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Vestibular schwannoma (VS) is a slow growing benign tumour originating in the Schwann cells surrounding the vestibulocochlear nerve. Over recent decades, the incidence rate for VS has steadily increased, with greater numbers of patients with smaller tumours being diagnosed. Today, it is estimated that around 1 in 500 people will suffer from VS in their lifetime. The most common symptom of VS is unilateral hearing loss, tinnitus or dizziness. The growth rate of the tumour is unpredictable and not related to degree of symptoms. The overall aim of this thesis was to provide new knowledge that could be used to improve routines for treatment and clinical guidelines for future patients with sporadic VS. A local clinical quality database was used to identify patients with VS treated at Uppsala University hospital. The information in the database of patients with VS was used to analyze postoperative complications after translabyrinthine surgery, hearing outcomes after hearing preservation middle cranial fossa surgery, both postoperative and after more than 10 years of follow up, and the risk of enduing a fall-related injury. The proteome of the human endolymphatic sac endolymph in six patients with VS was described. 13% of the translabyrinthine operated patients (93 of 700) suffered from one or more complications postoperatively. Increasing age and tumour size were both risk factors for postoperative facial nerve dysfunction. Greater tumour size increased the risk for intracranial hemorrhage. 60 out of 84 patients with VS operated on through middle fossa surgery had preserved hearing after surgery. After 10 years, the hearing had deteriorated symmetrically in the tumour ear and the contralateral ear. There was no increased risk for fall-related injuries among patient with VS compared to VS-free controls. Studying subgroups, an increased risk of fall-related injury was displayed among middle-aged patients before being diagnosed with VS and postoperatively in patients treate

Vestibular schwannoma (VS) is a slow growing benign tumour originating in the Schwann cells surrounding the vestibulocochlear nerve. Over recent decades, the incidence rate for VS has steadily increased, with greater numbers of patients with smaller tumours being diagnosed. Today, it is estimated that around 1 in 500 people will suffer from VS in their lifetime. The most common symptom of VS is unilateral hearing loss, tinnitus or dizziness. The growth rate of the tumour is unpredictable and not related to degree of symptoms. The overall aim of this thesis was to provide new knowledge that could be used to improve routines for treatment and clinical guidelines for future patients with sporadic VS. A local clinical quality database was used to identify patients with VS treated at Uppsala University hospital. The information in the database of patients with VS was used to analyze postoperative complications after translabyrinthine surgery, hearing outcomes after hearing preservation middle cranial fossa surgery, both postoperative and after more than 10 years of follow up, and the risk of enduing a fall-related injury. The proteome of the human endolymphatic sac endolymph in six patients with VS was described. 13% of the translabyrinthine operated patients (93 of 700) suffered from one or more complications postoperatively. Increasing age and tumour size were both risk factors for postoperative facial nerve dysfunction. Greater tumour size increased the risk for intracranial hemorrhage. 60 out of 84 patients with VS operated on through middle fossa surgery had preserved hearing after surgery. After 10 years, the hearing had deteriorated symmetrically in the tumour ear and the contralateral ear. There was no increased risk for fall-related injuries among patient with VS compared to VS-free controls. Studying subgroups, an increased risk of fall-related injury was displayed among middle-aged patients before being diagnosed with VS and postoperatively in patients treate

Acute kidney injury (AKI) is a major postoperative complication that lacks established intraoperative predictors. Our objective was to develop a prediction model using preoperative and high-frequency intraoperative data for postoperative AKI. In this retrospective cohort study, we evaluated 77,428 operative cases at a single academic center between 2016 and 2022. A total of 11,212 cases with serum creatinine (sCr) data were included in the analysis. Then, 8519 cases were randomly assigned to the training set and the remainder to the validation set. Fourteen preoperative and twenty intraoperative variables were evaluated using elastic net followed by hierarchical group least absolute shrinkage and selection operator (LASSO) regression. The training set was 56% male and had a median [IQR] age of 62 (51-72) and a 6% AKI rate. Retained model variables were preoperative sCr values, the number of minutes meeting cutoffs for urine output, heart rate, perfusion index intraoperatively, and the total estimated blood loss. The area under the receiver operator characteristic curve was 0.81 (95% CI, 0.77-0.85). At a score threshold of 0.767, specificity was 77% and sensitivity was 74%. A web application that calculates the model score is available online. Our findings demonstrate the utility of intraoperative time series data for prediction problems, including a new potential use of the perfusion index. Further research is needed to evaluate the model in clinical settings.

Background: Third molar displacement (TM) is a rare complication that occurs in both the maxilla and the mandible and can be of complete teeth or root fragments. Objective: The objective of this article was to perform a systematic review of the articles published on third molar displacement during the surgical procedure, analyzing the predisposing factors, the cause, symptomatology, and treatment used to resolve this complication. Material and Methods: A systematic review was performed. The review included articles on displacement of third molars to different anatomical spaces; articles dealing with displacement of teeth other than third molars, displacement of surgical instruments or displacement of materials were excluded. Results: Fifty articles met the inclusion and exclusion criteria. The most frequent site to which a third molar is displaced in the maxilla is to the infratemporal fossa while in the mandible it is to the submandibular space. The incidence was higher in women than in men with a 2:1 rate. Conclusion: When displacement occurs, the risk/benefit of immediate or delayed extraction should be assessed. If there is a risk to vital structures and there is no symptomatology, it can be kept under follow-up. CBCT is the best method for preoperative localization. © 2023, The Association of Oral and Maxillofacial Surgeons of India

Introducción: El trasplante renal se establece como primera opción terapéutica para aquellos pacientes con insuficiencia renal terminal. Desde sus inicios, la técnica se ha perfeccionado, y los resultados son cada vez mejores. No obstante, las complicaciones quirúrgicas siguen presentes, constituyendo una importante fuente de morbimortalidad. Destacan entre las mismas las urológicas (las más frecuentes) y las vasculares (que condicionan una mayor mortalidad y pérdida del injerto). Objetivo: A través de la bibliografía disponible, actualizar los datos sobre complicaciones quirúrgicas urológicas más frecuentes del trasplante renal, sus factores de riesgo, su diagnóstico y su tratamiento. Asimismo, se pretende introducir la perspectiva reciente de la cirugía laparoscópica y la robótica. Método: Se ha realizado una revisión bibliográfica mediante una búsqueda en PubMed de artículos relacionados con las complicaciones quirúrgicas urológicas del trasplante renal de cadáver en los últimos cinco años. Resultados: De manera compatible con revisiones previas, las complicaciones urológicas continúan constituyendo las más frecuentes en el trasplante renal, destacando la fuga o fístula urinaria. Las complicaciones precoces (que aparecen en los tres meses que siguen al trasplante) son las que condicionan esencialmente la mortalidad y la supervivencia del injerto. La cirugía robótica y la laparoscópica se establecen (a falta de más estudios y en caso de reducción de los costes) como una alternativa no inferior a la cirugía abierta. Por último, se identifican factores de riesgo en donantes y receptores que presentan asociaciones estadísticamente significativas con algunas de las complicaciones más frecuentes. Conclusiones: Se deben implementar criterios uniformes que definan las complicaciones urológicas y protocolos de diagnóstico de las mismas para homogeneizar los resultados entre estudios de manera que sean comparables. La investigación en mejores cuidados postrasplante y bioma, Introdución: O transplante renal establécese como a primeira opción terapéutica para os pacientes con insuficiencia renal terminal. Desde os seus inicios, a técnica perfeccionouse, e os resultados son cada vez mellores. Porén, as complicacións cirúrxicas continúan presentes, constituíndo unha importante fonte de morbimortalidade. Destacan entre as mesmas as urolóxicas (as máis frecuentes) e as vasculares (que condicionan unha maior mortalidade e perda do enxerto). Obxectivo: A través da bibliografía dispoñible, actualizar os datos sobre as complicacións cirúrxicas urolóxicas máis frecuentes do transplante renal, os seus factores de risco, diagnóstico e tratamento. Ademais, preténdese introducir a perspectiva recente da cirurxía laparoscópica e a robótica. Método: Realizouse unha revisión bibliográfica mediante unha busca en PubMed de artigos relacionados coas complicacións cirúrxicas urolóxicas do transplante renal de cadáver nos últimos cinco anos. Resultados: De xeito compatible con revisións previas, as complicacións urolóxicas continúan sendo as máis frecuentes no transplante renal, destacando a fuga ou fístula urinaria. As complicacións precoces (que aparecen nos tres primeiros meses postransplante) son as que condicionan esencialmente a mortalidade e a supervivencia do enxerto. A cirurxía robótica e a laparoscópica establécense (a falta de máis estudos e en caso de reducións dos costos) como unha alternativa non inferior á cirurxía aberta. Por último, identifícanse factores de risco en doantes e receptores que presentan asociacións estatisticamente significativas con algunhas das complicacións máis frecuentes. Conclusións: É necesario introducir criterios uniformes que definan as complicacións urolóxicas e protocolos de diagnóstico das mesmas para homoxeneizar os resultados entre estudos de xeito que sexan comparables. A investigación en mellores coidados postransplante e biomarcadores que permitan unha detección precoz das complicacións é esencial para contin

Introduction Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. MethodsA pre-planned analysis of the European Soci-ety of Coloproctology 2017 audit. Adult patients(>16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic orrectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindograde 3 to 5).ResultsFrom 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). Inmultivariable models, anastomosis was associated with asimilar major complication rate to end stoma (adjustedodds ratio for end stoma 1.52, 95%CI 0.83–2.79,P=0.173). Although a defunctioning stoma was notassociated with reduced anastomotic leak (12% defunc-tioned [4/33]vs13% not defunctioned [13/97],adjusted odds ratio 2.19, 95%CI 0.43–11.02,P=0.343), it was associated with less severe complica-tions (75% [3/4] with defunctioning stoma, 86.7%anastomosis only [13/15]), a lower mortality rate (0%[0/4]vs20% [3/15]), and fewer reoperations (50%[2/4]vs73% [11/15]) when a leak did occur.ConclusionsPrimary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.

Introduction Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. MethodsA pre-planned analysis of the European Soci-ety of Coloproctology 2017 audit. Adult patients(>16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic orrectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindograde 3 to 5).ResultsFrom 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). Inmultivariable models, anastomosis was associated with asimilar major complication rate to end stoma (adjustedodds ratio for end stoma 1.52, 95%CI 0.83–2.79,P=0.173). Although a defunctioning stoma was notassociated with reduced anastomotic leak (12% defunc-tioned [4/33]vs13% not defunctioned [13/97],adjusted odds ratio 2.19, 95%CI 0.43–11.02,P=0.343), it was associated with less severe complica-tions (75% [3/4] with defunctioning stoma, 86.7%anastomosis only [13/15]), a lower mortality rate (0%[0/4]vs20% [3/15]), and fewer reoperations (50%[2/4]vs73% [11/15]) when a leak did occur.ConclusionsPrimary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.

Introduction: End-Stage Renal Disease (ESRD) is a complex clinical-humoral syndrome characterized by irreversible deterioration of renal function with multiple etiologies, typically evolving slowly and progressively, leading to terminal uremia and its associated complications. Objective: To understand the potential complications of kidney transplantation, with particular emphasis on incidence, clinical characteristics, and the potential for effective therapy, which will facilitate analysis for future health studies. Development: Using MESH terms or keywords, we conducted an information search, resulting in 101 initial articles, of which 61 were from Pubmed, 18 from Science Direct, 15 from Google Scholar, and 7 from Scielo. At the end of the process, a reading was conducted where 23 were excluded for duplicates, 11 for being partially relevant, 21 for title or abstract screening, 6 for full text review, and finally, after eliminating 11 that did not meet the inclusion criteria, a total of 34 articles were analyzed. Conclusions: Post-transplant complications are divided into pathological ones such as rejection, infection, CVD, and surgical complications that can be vascular, urological, lymphoceles, and hernias., Introducción: La Enfermedad Renal Crónica Terminal (ERCT) constituye un síndrome clínico-humoral complejo como expresión de un deterioro irreversible de la función renal con múltiples etiologías, que evoluciona habitualmente de manera lenta y progresiva, hasta llegar al estado de uremia terminal, con todas sus complicaciones Objetivo: conocer las posibles complicaciones del trasplante renal, con especial énfasis en la incidencia, las características clínicas y el potencial para una terapia eficaz, la misma que facilitará el análisis para futuros estudios de salud. Desarrollo: Mediante los términos MESH o palabras clave desarrollamos la búsqueda de información, en donde tuvimos como resultado 101 artículos iniciales, de los cuales 61 artículos fueron de Pubmed, 18 de Science direct, 15 de Google académico, 7 de Scielo. Al fin del proceso se realizó a una lectura en donde se excluyeron 23 por duplicados, 11 por parcialmente relevantes, 21 por cribado de título o abstract, 6 por revisión del texto completo, y por último después de eliminar 11 que no cumplieron con los criterios de inclusión quedando un total de 34 artículos que se analizaron. Conclusiones: Las complicaciones post trasplante se dividen en patológicas que son el rechazo, la infección, los ECV, y las complicaciones quirúrgicas que pueden ser vasculares, urológicas, linfoceles y hernias

Introduction: Surgical complications can occur after renal transplantation, leading to graft loss. For this reason, it is important to diagnose complications early and establish an adequate treatment. Objective: To analyze the surgical complications associated with kidney transplantation in patients from the Nephrology Department of the Hospital de Clínicas from November 2014 to October 2018. Method: Observational, descriptive cross-sectional study. Consecutive cases of kidney transplant patients at the Hospital de Clínicas. The sample consisted of 108 transplant patients in the Department of Nephrology in said period. Results: 108 kidney transplant patients were evaluated, 70 (64.8%) from living donors and 38 (35.2%) from cadaveric donors. The mean age was 38.6 ± 13.6 years, 72.3% were male, 65.1% were from urban areas, and dialysis time before transplantation was 21.2 ± 30.1 months. The etiology of chronic kidney disease was diabetic nephropathy 14.8%, unknown 60.1%. The age at the time of ablation was 61.1 ± 18.5 years. Seventeen (15.7%) patients presented some surgical complication; 8 (47.2%) occurred in patients transplanted from cadaveric donors and 9 (52.8%) from living donors. Complications were: ureterovesical stenosis in 2 patients (11.7%), followed by urinary fistula, renal vein thrombosis of the graft, and renal artery thrombosis of the transplanted kidney in the same number and percentage. Mortality was 3.6% due to causes other than surgical. There was graft loss in 3.6% associated with vascular surgical complications. There was no association of the different variables studied with the appearance of complications of the surgical type (p>0.05). Conclusion: The figures for surgical complications related to the transplant were low (15.7%). There were vascular complications such as graft thrombosis, urinary fistulas, and ureteral stenosis, 5.8% for urinoma, deep vein thrombosis of the lower limbs associated with renal hematoma, active arterial bleeding, Introducción: Las complicaciones quirúrgicas pueden ocurrir posterior al trasplante renal y como consecuencia llevar a pérdida del injerto. Por ello es importante diagnosticar las complicaciones de forma precoz y establecer un tratamiento adecuado. Objetivo: Analizar las complicaciones quirúrgicas asociadas al trasplante renal de los pacientes del Departamento de Nefrología del Hospital de Clínicas durante el periodo de noviembre 2014 a octubre del 2018. Pacientes y métodos: Estudio observacional, descriptivo de corte transverso. Casos consecutivos de enfermos renales trasplantados en el Hospital de Clínicas. La muestra estuvo conformada por 108 pacientes trasplantados en el Departamento de Nefrología en dicho período. Resultados: Fueron evaluados 108 pacientes trasplantados renales, 70 (64,8%) de donante vivo y 38 (35,2%) de donante cadavérico. La edad media fue de 38,6 ± 13,6 años, 72,3% perteneció al sexo masculino; 65,1% fueron de procedencia urbana. El tiempo de diálisis previo al trasplante fue de 21,2 ± 30,1 meses. La etiología de la enfermedad renal crónica fue: nefropatía diabética 14,8%, no filiadas 60,1%. La edad al momento de la ablación fue de 61,1 ± 18,5 años. Presentaron algún tipo de complicación quirúrgica 17 (15,7%) pacientes; 8 (47,2%) ocurrieron en pacientes trasplantados de donante cadavérico y 9 (52,8%) de donante vivo. Las complicaciones fueron: estenosis ureterovesical en 2 pacientes (11,7%), en misma cantidad y porcentaje le siguieron fístula urinaria, trombosis de la vena renal del injerto y trombosis de la arteria renal del riñón trasplantado. La mortalidad fue de 3,6% por causas distintas a las quirúrgicas. Hubo pérdida del injerto en 3,6% asociado a las complicaciones quirúrgicas vasculares. No hubo asociación de las diversas varia- bles estudiadas con la aparición de las complicaciones del tipo quirúrgico (p >0,05). Conclusión: Las cifras de complicaciones quirúrgicas relacionadas al trasplante fueron bajas (15,7%). Hubo complicacion

Objectives: This study investigated age at implantation, improvement in hearing and speech perception outcomes, as well as surgical complications in pediatric cochlear implant recipients with Pendred Syndrome (PS) or non-syndromic enlarged vestibular aqueduct (NSEVA). Design: A systematic review of the literature between 1984 and 2021 was performed. Two independent reviewers performed abstract and full-text screening using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were: English language, cochlear implant, age at implantation available, age <18 years, PS, Mondini malformation, and enlarged vestibular aqueduct. Full-text analysis was completed using the National Institute of Health assessment tool for case series and case-control studies. Studies were also graded according to the Oxford Centre for Evidence-Based Medicine grading system. Results: In total, 198 studies were identified and screened, and 55 studies were included for analysis. Audiological outcomes were available in 46 studies, and the four-frequency pure-tone audiogram average improved by 60 to 78 dB HL due to cochlear implantation. Auditory performance and speech intelligibility scores increased by 44%. The overall average implantation age was 60 months. The implantation age was 21 months lower in the studies where individuals were implanted after the year 2000 compared with those implanted before the year 2000. Perilymph gusher/oozing was the most common surgical incident reported, occurring in 187 of 1572 implantations. Conclusions: In children with PS/NSEVA, cochlear implantation improves pure-tone average by 60 to 78 dB HL and capacity of auditory performance/speech intelligibility by 44%. The implantation age for these children has decreased during the last two decades but is still somewhat higher than reported for unselected pediatric cochlear implantation. Perilymph gusher/oozing is the most common surgical complication.

Objective: To analyze visual acuity, refractive cylinder, refractive sphere and complications in cataract surgery by phacoemulsification with Clareon intraocular lens. Methodology: A descriptive-observational, longitudinal study based on the review of medical records of the Exilaser Ophthalmology Clinic of 114 patients who underwent cataract surgery by phacoemulsification with a Clareon intraocular lens was carried out. Descriptive statistical techniques such as frequencies, measured percentages were used on those cases of central tendency and comparative analysis with T Student. Results: The most frequent pre-surgical visual acuity on the Snellen scale was 20/CD with 27.2%, the most frequent corrected pre-surgical visual acuity was 20/CD with 14.0%, the most frequent pre-surgical refractive cylinder value was 0 with 50.9%, the most frequent pre-surgical refractive sphere value was 0 with 28.9%. Post-surgical visual acuity was 20/30 with 20.2%, Corrected Post-surgical Visual Acuity was 20/20 with 53.5%, the most frequent post-surgical refractive sphere value was 0 with 40.4%, the most frequent Post-surgical Refractive Cylinder value was 0 with 14.0%. 99.1% did not present trans-surgical complications and 91.2% did not present post-surgical complications. Conclusions: Cataract surgery by phacoemulsification with CLAREON intraocular lens improves Visual Acuity and the Refractive Sphere, with statistically significant results, with minimal intra-surgical and post-surgical complications., Objetivo: Analizar de la Agudeza visual, cilindro refractivo, esfera refractiva y complicaciones en la cirugía de catarata por facoemulsificación con lente intraocular Clareon. Metodología: se realizó un estudio descriptivo - observacional, de corte longitudinal basado en la revisión de historias clínicas de la Clínica Oftalmológica Exilaser de 114 pacientes sometidos a cirugía de catarata por facoemulsificación con lente intraocular Clareon, se utilizaron técnicas estadísticas descriptivas como frecuencias, porcentajes medidas de tendencia centra y análisis comparativo con T de student. Resultados: la agudeza visual prequirúrgica más frecuente en escala de Snellen fue 20/CD con el 27,2%, la agudeza visual prequirúrgica corregida más frecuente fue 20/CD con el 14,0%, el valor de cilindro refractivo prequirúrgico más frecuente fue 0 con el 50,9%, el valor de esfera refractiva prequirúrgica más frecuente fue 0 con el 28,9%, la agudeza visual postquirúrgica fue 20/30 con el 20,2%, la Agudeza Visual Postquirúrgica Corregida fue 20/20 con el 53,5%, el valor de esfera refractiva postquirúrgica más frecuente fue 0 con el 40,4%, el valor de Cilindro Refractivo Postquirúrgico más frecuente fue 0 con el 14,0%, en el 99,1% no presentaron complicaciones transquirúrgicas, en el 91,2% no presentaron complicaciones postquirúrgicas. Conclusiones: la cirugía de catarata por facoemulsificación con lente intraocular CLAREON, mejora la Agudeza Visual y la Esfera Refractiva, con resultados estadísticamente significativos, con mínimas complicaciones transquirúrgicas y postquirúrgicas.

Laparoscopic surgery, although widely used and less invasive, presents particular challenges in patients with obesity. In this article we will address the surgical complications using the laparoscopy technique that could occur in obese patients, as in the case of gynecological patients with obesity, they face complications such as difficulty in visualizing structures due to excess adipose tissue. Additionally, handling instruments in confined spaces may increase the risk of injury to surrounding organs. In patients with cholelithiasis, obesity may complicate the identification and removal of the gallbladder due to altered anatomy. The presence of Inflammatory Bowel Disease also adds complexity, as inflamed tissue can hinder visualization and manipulation during laparoscopic surgery. Additionally, obesity in these patients increases the risk of postoperative complications, including infections and respiratory problems. It is essential that surgeons carefully consider these factors when planning and carrying out laparoscopic procedures in patients with obesity, implementing adapted approaches and additional precautions to mitigate risks., La cirugía laparoscópica, aunque ampliamente utilizada y menos invasiva, presenta desafíos particulares en pacientes con obesidad. En este artículo abordaremos las complicaciones quirúrgicas mediante la técnica de laparoscopía que se podrían producir en el paciente obeso, como en el caso de pacientes ginecológicos con obesidad, se enfrentan a complicaciones como la dificultad en la visualización de estructuras debido al exceso de tejido adiposo. Además, la manipulación de instrumentos en espacios reducidos puede aumentar el riesgo de lesiones en órganos circundantes. En pacientes con colelitiasis, la obesidad puede complicar la identificación y extracción de la vesícula biliar debido a la anatomía alterada. La presencia de la Enfermedad Intestinal Inflamatoria también agrega complejidad, ya que el tejido inflamado puede obstaculizar la visualización y manipulación durante la cirugía laparoscópica. Adicionalmente, la obesidad en estos pacientes aumenta el riesgo de complicaciones postoperatorias, incluyendo infecciones y problemas respiratorios. Resulta esencial que los cirujanos ponderen minuciosamente estos factores al planificar y llevar a cabo los procedimientos laparoscópicos en pacientes con obesidad, implementando enfoques adaptados y precauciones adicionales para mitigar riesgos.

Laparoscopic surgery, although widely used and less invasive, presents particular challenges in patients with obesity. In this article we will address the surgical complications using the laparoscopy technique that could occur in obese patients, as in the case of gynecological patients with obesity, they face complications such as difficulty in visualizing structures due to excess adipose tissue. Additionally, handling instruments in confined spaces may increase the risk of injury to surrounding organs. In patients with cholelithiasis, obesity may complicate the identification and removal of the gallbladder due to altered anatomy. The presence of Inflammatory Bowel Disease also adds complexity, as inflamed tissue can hinder visualization and manipulation during laparoscopic surgery. Additionally, obesity in these patients increases the risk of postoperative complications, including infections and respiratory problems. It is essential that surgeons carefully consider these factors when planning and carrying out laparoscopic procedures in patients with obesity, implementing adapted approaches and additional precautions to mitigate risks., La cirugía laparoscópica, aunque ampliamente utilizada y menos invasiva, presenta desafíos particulares en pacientes con obesidad. En este artículo abordaremos las complicaciones quirúrgicas mediante la técnica de laparoscopía que se podrían producir en el paciente obeso, como en el caso de pacientes ginecológicos con obesidad, se enfrentan a complicaciones como la dificultad en la visualización de estructuras debido al exceso de tejido adiposo. Además, la manipulación de instrumentos en espacios reducidos puede aumentar el riesgo de lesiones en órganos circundantes. En pacientes con colelitiasis, la obesidad puede complicar la identificación y extracción de la vesícula biliar debido a la anatomía alterada. La presencia de la Enfermedad Intestinal Inflamatoria también agrega complejidad, ya que el tejido inflamado puede obstaculizar la visualización y manipulación durante la cirugía laparoscópica. Adicionalmente, la obesidad en estos pacientes aumenta el riesgo de complicaciones postoperatorias, incluyendo infecciones y problemas respiratorios. Resulta esencial que los cirujanos ponderen minuciosamente estos factores al planificar y llevar a cabo los procedimientos laparoscópicos en pacientes con obesidad, implementando enfoques adaptados y precauciones adicionales para mitigar riesgos.

WHO tog 2009 fram en checklista för att öka patientsäkerheten i samband med operationer, SafeSurgery Checklist [SSC] eller på svenska: Checklista för säker kirurgi. Syftet med checklistan är attförebygga de risker som kan leda till vårdskador vid operationer och att förbättra operationsteametskommunikation. Detta via ett antal säkerhetsfrågor samt att alla på operationssalen presenterar sig mednamn och profession.En rad studier visar på att checklistan om den är rätt använd reducerar operationskomplikationerna.Dessvärre finns det också studier som menar att följsamheten till checklista för säker kirurgi brister.I en kartläggning på författarens arbetsplats så identifierades flera förbättringsgap. Det framkom blandannat att det i operationsteamen brister i följsamhet på flera punkter i checklistan och att det var storaskillnader i hur den genomfördes. Det visade sig också att flera professioner i mikrosystemet inte kändesig delaktiga och inkluderade när checklistan genomfördes.Författaren valde därför att genomföra ett förbättringsarbete för att få bättre följsamhet till checklistaför säker kirurgi. Förbättringsarbetet genomfördes i samband med att den ursprungliga checklistanskulle ersättas med en uppdaterad version, Checklista 2.0 framtagen av Landstingens ömsesidigaförsäkringsbolag.Med Nolans förbättringsmodell som stöd så genomfördes utbildningsdagar, workshops och dialogerunder 2020–2021. Därefter infördes Checklista 2.0 på en operationssal som ett pilottest.En majoritet av medarbetarna upplevde att de nya rutinerna förbättrat delaktigheten. Sedan november2021 så är de nya rutinerna implementerade på hela avdelningen.Under 2022 genomfördes en kvalitativ intervjustudie som undersökte operationsteamets uppfattningav vilka faktorer som påverkat följsamheten under tiden förbättringsarbetet pågick. Resultatet mynnadeut i tre teman; motivation, ledarskapets betydelse och känsla av tillhörighet.Resultatet kan användas som vägledning för framtida förbättringsarbeten och, In 2009, WHO introduced a checklist to increase patient safety during surgery, Safe Surgery Checklist[SSC]. The purpose of the checklist is to prevent risks that can lead to medical injuries during surgeryand to improve team communication.A number of studies show that the checklist, if used correctly, reduces surgical complications.Unfortunately, there are also studies that suggest that compliance with the checklist for safe surgery isinaccurate.In a survey at the author's workplace, several improvement gaps were identified. It emerged, amongother things, that there was a lack of compliance in surgery teams and there were major differences inhow the checklist was carried out. It also turned out that several professionals in the microsystem didnot feel involved and included when the checklists were conducted.The author therefore chose to carry out an improvement work to get better compliance to the SSC. Theimprovement work was carried out in connection with the original checklist being replaced with anupdated version, Checklist 2.0, developed by the County Council's mutual insurance company.With Nolan's improvement model as support, training days, workshops and dialogues were heldbetween 2020–2021. Then Checklist 2.0 was introduced in one theatre as a pilot test.A majority of the employees felt that the new routines improved participation. Since November 2021,the new routine have been implemented throughout the department.In 2022, a qualitative interview study was conducted that examined the surgical team's perception ofthe factors that affected compliance during the improvement work. The result resulted in three themes.Motivation, the importance of leadership and sense of belonging. The perception differed somewhatdepending on one's professional affiliation.The results can be used as a guide for future implementations and changes in routines. It can provide anincreased understanding that the surgical team's professions have different starting points and thereforecha

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient’s tumor size and location allow for both procedures.

PurposeTo describe an unexpected and atypical transvitreal and subretinal fibrinoid reaction following vitrectomy for non-clearing vitreous hemorrhage due to proliferative diabetic retinopathy.ObservationsA 58-year-old woman with bilateral proliferative diabetic retinopathy and non-clearing vitreous hemorrhage underwent combined phacoemulsification, intraocular lens implantation and vitrectomy in the right eye. Two months later she underwent staged phacoemulsification with intraocular lens implantation followed by vitrectomy in the left eye. The early postoperative course of each eye was complicated by choroidal effusion and submacular fibrinoid material on optical coherence tomography. The left eye also developed transvitreal fibrinoid bands.Conclusions and importanceSubretinal fibrin accumulation is a rare complication of diabetic vitrectomy. Optical coherence tomography (OCT) in the early post-operative period may assist in the recognition of this complication.

WHO tog 2009 fram en checklista för att öka patientsäkerheten i samband med operationer, SafeSurgery Checklist [SSC] eller på svenska: Checklista för säker kirurgi. Syftet med checklistan är attförebygga de risker som kan leda till vårdskador vid operationer och att förbättra operationsteametskommunikation. Detta via ett antal säkerhetsfrågor samt att alla på operationssalen presenterar sig mednamn och profession.En rad studier visar på att checklistan om den är rätt använd reducerar operationskomplikationerna.Dessvärre finns det också studier som menar att följsamheten till checklista för säker kirurgi brister.I en kartläggning på författarens arbetsplats så identifierades flera förbättringsgap. Det framkom blandannat att det i operationsteamen brister i följsamhet på flera punkter i checklistan och att det var storaskillnader i hur den genomfördes. Det visade sig också att flera professioner i mikrosystemet inte kändesig delaktiga och inkluderade när checklistan genomfördes.Författaren valde därför att genomföra ett förbättringsarbete för att få bättre följsamhet till checklistaför säker kirurgi. Förbättringsarbetet genomfördes i samband med att den ursprungliga checklistanskulle ersättas med en uppdaterad version, Checklista 2.0 framtagen av Landstingens ömsesidigaförsäkringsbolag.Med Nolans förbättringsmodell som stöd så genomfördes utbildningsdagar, workshops och dialogerunder 2020–2021. Därefter infördes Checklista 2.0 på en operationssal som ett pilottest.En majoritet av medarbetarna upplevde att de nya rutinerna förbättrat delaktigheten. Sedan november2021 så är de nya rutinerna implementerade på hela avdelningen.Under 2022 genomfördes en kvalitativ intervjustudie som undersökte operationsteamets uppfattningav vilka faktorer som påverkat följsamheten under tiden förbättringsarbetet pågick. Resultatet mynnadeut i tre teman; motivation, ledarskapets betydelse och känsla av tillhörighet.Resultatet kan användas som vägledning för framtida förbättringsarbeten och, In 2009, WHO introduced a checklist to increase patient safety during surgery, Safe Surgery Checklist[SSC]. The purpose of the checklist is to prevent risks that can lead to medical injuries during surgeryand to improve team communication.A number of studies show that the checklist, if used correctly, reduces surgical complications.Unfortunately, there are also studies that suggest that compliance with the checklist for safe surgery isinaccurate.In a survey at the author's workplace, several improvement gaps were identified. It emerged, amongother things, that there was a lack of compliance in surgery teams and there were major differences inhow the checklist was carried out. It also turned out that several professionals in the microsystem didnot feel involved and included when the checklists were conducted.The author therefore chose to carry out an improvement work to get better compliance to the SSC. Theimprovement work was carried out in connection with the original checklist being replaced with anupdated version, Checklist 2.0, developed by the County Council's mutual insurance company.With Nolan's improvement model as support, training days, workshops and dialogues were heldbetween 2020–2021. Then Checklist 2.0 was introduced in one theatre as a pilot test.A majority of the employees felt that the new routines improved participation. Since November 2021,the new routine have been implemented throughout the department.In 2022, a qualitative interview study was conducted that examined the surgical team's perception ofthe factors that affected compliance during the improvement work. The result resulted in three themes.Motivation, the importance of leadership and sense of belonging. The perception differed somewhatdepending on one's professional affiliation.The results can be used as a guide for future implementations and changes in routines. It can provide anincreased understanding that the surgical team's professions have different starting points and thereforecha

Background: Non-melanoma skin cancer (NMSC) takes up a substantial fraction of dermatological and plastic surgical outpatient visits and surgeries. NMSC develops as an accumulated exposure to UV light with the face most frequently diagnosed. Method: This retrospective study investigated the risk of complications in relation to full-thickness skin grafts (FTSG) or local flaps in 607 patients who underwent facial surgery and reconstruction at a high-volume center for facial cancer surgery at a tertiary university hospital. Results: Between 01.12.2017 and 30.11.2020, 304 patients received reconstructive flap surgery and 303 received FTSG following skin cancer removal in the face. Flap reconstruction was predominantly performed in the nasal region (78%, n = 237), whereas FTSG reconstruction was performed in the nasal (41,6%, n = 126), frontal (19.8%, n = 60), and temporal areas (19.8%, n = 60), respectively. Patients undergoing FTSGs had a significantly higher risk of hematoma (p = 0.003), partial necroses (p < 0.001), and total necroses (p < 0.001) compared to flap reconstruction. Age and sex increased the risk of major complications (hematoma, partial or total necrosis, wound dehiscence, or infection) for FTSG, revealing that men exhibited 3.72 times increased risk of major complications compared to women reconstructed with FTSG. A tumor size above 15 mm increased the risk of hematoma and necrosis significantly. In summary, local flaps for facial reconstruction after skin cancer provide lower complication rate compared with FTSGs, especially in elderly and/or male patients. The indication for FTSG should be considered critically if the patient’s tumor size and location allow for both procedures.

BACKGROUND: Although high grade gliomas largely affect older patients, current evidence on neurosurgical complications is mostly based on studies including younger study populations. We aimed to investigate the risk for postoperative complications after neurosurgery in a population-based cohort of older patients with high grade gliomas, and explore changes over time. METHODS: In this retrospective study we have used data from the Swedish Brain Tumour Registry and included patients in Sweden age 65 years or older, with surgery 1999-2017 for high grade gliomas. We analysed number of surgical procedures per year and which factors contribute to postoperative morbidity and mortality. RESULTS: The study included 1998 surgical interventions from an area representing 60% of the Swedish population. Over time, there was an increase in surgical interventions in relation to the age specific population (p < 0.001). Postoperative morbidity for 2006-2017 was 24%. Resection and not having a multifocal tumour were associated with higher risk for postoperative morbidity. Postoperative mortality for the same period was 5%. Increased age, biopsy, and poor performance status was associated with higher risk for postoperative mortality. CONCLUSIONS: This study shows an increase in surgical interventions over time, probably representing a more active treatment approach. The relatively low postoperative morbidity- and mortality-rates suggests that surgery in older patients with suspected high grade gliomas can be a feasible option. However, caution is advised in patients with poor performance status where the possible surgical intervention would be a biopsy only. Further, this study underlines the need for more standardised methods of reporting neurosurgical complications.

BACKGROUND: Meningioma is the most common primary CNS tumour. Most meningiomas are benign, and most patients are 65 years or older. Surgery is usually the primary treatment option. Most prior studies on early surgical outcomes in older patients with meningioma are small, and there is a lack of larger population-based studies to guide clinical decision-making. We aimed to explore the risks for perioperative mortality and morbidity in older patients with meningioma and to investigate changes in surgical incidence over time. METHODS: In this retrospective population-based study on patients in Sweden, 65 years or older with surgery 1999-2017 for meningioma, we used data from the Swedish Brain Tumour Registry. We analysed factors contributing to perioperative mortality and morbidity and used official demographic data to calculate yearly incidence of surgical procedures for meningioma. RESULTS: The final study cohort included 1676 patients with a 3.1% perioperative mortality and a 37.6% perioperative morbidity. In multivariate analysis, higher age showed a statistically significant association with higher perioperative mortality, whereas larger tumour size and having preoperative symptoms were associated with higher perioperative morbidity. A numerical increased rate of surgical interventions after 2012 was observed, without evidence of worsening short-term surgical outcomes. CONCLUSIONS: Higher mortality with increased age and higher morbidity risk in larger and/or symptomatic tumours imply a possible benefit from considering surgery in selected older patients with a growing meningioma before the development of tumour-related symptoms. This study further underlines the need for a standardized method of reporting and classifying complications from neurosurgery.

The study describes all patients in Denmark with vascular Ehlers–Danlos syndrome (vEDS). Carriers of pathogenic or likely pathogenic COL3A1 variants were retrospectively identified through registries and specialized clinics. Medical records were reviewed for vascular- or organ ruptures and invasive procedures performed. Identified families were divided by variant type (null, splice, and missense) and familial phenotypes (severe or attenuated). Families in which at least one carrier has suffered a major event before the age of 30 were classified as severe, whereas families in which at least three carriers had reached the age of 40 without a major event were classified as attenuated. Eighty-seven persons (59 still alive) from 25 families were included with a mean observation time of 44 years. Sixty-seven percent of patients could be subclassified in a familial phenotype. Thirty-one major events were observed. Eleven complications in 172 invasive procedures were recorded. No fatal complications to elective surgery were observed. The type of COL3A1 variant did not reliably predict phenotype, but a pattern of intrafamilial consistency emerged with some families showing an attenuated form of vEDS. Elective medical procedures appear to be safer than previously thought, although data only allow for conclusions regarding individuals from families with the attenuated form of vEDS.

The study describes all patients in Denmark with vascular Ehlers–Danlos syndrome (vEDS). Carriers of pathogenic or likely pathogenic COL3A1 variants were retrospectively identified through registries and specialized clinics. Medical records were reviewed for vascular- or organ ruptures and invasive procedures performed. Identified families were divided by variant type (null, splice, and missense) and familial phenotypes (severe or attenuated). Families in which at least one carrier has suffered a major event before the age of 30 were classified as severe, whereas families in which at least three carriers had reached the age of 40 without a major event were classified as attenuated. Eighty-seven persons (59 still alive) from 25 families were included with a mean observation time of 44 years. Sixty-seven percent of patients could be subclassified in a familial phenotype. Thirty-one major events were observed. Eleven complications in 172 invasive procedures were recorded. No fatal complications to elective surgery were observed. The type of COL3A1 variant did not reliably predict phenotype, but a pattern of intrafamilial consistency emerged with some families showing an attenuated form of vEDS. Elective medical procedures appear to be safer than previously thought, although data only allow for conclusions regarding individuals from families with the attenuated form of vEDS.

BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experi

Acute neurologic deficits in the postoperative period after carotid endarterectomy (CEA) can prompt extensive diagnostic evaluation. Reversible cerebral vasoconstriction syndrome (RCVS) is an underrecognized cause of acute neurologic deficit after CEA. We present the case of RCVS in an 84-year-old male patient who had experienced left limb weakness after CEA, prompting multiple code stroke activations. The present case is novel because the obtained computed tomography perfusion imaging studies demonstrated abnormalities that have not been previously described in patients with RCVS. These findings, combined with the cerebral angiography findings, led to the rapid diagnosis and delivery of intra-arterial vasodilator therapy. He experienced subsequent resolution of his symptoms and radiologic abnormalities.

Introduction: Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown.Methods: This retrospective study evaluates colorectal cancer patients >_70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 <_ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated.Results: 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 <_ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST >_1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 <_ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%.Conclusion: Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications. (c) 2020 Elsevier Ltd. All rights reserved.

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health. Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery. Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery. Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, Oregelbunden paginering.

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health. Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery. Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery. Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, Oregelbunden paginering.

Acute neurologic deficits in the postoperative period after carotid endarterectomy (CEA) can prompt extensive diagnostic evaluation. Reversible cerebral vasoconstriction syndrome (RCVS) is an underrecognized cause of acute neurologic deficit after CEA. We present the case of RCVS in an 84-year-old male patient who had experienced left limb weakness after CEA, prompting multiple code stroke activations. The present case is novel because the obtained computed tomography perfusion imaging studies demonstrated abnormalities that have not been previously described in patients with RCVS. These findings, combined with the cerebral angiography findings, led to the rapid diagnosis and delivery of intra-arterial vasodilator therapy. He experienced subsequent resolution of his symptoms and radiologic abnormalities.

Bilateral Tessier type 4 craniofacial clefts are extremely rare and disfiguring malformations with vision-threatening ramifications. To date, there is no consensus in the literature with respect to the ideal surgical technique and management of these patients. Emergent eyelid reconstruction and additional procedures may be required to protect the cornea and avoid further ophthalmic and surgical complications. We present our experience and challenges of managing a case of bilateral Tessier type 4 clefting with an emphasis on oculoplastic considerations.

BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experi

BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experi

BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experi

[Background] There are limited data on toxicity and surgical safety associated with neoadjuvant programmed death ligand 1 (PD-L1) inhibitors prior to radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC)., [Objective] To present a comprehensive safety analysis of the largest neoadjuvant series, with focus on timing and severity of toxicity and surgical complications occurring after neoadjuvant atezolizumab in patients with MIBC enrolled in the ABACUS trial., [Design, setting, and participants] ABACUS (NCT02662309) is an open-label, multicenter, phase II trial for patients with histologically confirmed (T2-T4aN0M0) MIBC, awaiting RC. Patients either were ineligible or refused cisplatin-based neoadjuvant chemotherapy., [Intervention] Two cycles of neoadjuvant atezolizumab (1200 mg, every 3 wk) followed by RC., [Outcome measurements and statistical analysis] Description of atezolizumab toxicity profile in the neoadjuvant setting, impact on surgery, and delayed immune-mediated adverse events (AEs) were assessed., [Results and limitations] Ninety-five patients received treatment. Of them, 44% (42/95) had atezolizumab-related AEs during the neoadjuvant period (fatigue [20%], decreased appetite [6%], and transaminases increased [6%]). Treatment-related grade 3–5 AEs occurred in 11% (10/95) of patients during the study. Of the patients, 21% (20/95) received only one cycle of atezolizumab due to AEs; 92% (87/95) underwent RC. No surgery was delayed due to atezolizumab-related toxicities. Surgical complications occurred in 62% (54/87) of patients. Of these patients, 43% (37/87) and 20% (17/87) had minor (grade 1–2) and major (grade 3–5) complications, respectively. Thirteen of 87 (15%) patients had post-RC atezolizumab-related AEs, including adrenal insufficiency and transaminases increased. Three deaths occurred during the period of study-related interventions (one non–treatment-related aspiration pneumonia, one immune-related myocardial infarction, and one cardiogenic shock after RC). Not all surgical safety parameters were available., [Conclusions] Two cycles of neoadjuvant atezolizumab are well tolerated and do not seem to impact surgical complication rates. Owing to the long half-life, AEs may occur in the postoperative period, including endocrine abnormalities requiring attention and intervention., [Patient summary] Here, we report a comprehensive dataset of patients receiving neoadjuvant immune checkpoint inhibitors before radical cystectomy. Treatment with neoadjuvant atezolizumab is safe and does not seem to complicate surgery significantly.

Introduction: Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown.Methods: This retrospective study evaluates colorectal cancer patients >_70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 <_ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated.Results: 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 <_ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST >_1 m/s (respectively 62% versus 28%,p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 <_ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%.Conclusion: Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications. (c) 2020 Elsevier Ltd. All rights reserved.

Background: For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. Methods: All patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression. Results: 564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications. Conclusions: Complications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.

Background: For colorectal liver metastases, surgery is a high-risk procedure due to perioperative morbidity. The objective was to assess severity of complications after fast-track liver surgery for colorectal liver metastases and their impact on morbidity and mortality. Methods: All patients were treated according to the same fast-track programme. Complications were graded according to the Clavien–Dindo classification for patients undergoing surgery from 2013 to 2015. Correlation between complications and length of stay was analysed by multivariate linear regression. Results: 564 patient cases were included of which three patients died within 3 months (0.53%, 95% CI: 0.17–1.64%). Complications were common with Grade ≤ 2 in 167 patients (30%) and ≥ Grade 3a in 93 (16%). Patients without complications had a mean length of stay of 4.1 days, which increased with complications: 1.4 days (95% CI: 1.3–1.5) for Grade 2, 1.7 days (1.5–2.0) for Grade 3a, 2.3 days (1.7–3.0) for Grade 3b, 2.6 days (1.6–4.2) for Grade 4a, and 2.9 days (2.8–3.1) for Grade 4b. Following were associated with increased length of stay: complication severity grade, liver insufficiency, ascites, biliary, cardiopulmonary, and infectious complications. Conclusions: Complications after liver surgery for colorectal liver metastases, in a fast track setting, were associated with low mortality, and even severe complications only prolonged length of stay to a minor degree.

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health. Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery. Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery. Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, Oregelbunden paginering.

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health. Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery. Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery. Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, Oregelbunden paginering.

Background: Obstetric anal sphincter injuries (OASIS) after vaginal delivery are the most common cause of anal incontinence in women. Symptoms range from faecal urgency and soiling to inability to control flatus and passive faecal incontinence. OASIS are also associated with urinary incontinence, perineal pain, and sexual dysfunction. Apart from being a challenge to diagnose and treat, these conditions often result in social stigma and embarrassment, and in many cases have a great impact on emotional and physical health. Caesarean section has developed over several hundred years, from a procedure with 100 % mortality for both mother and child, to routine surgery that is rapidly increasing in many countries. However, both caesarean section and vaginal delivery are associated with complications that can affect the woman for the rest of her life. The aim of this thesis was primarily to investigate surgical complications after delivery. Methods: Papers I-III were population-based cohort-studies utilising national registries to examine the risk for anal incontinence, cardiovascular complications, and other surgical complications such as bowel obstruction, incisional hernia, and abdominal pain. Paper IV was a diagnostic cohort study comparing the traditional clinical method using inspection and palpation, to a new method with three-dimensional endoanal ultrasound (3D-EAUS) to diagnose anal sphincter injuries after delivery. Results: The risk for being diagnosed with anal incontinence after vaginal delivery was almost twice that after caesarean section. On the other hand, caesarean section was associated with a greater risk for serious cardiovascular complications, bowel obstruction, and incisional hernia. High maternal age, overweight and smoking were all risk factors for complications. Instrumental delivery, in particular, increased the risk for anal incontinence. In Study IV, more sphincter injuries were diagnosed using the 3D-EAUS than by clinical examination. However, Oregelbunden paginering.

BACKGROUND & AIMS: This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). METHODS: A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). RESULTS: Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD -16, 95% CI: -27 to -4) and social function (MD -17, 95% CI: -32 to -3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD -27, 95% CI: -47 to -7) and emotional function (MD -24, 95% CI: -47 to -2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. CONCLUSIONS: Patients who have undergone curative treatment for oesophageal cancer experi

Background and Aims: Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10-20 esophagectomies annually) with focus on surgical results. Material and Methods: Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007-2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders. Results: One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13-23) vs 12 (8-16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11-8.98, p = 0.032). Conclusion: The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.

At present, surgical site infections (SSI) persist as key clinical problems, being one of the most important causes of intra-hospitalary morbidity and mortality, with a high prevalence. In addition, SSI constitute a heavy economic burden for health services, due to their high frequency, their tendency towards a chronic course and complications, and their high mortality. SSI also represent an important limiting factor for patients’ daily functioning and their capacity for autonomy and inde-pendence. This article discusses risk factors for SSI and ex-plores preventive measures for them. Recognition of the risk factors for SSI facilitates their identification in practice, and therefore their pertinent and opportune modification, as well as individualized stratification of each case in regards to risk level. These factors may be related to characteristics of the patients or the surgical procedure itself, and encompass tens of components between both categories. Abundant unknowns remain surrounding SSI in both clinical and epidemiological aspects, which may explain their persistence as frequent and relevant problems in contemporary practice. Concretely, fur-ther epidemiological characterization of SSI is required, as well as research on the true efficacy of the large catalogue of preventive measures that have been proposed historically. Moreover, it is also important to examine the cost-effectivity of these interventions, in light of the economic impact SSI exert worldwide.

Background: In earlier studies an association between older patients and higher morbidity and mortality after colorectal surgery is shown, especially in the first postoperative year. We conducted this study to investigate if there is improvement in postoperative morbidity and mortality in senior CRC patients over time.Materials and methods: All patients, except those with distant metastasis, who received curative CRC surgery between 2006 and 2017 in the Catharina Hospital (Eindhoven, the Netherlands) were selected retrospectively. Differences in mortality and relative survival between different age groups (= 75 years), period of surgery (2006-2012 and 2013-2017) and type of tumor (colon and rectum) were investigated.Results: In total 2018 patients, of whom 57.4% is male, were selected (n = 1037 colon and n = 981 rectum). 615 (30.5%) patients were >= 75 years old. For electively treated CRC patients aged >= 75 years 30-and 90-day mortality improved from 5.8% to 1.2% (p = 0.004) and 9.1% to 4.6% (p = 0.043) respectively, in favour of the latest time period. Relative one-year survival rates of all electively treated CRC patients were not significantly different between younger and older patients in the latest time period (95.5% vs. 94.3%, p = n.s.)Conclusions: This study shows significant improvement in postoperative morbidity and mortality over time for both age and treatment groups. Relative survival rates improved especially for older patients and no significant differences were seen between both age groups. Senior CRC patients should not be withheld curative treatment based on age or comorbidities alone. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Background/Aims: To investigate the relation between skeletal muscle measurements (muscle mass, radiation attenuation, and sarcopenic obesity), postoperative morbidity, and survival after treatment of locally advanced rectal cancer. Methods: This explorative retrospective study identified 99 consecutive patients who underwent neoadjuvant chemoradiation and surgery between January 2007 and May 2012. Skeletal muscle mass was measured as total psoas area and total abdominal muscle area (TAMA) at 3 anatomical levels using the patient's preoperative computed tomography scan. Radiation attenuation was measured using corresponding mean Hounsfield units for TAMA. Sarcopenic obesity was defined as body mass index above 25 kg.m(-2) combined with skeletal muscle mass index below the sex-specific median. Postoperative complications were graded by using the Clavien-Dindo classification. Results: Twenty-five patients (25.3%) developed a grade 3-5 complication. Lower radiation attenuation was independently associated with overall (p = 0.003) and grade 3-5 complications (p = 0.002). Sarcopenic obesity was associated with overall complications (all p <0.05). Skeletal muscle measurements and survival were not significantly related. Conclusion: Radiation attenuation was associated with overall and grade 3-5 postoperative morbidity after neoadjuvant chemoradiation and non-laparoscopic resection for rectal cancer. Sarcopenic obesity was associated with overall complications. (C) 2018 S. Karger AG, Basel

Background: In earlier studies an association between older patients and higher morbidity and mortality after colorectal surgery is shown, especially in the first postoperative year. We conducted this study to investigate if there is improvement in postoperative morbidity and mortality in senior CRC patients over time.Materials and methods: All patients, except those with distant metastasis, who received curative CRC surgery between 2006 and 2017 in the Catharina Hospital (Eindhoven, the Netherlands) were selected retrospectively. Differences in mortality and relative survival between different age groups (= 75 years), period of surgery (2006-2012 and 2013-2017) and type of tumor (colon and rectum) were investigated.Results: In total 2018 patients, of whom 57.4% is male, were selected (n = 1037 colon and n = 981 rectum). 615 (30.5%) patients were >= 75 years old. For electively treated CRC patients aged >= 75 years 30-and 90-day mortality improved from 5.8% to 1.2% (p = 0.004) and 9.1% to 4.6% (p = 0.043) respectively, in favour of the latest time period. Relative one-year survival rates of all electively treated CRC patients were not significantly different between younger and older patients in the latest time period (95.5% vs. 94.3%, p = n.s.)Conclusions: This study shows significant improvement in postoperative morbidity and mortality over time for both age and treatment groups. Relative survival rates improved especially for older patients and no significant differences were seen between both age groups. Senior CRC patients should not be withheld curative treatment based on age or comorbidities alone. (C) 2019 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Background/Aims: To investigate the relation between skeletal muscle measurements (muscle mass, radiation attenuation, and sarcopenic obesity), postoperative morbidity, and survival after treatment of locally advanced rectal cancer. Methods: This explorative retrospective study identified 99 consecutive patients who underwent neoadjuvant chemoradiation and surgery between January 2007 and May 2012. Skeletal muscle mass was measured as total psoas area and total abdominal muscle area (TAMA) at 3 anatomical levels using the patient's preoperative computed tomography scan. Radiation attenuation was measured using corresponding mean Hounsfield units for TAMA. Sarcopenic obesity was defined as body mass index above 25 kg.m(-2) combined with skeletal muscle mass index below the sex-specific median. Postoperative complications were graded by using the Clavien-Dindo classification. Results: Twenty-five patients (25.3%) developed a grade 3-5 complication. Lower radiation attenuation was independently associated with overall (p = 0.003) and grade 3-5 complications (p = 0.002). Sarcopenic obesity was associated with overall complications (all p <0.05). Skeletal muscle measurements and survival were not significantly related. Conclusion: Radiation attenuation was associated with overall and grade 3-5 postoperative morbidity after neoadjuvant chemoradiation and non-laparoscopic resection for rectal cancer. Sarcopenic obesity was associated with overall complications. (C) 2018 S. Karger AG, Basel

Introduction The fully endoscopic expanded endonasal approach (EEA) has been shown to be safe and efficacious in pediatric patients. However, in the very young patient (ages six and under), the anatomical challenge of working through a small nasal corridor is problematic. The ability to repair the skull base and use a nasoseptal flap (NSF) has also been called into question. Here, we review skull base resections using EEA in patients aged 6 years and younger. Methods A retrospective chart review was conducted on pediatric patients age 6 years and younger who underwent EEA skull base resections over a 3-year period (June 2014 through June 2017). Results Eight children aged 6 and under with seven tumor pathologies underwent an EEA for the resection of their skull base tumors, with a mean follow-up of 1.45 years. Only chordoma cases required multiple-staged resections. There are no tumor recurrences to date. A high-flow intraoperative cerebrospinal fluid (CSF) leak was encountered in three cases, and there were no postoperative CSF leaks. CSF leaks were effectively repaired with NSFs. One patient suffered from postoperative hypopituitarism, one patient experienced recurrent epistaxis secondary to turbinate destruction by the tumor, and one patient expired 8 months postresection secondary to metastatic disease. Conclusion In our case series, EEA for skull base tumors in children aged 6 and under was a safe and effective surgical approach. Skull base defects are able to be effectively addressed with typical repairs including NSFs. Larger studies are warranted to further investigate this technique in this pediatric population.

Las roturas del tendón de Aquiles han aumentado considerablemente en los últimos años. El tratamiento de estas lesiones puede ser conservador o quirúrgico. Pese a la vasta literatura, no existe un “patrón de referencia” para el tratamiento de estas lesiones. Las opciones quirúrgicas incluyen la cirugía abierta, mini-invasiva y técnica percutánea. El objetivo de este estudio fue caracterizar la presentación clínica y mostrar los resultados quirúrgicos y las complicaciones en pacientes con rotura del tendón de Aquiles tratados con técnica percutánea. Materiales y Métodos: Se realizó un estudio descriptivo retrospectivo. Se incluyeron pacientes adultos y se obtuvieron datos clínicos y epidemiológicos. Todos fueron operados con técnica percutánea con raquetas de Dresden. Resultados: Se incluyó a 60 pacientes. Todos tenían dolor y el 92% presentaba también signo de Thompson y brecha palpable. A 7 pacientes (12%) se les solicitaron imágenes complementarias. El tiempo promedio hasta la cirugía fue de 4.28 días. Siete pacientes sufrieron complicaciones posoperatorias menores. Conclusiones: Las roturas del tendón de Aquiles son una patología prevalente en la población activa de mayor edad y en deportistas de fin de semana. El diagnóstico es clínico; sin embargo, algunos pacientes pueden requerir imágenes complementarias para el diagnóstico. La evidencia nos demuestra que el tratamiento quirúrgico es superior al tratamiento conservador clásico. En comparación con la técnica abierta, la técnica percutánea logra mejores resultados estéticos y menos complicaciones., Introduction: Achilles tendon ruptures have increased considerably in recent years. Treatment of these lesions can be either conservative or surgical. Despite extensive literature, no gold standard exists. Surgical options include open surgery, mini-open surgery and percutaneous technique. The objective of this study was to characterize the clinical presentation and to report surgical results and complications in patients with ruptured Achilles tendon treated surgically with percutaneous technique. Methods: A retrospective descriptive study was carried out. Adult patients were included, and clinical and epidemiological data were obtained. All patients were operated on with percutaneous technique using the Dresden Instrument. Results: Sixty patients were enrolled. All presented pain, and 92% had also associated Thompson’s sign and palpable gap. Complementary images were requested in 7 patients (12%). Average time until surgery was 4.28 days. Seven patients presented minor post-operative complications. Conclusions: Achilles tendon ruptures are a prevalent pathology in older active population and weekend athletes. Diagnosis is mostly clinical; however, some patients may require complementary images for diagnosis. Strong evidence in the literature suggests that surgical treatment is superior to the classic conservative treatment. In comparison with open surgery, percutaneous technique has shown better aesthetic results and fewer complications.

Introduction: Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. Methods: A pre-planned analysis of the European Society of Coloproctology 2017 audit. Adult patients (> 16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic or rectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindo grade 3 to 5). Results: From 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). In multivariable models, anastomosis was associated with a similar major complication rate to end stoma (adjusted odds ratio for end stoma 1.52, 95%CI 0.83–2.79, P = 0.173). Although a defunctioning stoma was not associated with reduced anastomotic leak (12% defunctioned [4/33] vs 13% not defunctioned [13/97], adjusted odds ratio 2.19, 95%CI 0.43–11.02, P = 0.343), it was associated with less severe complications (75% [3/4] with defunctioning stoma, 86.7% anastomosis only [13/15]), a lower mortality rate (0% [0/4] vs 20% [3/15]), and fewer reoperations (50% [2/4] vs 73% [11/15]) when a leak did occur. Conclusions: Primary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.