in the three‐field arm needed reintubation compared with none in the two‐field group (3·0 versus 0 per cent; P = 0·030). The 90‐day mortality rate was 0 per cent in the three‐field group and 0·5 per cent (1 patient) in the two‐field group (P = 1·000). Conclusion: Oesophagectomy with three‐field lymphadenectomy increased the number of lymph nodes dissected and led to stage migration owing to a 21·5 per cent rate of cervical lymph node metastasis. Postoperative complications were largely comparable between two‐ and three‐field lymphadenectomy. Registration number: NCT01807936 (https://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Objective: To report clinical and radiological follow‐up outcomes of stent‐assisted coiling of wide‐necked basilar tip aneurysms and to evaluate the safety and efficacy of this treatment choice. Methods: A retrospective review was carried out of 19 patients with wide‐necked basilar tip aneurysms in our institution between 2010 and 2020. The rates of perioperative complication, morbidity, mortality, imaging follow‐up and re‐treatment were analysed. Results: Our technical complication rate was 11% but did not result in treatment failure. The combined procedure related morbidity and mortality rate of the 19 patients who underwent stent assisted coiling was also 11%. 16 of 19 patients had undergone angiographic follow‐up with a mean period of 32 months. 81% of patients with angiographic follow‐up had a satisfactory occlusion (RROI or II) with 11% requiring re‐treatment. Those requiring re‐treatment were both treated with laser‐cut stents; this is in contrast with no re‐treatments required in the patients treated with braided stents. Conclusion: Our report provides acceptable outcomes in wide‐necked basilar termination aneurysms which are very challenging to treat. Aneurysms treated with braided stents had better efficacy outcomes than those with laser‐cut stents. Advances in knowledge: Given the emergent and increasing utility of alternative endovascular techniques such as intrasaccular devices and flow diverters, real‐world data are lacking on more conventional approaches such stent‐assisted coiling, especially so in the posterior circulation. The associated relatively higher aneurysmal haemorrhagic risk in this location warrants further additional safety and efficacy data for this treatment approach, which this paper provides. [ABSTRACT FROM AUTHOR]

Flood syndrome, first described by Dr. Frank Flood in 1961, is a rare condition involving the leakage of ascitic fluid through a ruptured ventral hernia. Most commonly, it occurs in patients with advanced, decompensated liver cirrhosis leading to significant amounts of ascites. Currently, there is no standard of care for Flood syndrome due to its very rare nature. Our case report details the medical, surgical and social aspects of a 45-year-old unhoused male with Flood syndrome with post-surgical complications and subsequent infection. This paper aims to add to the sparse literature on Flood syndrome and to discuss some of the complications and treatment approaches for this condition. [ABSTRACT FROM AUTHOR]

Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socioeconomic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability. Here, a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery is proposed. Pain neuroscience education (PNE) is a biopsychosocial approach that aims to decrease the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain. This paper provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for postsurgical pain and how to cope with it. [ABSTRACT FROM AUTHOR]

Postoperative nausea and vomiting (PONV) is an important clinical problem. Aprepitant is a relatively new agent for this condition which may be superior to other treatment. A systematic review was performed after searching a number of medical databases for controlled trials comparing aprepitant with conventional antiemetics published up to 25 April 2015 using the following keywords: 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists' and 'NK-1 versus 5-HT3 for PONV'. The primary outcome for the pooled analysis was efficacy of aprepitant in preventing vomiting on postoperative day (POD) 1 and 2. 172 potentially relevant papers were identified of which 23 had suitable data. For the primary outcome, 14 papers had relevant data. On POD1, 227/2341 patients (9.7%) patients randomised to aprepitant had a vomiting episode compared with 496/2267 (21.9%) controls. On POD2, the rate of vomiting among patients receiving aprepitant was 6.8% compared with 12.8% for controls. The OR for vomiting compared with controls was 0.48 (95% CI 0.34 to 0.67) on POD1 and 0.54 (95% CI 0.40 to 0.72) on POD2. Aprepitant also demonstrated a better profile with a lower need for rescue antiemetic and a higher complete response. Efficacy for vomiting prevention was demonstrated for 40 mg, 80 mg and 125 mg without major adverse effects. For vomiting comparison there was significant unexplainable heterogeneity (67.9% and 71.5% for POD1 and POD2, respectively). We conclude that (1) aprepitant reduces the incidence of vomiting on both POD1 and POD2, but there is an unexplained heterogeneity which lowers the strength of the evidence; (2) complete freedom from PONV on POD1 is highest for aprepitant with minimum need for rescue; and (3) oral aprepitant (80 mg) provides an effective and safe sustained antivomiting effect. [ABSTRACT FROM AUTHOR]

Background Recruitment into surgical RCTs can be threatened if new interventions available outside the trial compete with those being evaluated. Adapting the trial to include the new intervention may overcome this issue, yet this is not often done in surgery. This paper describes the challenges, rationale and methods for adapting an RCT to include a new intervention. Methods The By-Band study was designed in the UK in 2009-2010 to compare the effectiveness of laparoscopic adjustable gastric band and Roux-en- Y gastric bypass for severe obesity. It contained a pilot phase to establish whether recruitment was possible, and the grant proposal specified that an adaptation to include sleeve gastrectomy would be considered if practice changed and recruitment was successful. Information on changing obesity surgery practice, updated evidence and expert opinion about trial design were used to inform the adaptation. Results The pilot phase recruited over 13 months in 2013-2014 and randomized 80 patients (79 anticipated). During this time, major changes in obesity practice in the UK were observed, with gastric band reducing from 32·6 to 15·8 per cent and sleeve gastrectomy increasing from 9·0 to 28·1 per cent. The evidence base had not changed markedly. The British Obesity and Metabolic Surgery Society and study oversight committees supported an adaptation to include sleeve gastrectomy, and a proposal to do so was approved by the funder. Conclusion Adaptation of a two-group surgical RCT can allow evaluation of a third procedure and maintain relevance of the RCT to practice. It also optimizes the use of existing trial infrastructure to answer an additional important research question. Registration number: ISRCTN00786323 (/). [ABSTRACT FROM AUTHOR]

This article is about an emerging issue in esophageal surgery: enhanced recovery after surgery (ERAS) Few data are published in literature and its safety and feasibility is still debated. The focus of our paper is on the feasibility of an ERAS protocol for esophagectomy (including both the Ivor-Lewis and McKeown procedure) in a high volume center comparing to a standard perioperative protocol. We introduced a novelty item on this type of surgery: resume of oral feeding in the first postoperative day. We analyzed the dropout rate for each item and the postoperative morbidity. We studied 39 patients operated in the Upper GI division of Verona University Hospital between January 2013 and August 2014; 22 patients (ERAS group) were studied in a perspective way while 17 patients (standard group) were studied retrospectively. The enhanced recovery protocol included intraoperative fluid management, time of extubation after surgery, intensive care unit discharge, drains and nasogastric tube management, mobilization of the patient, oral food intake. We compared the results between the two groups in term of hospital stay, postoperative morbidity and mortality.We also calculated the percentage completion of the protocol, evaluating patient drop-out rates for each of the items. Patients showed an improvement in the ERAS group in terms of earlier extubation, earlier intensive care unit discharge (p < 0.01), earlier thoracic drain, urinary catheter (p < 0.01) and nasogastric tube removal (p=0.02), earlier mobilization (p<0.01), and resume of oral feeding (p<0.01). Median length of hospital stays in the ERAS group was 9 days while in the standard group was 10 days (p = 0.23). Postoperative morbidity and mortality were comparable between the two groups. This study shows the feasibility and safety of an ERAS protocol for esophageal surgery in a high-volume center. These data strengthen the literature results on this argument calling for larger sample size studies. [ABSTRACT FROM AUTHOR]

Background Surgical interventions are complex, with multiple components that require consideration in trial reporting. This review examines the reporting of details of surgical interventions in randomized clinical trials ( RCTs) within the context of explanatory and pragmatic study designs. Methods Systematic searches identified RCTs of surgical interventions published in 2010 and 2011. Included studies were categorized as predominantly explanatory or pragmatic. The extent of intervention details in the reports were compared with the CONSORT statement for reporting trials of non-pharmacological treatments ( CONSORT-NPT). CONSORT-NPT recommends reporting the descriptions of surgical interventions, whether they were standardized and adhered to (items 4a, 4b and 4c). Reporting of the context of intervention delivery (items 3 and 15) and operator expertise (item 15) were assessed. Results Of 4541 abstracts and 131 full-text articles, 80 were included (of which 39 were classified as predominantly pragmatic), reporting 160 interventions. Descriptions of 129 interventions (80·6 per cent) were provided. Standardization was mentioned for 47 (29·4 per cent) of the 160 interventions, and 22 articles (28 per cent) reported measurement of adherence to at least one aspect of the intervention. Seventy-one papers (89 per cent) provided some information about context. For one-third of interventions (55, 34·4 per cent), some data were provided regarding the expertise of personnel involved. Reporting standards were similar in trials classified as pragmatic or explanatory. Conclusion The lack of detail in trial reports about surgical interventions creates difficulties in understanding which operations were actually evaluated. Methods for designing and reporting surgical interventions in RCTs, contributing to the quality of the overall study design, are required. This should allow better implementation of trial results into practice. [ABSTRACT FROM AUTHOR]

Background Anastomotic leak ( AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs. Methods A systematic review was performed to identify adjustable and non-adjustable preoperative, intraoperative and postoperative factors in the pathogenesis of AL. Additionally, a severity grading system was proposed to guide treatment. Results Of 1707 papers screened, 451 fulfilled the criteria for inclusion in the review. Significant preoperative risk factors were: male sex, American Society of Anesthesiologists fitness grade above II, renal disease, co-morbidity and history of radiotherapy. Tumour-related factors were: distal site, size larger than 3 cm, advanced stage, emergency surgery and metastatic disease. Adjustable risk factors were: smoking, obesity, poor nutrition, alcohol excess, immunosuppressants and bevacizumab. Intraoperative risk factors were: blood loss/transfusion and duration of surgery more than 4 h. Stomas lessen the consequences but not the prevalence of AL. In the postoperative period, CT is the most commonly used imaging tool, with or without rectal contrast, and a C-reactive protein level exceeding 150 mg/l on day 3-5 is the most sensitive biochemical marker. A five-level classification system for AL severity and appropriate management is presented. Conclusion Specific risk factors and their potential correction or indications for stoma were identified. An AL severity score is proposed to aid clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension. The main aims of this paper were to review outcome after surgical versus medical treatment of PA and partial versus total adrenalectomy in patients with PA. Methods: Relevant medical literature from PubMed, the Cochrane Library and Embase OvidSP from 1985 to June 2014 was reviewed. Results: Of 2036 records, 43 articles were included in the final analysis. Twenty-one addressed surgical versus medical treatment of PA, four considered partial versus total adrenalectomy for unilateral PA, and 18 series reported on surgical outcomes. Owing to the heterogeneity of protocols and reported outcomes, only a qualitative analysis was performed. In six studies, surgical and medical treatment had comparable outcomes concerning blood pressure, whereas six showed better outcome after surgery. No differences were seen in cardiovascular complications, but surgery was associated with the use of fewer antihypertensive medications after surgery, improved quality of life, and (possibly) lower all-cause mortality compared with medical treatment. Randomized studies indicate a role for partial adrenalectomy in PA, but the high rate of multiple adenomas or adenoma combined with hyperplasia in localized disease is disconcerting. Surgery for unilateral dominant PA normalized BP in a mean of 42 (range 20-72) per cent and the biochemical profile in 96-100 per cent of patients. The mean complication rate in 1056 patients was 4·7 per cent. Conclusion: Recommendations for treatment of PA are hampered by the lack of randomized trials, but support surgical resection of unilateral disease. Partial adrenalectomy may be an option in selected patients. [ABSTRACT FROM AUTHOR]

Background: Depressed skull fracture overlying venous sinuses deserves a special attention among skull fractures. It puts high demand on every neurosurgeon, as the management of this kind of trauma carry high risk of mortality. It is considered as one of the most dangerous complications of head injuries. Either it is due to fatal venous bleeding, or disturbing the intracranial pressure via thrombosis or stenosis. Therefore, knowledge of appropriate treatment of this kind of head injury is essential. Moreover, it should always be treated with high cautions. Aim of the Work: This study aims at reviewing available scientific data based on clinical trials about the proper management approaches for the treatment of depressed skull fractures overlying major cranial venous sinuses. Either through surgery or medical and conservative management. Patients and Methods: The study review yielded 22 relevant papers, with a total number of 85 patients. These patients presented to different institutes, at the period between 1996 and 2017. Diagnosed with depressed skull fracture overlying major venous sinuses. The cases divided according to the way of management as follow: 72% of patients treated with surgical approaches. While 28% of patients treated with conservative care. Results: In total surgical intervention showed to be successful in 53 patients, out of 85 patients included in the study, without any intraoperative complication of bleeding. While 6 patients passed away during the surgical interventions. On the other hand, 18 patients who treated conservatively did not need any further intervention. While 2 studies reported the need of medication following surgery. Furthermore, 6 studies reported failure of conservative management, and needed urgent surgical elevation of the depressed fragment that compressing the sinus. Based on the results, the mortality rate over all was 7%; death was mainly due to inability to control the profusely bleeding from the injured sinuses. With a success rate over the surgical cases in 87%. While it was 75% over the conservative cases. However, this pooled data need further statistical analysis to obtain guiding evidence for current practice. Conclusions: Clinical decision making must be tailored to each patient independently. In the presence of clinical and radiographic evidence of sinus occlusion surgery is preferred. In such instances where there is a clear need for surgery, adequate precautions should be taken, and an expertise in neurotrauma should always be available. Delayed intracranial hypertension is a possible complication and should always be considered in all patients. [ABSTRACT FROM AUTHOR]

To compare two kinds of metal markers for preoperative localization of ground glass nodules (GGNs). We retrospectively investigated data from 198 cases of GGN localization and compared the success rate and complications of both approaches. In the hook wire and coil groups, the success rates of CT-guided localization for GGNs were 99.2 and 98.7%, respectively (p = 1.000). The success rates of video-assisted thoracoscopic surgery in both groups were 100% without transthoracic surgery. The post-localization complication rates in the hook wire group and coil group were 36.9 and 32.9% (p = 0.568), and the postoperative complication rates in the hook wire and coil groups were 13.9 and 11.8%, respectively (p = 0.672). Preoperative localization of GGNs with both hook wire and coil methods proved to be useful and effective. Both methods have acceptable preoperative and postoperative complication rates, but the localization and operation times were shorter for the hook wire group than the coil group. Most of previous articles studied a single preoperative localization method. Few studies have compared the preoperative and postoperative methods for metal markers. This paper compared two preoperative localization methods for GGNs to provide clinical guidance. [ABSTRACT FROM AUTHOR]

In their recent paper, Spinelli and Pellino talked about emergency surgery during the COVID-19 pandemic[1]. A 65-4 per cent decrease in emergency surgery activity was observed; the mean number of patients who underwent emergency surgery daily in each hospital decreased from 2-6 during the control period to 0-9 during pandemic period ( I P i < 0-001). Considering these results, those regions where the COVID-19 pandemic is now developing should assume that emergency surgery activity will decrease to one-third of normal. [Extracted from the article]

Comment on: Performance of a modified three-level classification in stratifying open liver resection procedures in terms of complexity and postoperative morbidity Kawaguchi I et al i . recently described a three-level classification for stratifying complexity of open liver surgery[1] based on their previously published classification of laparoscopic liver operations[2]. But caudate resection and segmentectomy (Sg) 2/3 resection values are present in the utility method and these fall into the posterosuperior and anterolateral segment groups according to Kawaguchi I et al i .'s original paper[2]. [Extracted from the article]

Background Anastomotic leaks after esophagectomy can lead to severe complications and account for 40% of postoperative deaths. During the last decades, several types of endoscopic treatments have became available, such as the use of esophageal stent and the use of vacuum therapy. In this paper we report one case of cervical anastomotic fistulas after esophagectomy treated with vacuum therapy and two cases treated with stent. Methods Three cases of cervical anastomotic fistulas after esophagectomy treated with an endoscopic aproach (stent and vacuum therapy) are reported. Results Case 1 61-year-old male with an mid-esophagus adenocarcinoma was treated with neoadjuvant chemotherapy and minimally invasve esophagectomy. On the 10th post-operative day (POD) a partial dehiscence of the anastomosis with communication with the mediastinum was identified, forming a cavity with a large amount of purulent secretion. A sponge attached to a nelaton probe, similar to the VAC device, was positioned inside the mentioned cavity and coupled to a continuous aspiration system. There was a gradual clinical improvement and on the 30th POD the sponge was finally removed. The patient was discharged on the 50th POD. Case 2: A 62-year-old male with a adenocarcinoma in the thoracic esophagus received neoadjuvant chemoradiotherapy and a minimally invasive esophagectomy. On the 7th POD, an anastomotic fistula draining by the chest tube was diagnosed. A stent that was positioned over the fistula area. The patient was discharged on the 28th POD with the stent, that was removed six weeks later. Case 3: 58 years old male patient presented with a superficial squamous cell carcinoma of the mid-thoracic esophagus. A minimally invasive esophagectomy was performed.On the 7th POD, a EGD was performed and showed a fistulous orifice in the esophagogastric anastomosis. A metal stent that was positioned over the fistula area. The patient evolved with empyema and a pulmonary decortication was performed by on the 17th POD. After progressive clinical improvement he was discharged on the 34th POD. Conclusion Esophageal stent has been successful used in treating this surgical complication. Recently, VAC therapy, is becoming an promising therapy for this complication, with lower morbidity and mortality rates and greater success in the closure of the anastomotic fistula when compared to the esophageal stent. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

There is increasing demand for prosthetic joint surgery and patients are becoming more challenging due to an ageing population often with comorbidities and immunosuppression. While prosthetic joint infection (PJI) rates are generally low, infection can be catastrophic for the patient and hence prevention of infection is critical. Infection, when it does occur, is further complicated by the global rise in antimicrobial resistance. This article introduces a series of papers on the epidemiology of PJI, its diagnosis, use of novel inflammatory markers and molecular techniques, clinical presentation, importance of biofilms, treatment guidelines and, finally, various strategies and novel antibiotic treatment regimens. [ABSTRACT FROM PUBLISHER]