Search

Abstract To assess the response to monocular occlusion test in basic type intermittent exotropia (IXT) and to evaluate the surgical outcomes of titrated surgery based on the test’s result. Medical records were retrospectively reviewed for patients who underwent bilateral lateral rectus recession for basic type IXT. Patients were categorized into two groups: those who underwent a preoperative diagnostic monocular occlusion test (occlusion group) and those who did not (no occlusion group). In the occlusion group, patients exhibiting a change in deviation angle of ≥ 5 prism diopters (PD), either at distance or near fixation following occlusion therapy, were classified as responders, and augmented surgery was performed for patients with an increased deviation. A total of 215 patients were included in this study, with 79 patients (36.7%) in the no occlusion group and 136 patients (63.3%) in the occlusion group. In the occlusion group, while the mean distance deviation did not significantly change, the mean near deviation significantly increased from 27.2 ± 7.7 PD to 32.5 ± 8.6 PD after diagnostic monocular occlusion (p

Objectives: The general concern about low back pain (LBP) necessitates thoroughly examining its various causes and feasible therapies. The current study investigated the causes and surgical treatments of back pain by tailoring treatments to the patient’s specific needs. Methods: Two hundred individuals with LBP have been enrolled in this cross-sectional research. The radiological, magnetic resonance imaging (MRI) images and clinical evaluations were completed by neurosurgeons and used to categorize the selected patients from those attending neurosurgical outpatient clinics. Multiple causes of LBP, including disk prolapse, spinal stenosis, and muscular spasms, were investigated. Detailed descriptions of surgical approaches for various stages of disk prolapse and stenosis were given to help decide the optimal surgical tactics. The data were compiled into an Excel sheet, and the percentages and numbers were sorted and computed appropriately. Results: The data present an extensive overview of the distribution pattern of back pain causes, disk prolapse, and spinal stenosis in the study community, along with the surgical procedures employed. Muscle spasms, disk prolapse, and spinal stenosis are the main causes of back pain (20%, 40%, and 13%, respectively). L5 and S1 are the most commonly involved in single-level disk prolapse (10%). Different spinal levels may have varying percentages of multiple-level disk prolapse (20%). There are multiple lumbar levels where spinal stenosis can occur, but the most common are L4 and L5 (20%). Distinct surgical approaches are employed for disk prolapse and stenosis at various levels of the spine, and the most frequent intervention was laminectomy in about 39% of total participants. Discussion: The study’s results demonstrate the complexity of the etiologies of back pain and the need for advanced surgical techniques. Particular emphasis is concentrated on spinal stenosis, including single- and multiple-level disk prolapse, and the relationship between surgical methods and causes. The study’s thorough comprehension is essential for tailored interventions based on patient traits, ultimately enhancing therapy and patient care.

Abstract To examine the influence of Body Mass Index (BMI) on laparoscopic gastrectomy (LG) short-term and long-term outcomes for gastric cancer. A retrospective analysis was conducted on gastric cancer patients undergoing LG at the Third Hospital of Nanchang City from January 2013 to January 2022. Based on WHO BMI standards, patients were categorized into normal weight, overweight, and obese groups. Factors such as operative time, intraoperative blood loss, postoperative complications, and overall survival were assessed. Across different BMI groups, it was found that an increase in BMI was associated with longer operative times (average times: 206.22 min for normal weight, 231.32 min for overweight, and 246.78 min for obese), with no significant differences noted in intraoperative blood loss, postoperative complications, or long-term survival among the groups. The impact of BMI on long-term survival following LG for gastric cancer was found to be insignificant, with no notable differences in survival outcome between different BMI groups. Although higher BMI is associated with increased operative time in LG for gastric cancer, it does not significantly affect intraoperative blood loss, postoperative complications, recovery, or long-term survival. LG is a feasible treatment choice for obese patients with gastric cancer.

Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes. Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs. Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy. Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798). Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.

Enhanced Recovery After Surgery (ERAS) protocols are a set of evidence-based guidelines designed to improve surgical outcomes by optimizing perioperative care. This approach integrates multidisciplinary strategies to reduce postoperative complications, shorten hospital stays, and enhance overall patient recovery. This article provides a comprehensive review of the advancements in ERAS protocols, including multimodal analgesia, optimized fluid management, early mobilization, and postoperative care. It also addresses the implementation challenges faced by healthcare systems, such as variability in adherence, resource constraints, and the need for interdisciplinary collaboration. By examining current evidence and real-world applications, this article highlights the potential benefits and obstacles of ERAS protocols, offering insights for future improvements and wider adoption.

Abstract We aimed to evaluate the association between inflammation-based prognostic markers and mortality after hip replacement. From March 2010 to June 2020, we identified 5,369 consecutive adult patients undergoing hip replacement with C-reactive protein (CRP), albumin, and complete blood count measured within six months before surgery. Receiver operating characteristic (ROC) curves were generated to evaluate predictabilities and estimate thresholds of CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Patients were divided according to threshold, and mortality risk was compared. The primary outcome was one-year mortality, and overall mortality was also analyzed. One-year mortality was 2.9%. Receiver operating characteristics analysis revealed areas under the curve of 0.838, 0.832, 0.701, and 0.732 for CAR, NLR, PLR, and modified Glasgow Prognostic Score, respectively. The estimated thresholds were 2.10, 3.16, and 11.77 for CAR, NLR, and PLR, respectively. According to the estimated threshold, high CAR and NLR were associated with higher one-year mortality after adjustment (1.0% vs. 11.7%; HR = 2.16; 95% CI 1.32–3.52; p = 0.002 for CAR and 0.8% vs. 9.6%; HR = 2.05; 95% CI 1.24–3.39; p = 0.01 for NLR), but PLR did not show a significant mortality increase (1.4% vs. 7.4%; HR = 1.12; 95% CI 0.77–1.63; p = 0.57). Our study demonstrated associations of preoperative levels of CAR and NLR with postoperative mortality in patients undergoing hip replacement. Our findings may be helpful in predicting mortality in patients undergoing hip replacement.

Introduction: Tibial shaft fractures pose a significant challenge in orthopaedic practice, often necessitating surgical intervention for optimal recovery. The selection of the entry point for intramedullary nailing, particularly between the suprapatellar and infrapatellar approaches, remains a debated aspect in fracture management. While both approaches aim to restore stability and function, their nuances influence outcomes and patient experiences. This study aims to comprehensively compare the suprapatellar and infrapatellar approaches, analyzing surgical techniques, complications, and functional outcomes to inform clinical decision-making. Methodology: A retrospective comparative analysis was conducted on patients undergoing intramedullary nailing for tibial shaft fractures, comparing outcomes between the suprapatellar and infrapatellar approaches. Data collection included patient demographics, fracture characteristics, intraoperative details, and postoperative outcomes. Statistical analysis was performed using appropriate tests, with a significance level set at p < 0.05. Result: Operative time was longer in the infrapatellar group (137.8 minutes) compared to the suprapatellar group (114.4 minutes). The mean radiation dose was higher in the infrapatellar group (74.3 cGY/cm2) and lower in the suprapatellar group (48.5 cGY/cm2). Postoperative outcomes showed a mean Lysholm score of 74 in the infrapatellar group and 90 in the suprapatellar group. one case of infection and one case of malunion were reported in the infrapatellar group, while the suprapatellar group had one infection case but no instances of non-union or malunion. Conclusion: This study provides valuable insights into the surgical and clinical outcomes of the suprapatellar and infrapatellar approaches for tibial shaft fractures. While both techniques offer viable options, the suprapatellar approach may offer advantages in terms of operative efficiency and functional recovery.

Introduction: Knee joint problems, such as Osteoarthritis (OA), primarily affect the upper weight-bearing end of the tibia. Total and unicompartmental knee arthroplasty are commonly performed as treatment options. However, existing studies on morphometric assessment of the knee joint mainly focus on the Western population, with a lack of data among the Indian population. Obtaining such data is crucial for designing tibial components of knee prostheses tailored to the Indian population. Aim: To compare the morphometric data of the upper end of the tibia between the North and East Indian populations. Materials and Methods: A cross-sectional observational study was conducted in the Department of Anatomy at FMHS Medical College, SGT University, Gurugram, Haryana, North India, involving 41 dry tibias, and at Medical College and Hospital Kolkata in East India, involving 43 dry tibias. Measurements of the Anteroposterior (AP) and Transverse Diameters (TD) of the Medial Tibial Condyle (MTC), Lateral Tibial Condyle (LTC), and Total Tibial Condyles (TTC) were performed using digital Vernier callipers with a least count of 0.01 mm. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) (version 21.0), and Student’s t-test was applied, with p

Abstract Purpose Unusual grafts, including extended left liver plus caudate lobe, right anterior section, and right posterior section grafts, are alternatives to left and right lobe grafts for living-donor liver transplantation. This study aimed to investigate unusual grafts from the perspectives of recipients and donors. Methods From 2016 to 2021, 497 patients received living-donor liver transplantation at Severance Hospital. Among them, 10 patients received unusual grafts. Three patients received extended left liver plus caudate lobe grafts, two patients received right anterior section grafts, and five patients received right posterior section grafts. Liver volumetrics and anatomy were analyzed for all recipients and donors. We collected data on laboratory examinations (alanine aminotransferase, total bilirubin, international normalized ratio), imaging studies, graft survival, and complications. A 1:2 ratio propensity-score matching method was used to reduce selection bias and balance variables between the unusual and conventional graft groups. Results The median of Model for End-stage Liver Disease score of unusual graft recipients was 13.5 (interquartile range 11.5–19.3) and that of graft–recipient weight ratio was 0.767 (0.7–0.9). ABO incompatibility was observed in four cases. The alanine aminotransferase level, total bilirubin level, and international normalized ratio decreased in both recipients and donors. Unusual and conventional grafts had similar survival rates (p = 0.492). The right and left subgroups did not differ from each counter-conventional subgroup (p = 0.339 and p = 0.695, respectively). The incidence of major complications was not significantly different between unusual and conventional graft recipients (p = 0.513). Wound seromas were reported by unusual graft donors; the complication ratio was similar to that in conventional graft donors (p = 0.169). Conclusion Although unusual grafts require a complex indication, they may show feasible surgical outcomes for recipients with an acceptable donor complication.

Introduction: Transsphenoidal resection of pituitary tumours presents challenges for an anaesthesiologist due to haemodynamic fluctuations caused by intense nociceptive stimuli during different surgical stages. This relatively short procedure requires a smooth and rapid emergence for spontaneous airway control and assessment of surgical outcomes. Therefore, the chosen anaesthetic agent should provide effective haemodynamic control and facilitate rapid recovery. Alpha-2 agonists such as dexmedetomidine and clonidine are known to centrally decrease noradrenaline release, thus reducing sympathetic outflow. This could be particularly beneficial in minimising haemodynamic fluctuations during such surgeries. Aim: To compare the effects of preoperative clonidine and perioperative dexmedetomidine in attenuating haemodynamic responses and blood loss in patients undergoing elective Transnasal Transsphenoidal resection (TNTS) of pituitary tumours. Materials and Methods: A randomised, double-blinded study was conducted in the Department of Neuroanesthesiology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, over a period of one year, from February 2022 to January 2023. Sixty patients of either sex, aged 18-65 years with ASA I or II, scheduled for elective TNTS pituitary surgery, were enrolled and divided into group A and group B. Group A received clonidine tablets (3 mcg/kg) 180 minutes prior to surgery, while group B received intravenous (i.v.) infusion of dexmedetomidine (1 mcg/kg/min) over 10 minutes before induction, followed by 0.5-0.7 mcg/kg/hr. Group A received a placebo of 0.9% Normal Saline (NS) (50 mL). Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were recorded at baseline, intubation, nasal pack insertion, endoscope insertion, and at various time intervals. Data obtained were analysed using unpaired sample t-test for independent groups, and Chi-square test was used for categorical data. A probability value of 0.05 was considered significant for both statistical tests. Results: The mean age of participants was 42±11 years for group A and 43±12 years for group B, with a male: female ratio of 66.6% to 33.3% in group A and 70% to 30% in group B, respectively. The mean Body Mass Index (BMI) was 26.4±3.2 in group A and 25.2±1.7 in group B. HR, SBP, and MAP decreased at various stages in group B compared to group A, and these differences were statistically significant (p-value

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. PCNL is the treatment of choice for renal stones ≥2 cm. Aims and Objectives: Our aim is to observe the various surgical outcomes of different types of PCNL. Materials and Methods: It is an observational study conducted in our institute a total of 160 pts of renal stone disease who presented to the outpatient department were included in the study. All patients underwent PCNL either in supine or prone position. The parameters such as stone free rate, body mass index (BMI), stone size, operative time, length of stay (LOS), in hospital, and complications were observed. Results: There were no significant differences in stone size between supine and prone PCNL patients. The supine group had a higher mean BMI, shorter mean surgical time, shorter mean LOS, and higher stone free rate. Prone PCNL patients had a higher rate of overall complications. Conclusion: PCNL is one of the best modalities for renal stones management, with supine and modified supine PCNL demonstrating better results in obese patients, and may be considered by all surgeons performing PCNLs.

Abstract Purpose The burden of the coronavirus disease of 2019 (COVID-19) pandemic on the healthcare sector has been overwhelming, leading to drastic changes in access to healthcare for the public. We aimed to establish the impact of implemented government partial and complete lockdown policies on the volume of surgical patient admissions at a tertiary referral center during the pandemic. Methods A database was retrospectively created from records of patients admitted to the surgical ward through the emergency department. Three 6-week periods were examined: The complete lockdown period (CLP), which included a ban on the use of cars with the exception of health service providers and essential sector workers; A pre-COVID period (PCP) 1 year earlier (no lockdown); and a partial lockdown period (PLP) that involved a comprehensive curfew and implementing social distancing regulations and wear of personal protective equipment (e.g., masks) in public places. Results The number of patients admitted to the surgery ward was significantly higher in the PCP cohort compared to the CLP and PLP cohorts (p = 0.009), with a 42.1% and 37% decline in patients’ admissions, respectively. Admission rates for patients with biliary pathologies and vascular thrombotic events increased. 30-day mortality rates did not differ significantly between the three periods (p = 0.378). Conclusions While COVID-19 lockdown regulations had a significant impact on patient admission rates, surgical outcomes were not affected and the standards of care were maintained. Future protocols should strive to improve access to healthcare to avoid complications caused by delayed diagnosis and treatment.

ABSTRACT Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission – the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients’ remission rates.

Abstract Background The effectiveness of laparoscopic total gastrectomy with D2 lymphadenectomy (LTGD2) remains controversial. This meta-analysis compares surgical and survival outcomes of LTGD2 and open total gastrectomy with D2 lymphadenectomy (OTGD2) for gastric cancer. Methods Controlled studies comparing LTGD2 and OTGD2 published before November 2021 were retrieved via database searches. We compared intraoperative outcomes, pathological data, postoperative outcomes, 5-year disease-free survival (DFS), and overall survival (OS). Results 17 studies were included, containing 4742 patients. Compared with OTGD2, the LTGD2 group had less blood loss (mean difference [MD] = − 122.48; 95% CI: − 187.60, − 57.37; P = 0.0002), fewer analgesic medication (MD = -2.48; 95% CI: − 2.69, − 2.27; P

Higher rates of postoperative complications have been found in preoperative chronic steroid users. However, the effects of preoperative chronic steroid use on outcomes in orthopedic surgery were unclear. We performed a systematic review of cohort studies examining the effects of chronic steroid use on postoperative outcomes following orthopedic surgery and searched PubMed, Embase, and CENTRAL through 29 April 2023. We included 17 studies with 1,546,562 patients. No increase in 30-day mortality (adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 0.64–3.09) and composite thromboembolic events (aOR 1.61, 95% CI 0.99–2.63) but increases in 30-day overall complications (aOR 1.42, 95% CI 1.16–1.75), wound dehiscence (aOR 2.91, 95% CI 1.49–5.66), infectious complications (any infection (aOR 1.61, 95% CI 1.44–1.80), sepsis (aOR 2.07, 95% CI 1.34–3.21), superficial surgical site infection (SSI) (aOR 1.73, 95% CI 1.03–2.89) and deep SSI (aOR 1.96, 95% CI 1.26–3.05)), re-admission (aOR 1.62, 95% CI 1.48–1.77), both 30-day (aOR 1.28, 95% CI 1.03–1.59) and 1-year re-operation (aOR 1.78, 95% CI 1.09–2.92), pulmonary embolism (aOR 5.94, 95% CI 1.52–23.29), and deep vein thrombosis (aOR 2.07, 95% CI 1.24–3.46) were detected in preoperative steroid users. An increased risk of adverse outcomes following orthopedic surgery in chronic steroid users was found.

Background : We evaluated our early experience of cardiac procedures in children with congenital heart defects (CHD) after asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to understand whether recent reverse transcription-polymerase chain reaction (RT-PCR) positivity had a negative impact on their postprocedural recovery and outcomes. Materials and Methods : In this retrospective observational study, all patients with CHD who underwent cardiac surgery or transcatheter intervention at our institution between March 2020 and June 2021 who were detected to have asymptomatic SARS-CoV-2 infection on routine RT-PCR were included. Details of the cardiac procedure and postprocedural recovery were reviewed and compared with RT-PCR-negative patients who concurrently underwent similar cardiac surgeries or interventions at our center. Results : Thirteen patients underwent cardiac surgery after recent SARS-CoV-2 positivity after a mean interval of 25.4 ± 12.9 days. One patient expired with multiorgan dysfunction and systemic inflammatory response with elevated D-dimer, serum Ferritin, C-reactive protein, and significant ground-glass opacities on chest radiograph. Another patient developed spontaneous thrombosis of the infrarenal abdominal aorta, bilateral iliac arteries, and bilateral femoral veins, requiring low-molecular weight heparin postoperatively. This patient's postoperative recovery was also prolonged due to lung changes delaying extubation. All other patients had uneventful postprocedural recovery with intensive care unit and hospital stays comparable to non-SARS-CoV-2-infected patients. Conclusions : From our early experience, we can surmise that an interval of 2–3 weeks after asymptomatic SARS-CoV-2 infection is adequate to undertake elective or semi-elective pediatric cardiac surgeries. For patients requiring emergent cardiac surgery prior to this interval, there is potentially increased risk of inflammatory and/or thrombotic complications.

Introduction and Objective Micropapillary urothelial carcinoma (MPUC) is a rare and aggressive histologic variant of bladder cancer. Treatment guidelines recommend forgoing Bacillus Calmette-Guérin (BCG) therapy in favor of early radical cystectomy for non-muscle invasive (NMI)-MPUC due to high rates of disease progression. We aimed to evaluate its management in patients with immediate cystectomy and BCG across various centers. Methods Patients with MPUC were identified from the National Cancer Database (2004-2017). Treatment trends and rates of pathological upstaging were identified. Bivariate and multivariate analyses were performed to assess differences in outcomes by treatment approach. Results 1,685 patients were diagnosed with MPUC during the study period with 531 identified with localized Ta, T1, or Tis disease. BCG was administered as an initial therapy in 24.1% of NMI-MPBC patients and in 16.3% of NMI-non-MPUC patients (p

Introduction: Hidradenitis Suppurativa (HS) is a chronic socially debilitating disorder of unknown aetiology. Surgical treatments include simple incision and drainage; excision followed by healing by secondary intention or split-skin grafting and the more recent method of excision followed by local flap reconstructions. In this study, the use of a lateral thoracic fasciocutaneous island flap based on vessels arising from the thoracodorsal or thoracic lateral vessels is described. Aim: To describe the benefit and outcomes of lateral thoracic flap reconstruction technique in treatment of axillary HS. Materials and Methods: This prospective interventional study was conducted at the Plastic Surgery Department at Amala Institute of Medical Sciences, Thrissur, Kerala, India (tertiary care center), from January 2017 to June 2018. The study included 36 patients with chronic axillary hidradenitis, who underwent lateral thoracic flap surgery on one or both axillae. These patients were studied closely preoperatively during surgery and during postoperative follow-up period. The basic demographic details, clinical parameters and Hurley stage; along with postoperative outcomes were recorded. Data was summarised using descriptive statistics. Results: The study sample consisted of 36 patients with a mean age of 38.33±13.11 years. There were 20 females and 16 males. Total 11 patients were having co-morbidities in the form of type 2 diabetes mellitus or hypertension. The mean duration of illness was 3.17±1.44 years. Six patients had bilateral axilla involvement and underwent bilateral axillary reconstructions. Out of these 36 patients; 30 patients only had antibiotic treatment previously and five patients underwent excision of affected axillary skin previously without flaps; one patient was treatment naïve. Total 24 patients were Hurley stage 2 and 12 were stage 3. These patients were taken up for repair with a lateral thoracic flap. The mean postoperative hospitalisation was six days. There was no impairment of shoulder movement in the early or late postoperative period. There were no surgical complications in terms of vessel damage or flap viability. All flaps healed without complications and there was no recurrence of disease or scar contracture during the follow-up period. Conclusion: Lateral thoracic flap reconstruction for axillary HS is without doubt the strategy for treating axillary HS due to its lower recurrence rates.

Background: The corrosive esophageal injury would result in mucosal damage related to type, exposure time, and volume of ingested substance ranging from mild burn to severe necrosis. It is usually seen in childhood. Stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and would require surgery. However postoperative problems should also be considered. The purpose of this study was to determine the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube. Methods: In this observational descriptive-comparative study, 50 consecutive patients attending to Mofid children hospital since 2006 to 2016 were enrolled and the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube among them were determined and compared according to other variables. Results: The results in this study demonstrated that 68% required surgery that 82.3% had repeat surgery. Out of them 22 were performed with Gastric Pull up method that was successful in majority of subjects. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were most common preoperative problems and dysphagia (46%), stricture (36%), and vomiting (26%) were most common postoperative problems. There were 4 mortality cases. Conclusion: Totally, according to the obtained results, it may be concluded that esophagus substitution in the management of corrosive esophageal injury is effective that Gastric Pull up method is best option.

Background Valvular infective endocarditis (IE) may occur in association with either native or prosthetic valves, with great risk of mortality and morbidity. Surgical management is an essential part of the therapeutic process in these patients. Objectives This study aims at evaluation of early outcomes of surgically treated patients with native or prosthetic IE together with determining predictors of mortality. Patients and methods Outcomes of 60 patients who underwent surgery for native or prosthetic valve endocarditis at National Heart Institute during a 3-year period (April 2016 to March 2019) were studied prospectively. Preoperative, intraoperative, and postoperative data were tested as possible predictors for mortality. All patients were followed for at least 6 months after surgery. Results The hospital mortality rate was 11 (18.3%) patients, and total mortality rate after 6-month follow-up was 17 (28.3%) patients. Native valve endocarditis was present in 36 (60.0%) patients and prosthetic valve endocarditis in 24 (40.0%) patients. The commonest involved valve was mitral valve in 19 (31.7%) followed by aortic valve in 14 (23.3%). The commonest isolated organisms were Staphylococcus spp., which was found in 19 (31.6%) patients, followed by Streptococcus spp. and Gram negative bacteria, which were found in nine (15.0%) patients each. Mean Euro score II was 6.21 ± 2.54 in the surviving group. Duration of bypass time was 144.75 ± 35.81 min in dead patients and 104.56 ± 20.43 min in the surviving patients. Congestive heart failure, embolization, and periannular extension of infection were the most powerful predictors of in-hospital mortality. Periannular extension of infection was the most powerful predictor of 6-month mortality. Conclusion Surgery for IE is risky, especially in redo cases. Extensive infection carried the worst prognosis. Euro score II is a reliable indicator for hospital and early mortality. Valve repair can be performed in selected cases.

ABSTRACT: Introduction: Previously, incisionless plication (IP) for correction of congenital penile curvature (CPC) has been performed after penile degloving via a circumscribing incision. Aim: To describe our experience with non-degloving incisionless penile plication (NDIP) for correction of CPC and compare these outcomes with those of men who underwent degloving incisionless penile plication (DIP). Methods: We conducted a retrospective review of men ≤ 45 years of age who underwent incisionless penile plication for correction of CPC between 2008 and 2020 at two adult tertiary hospitals. Patients underwent either NDIP, performed through a 2-3 cm longitudinal incision along the proximal-to-mid shaft opposite the point of maximum penile curvature, or DIP via a sub-coronal circumscribing incision. Main Outcome Measures: Surgical and patient-reported outcomes were compared between the non-degloving and degloving groups. Results: Among the 38 men (mean age, 26 years) who met the inclusion criteria, 25 underwent NDIP, including 6 patients with biplanar curvature (2 Ventral, 4 Dorsal, 6 Lateral). Thirteen patients underwent DIP, including 1 patient with biplanar curvature (1 ventral, 1 lateral). Curvature reduction was 50 ± 23 degrees for the NDIP group and 36 ± 10 degrees for the DIP group (P = .04). Five (20%) patients in the NDIP group and nine (69%) patients in the DIP group experienced a reduction in stretched penile length following plication (SPL) (P = .01). One patient in the NDIP group underwent an additional plication for recurrent curvature. Conclusion: Both NDIP and DIP are safe and highly efficacious techniques for the correction of CPC.Kusin SB, Khouri RK, Dropkin BM, et al., Plication for Correction of Congenital Penile Curvature: With or Without Degloving?. Sex Med 2021;9:100462.

Ovarian cancer has the worst prognosis of all gynecologic malignancies. The standard treatment of patients with ovarian cancer is a multidisciplinary assignment involving aggressive surgery with or without chemotherapy. Among the prognostic factors, the residual disease is of capital importance. Surgical outcomes, including the amount of residual disease, would be better if the surgical oncologist performed it. This optimal surgical treatment according to guidelines may provide the most important benefit in survival. This current review aims at highlighting the positive relationship between complete cytoreductive surgery and survival. Patients with OC should be referred to surgical oncologists providing high-quality comprehensive care.

Objective: To compare the utility of sonouretherography (SUG) in conjunction with luoroscopic guided uretherography in determination of uretheral strictures taking surgical indings as gold standard. Methods: This cross-sectional study was conducted at department of Radiology, Liaquat National Hospital, Karachi from May to October 2016. All male patients having lower urinary tract symptoms (thin streak of micturation or interrupted micturation) for 1 week or longer were included. Probe with high frequency was used for evaluation of strictures by SUG. Procedure was done by introduction of normal saline via Foley's catheter with its bulb inlated in navicular fossa. Anterior urethra was visualized up to the penoscrotal junction with multiple longitudinal and transverse scans by placing the transducer on the ventral surface of penis. The indings of SUG were compared with retrograde uretherogram and surgical indings when stricture was preoperatively detected. Results: Out of total 145 patients, the average age of the patients was 37.22±11.09 years. SUG indings showed true positive cases in 31 (21.37%) patients whereas 98 (67.58%) patients were true negative. The sensitivity, specificity, PPV and NPV and accuracy of SUG for detection of anterior urethral stricture was 81.6%, 91.6%%, 77.5%, 93.3% and 88.9% respectively. Postsurgical conirmation of anterior urethral stricture was 26.2% while SUG was diagnosed in 27.6% cases Conclusion: SUG can be used as an alternative to conventional luoroscopic guided uretherography in evaluation and categorization of strictures in urethra, their grading and is the procedure without ionization radiation.

Operatively induced inflammation has been the focus of many studies to evaluate the most efficient responses and protocols to be used for its control. Insulin has been characterized with nonmetabolic properties and is used as a preoperative anti-inflammatory agent. We reviewed the published evidence in the past 10 years reporting on the use of glucose–insulin-normoglycemia therapy as a potential anti-inflammatory therapy to improve surgical outcomes about tissue trauma, with the challenges and progress attenuated so far. We also portray our experience in the use of insulin therapy on our liver resection patients as well as the significant knowledge gaps that still exist and the need for a multidisciplinary approach to bridge them.

Background: The anaesthestic management of the elderly surgical patients deserves attention because of the increased risk of intercurrent medical diseases. This retrospective study evaluated the reasons for surgical care and the pattern of anaesthesia provided. Methodology: This retrospective study of all elderly patients billed for surgery irrespective of the surgical specialties over a 13year period (1997-2010). Indication for surgery, anaesthetic technique, level of anaesthetist / surgeon and procedures performed were studied. Results: A total 1168 elderly patients were operated during the study period, of which 678(58%) were male while 490 (42%) were female. Ophthalmology and Urology recorded the highest surgeries respectively. The commonest procedures included cataract extraction 399 (9.25%) with a male preponderance and prostatectomy 166 (6.17%). The anaesthetic techniques commonly used include Local Anaesthesia 733 (62.8%) and General Anaesthesia 302 (25.8%). The cadre of the attending anaesthetists included consultant Anaesthetists 130(11.1%) while Senior Registrars provided care for 280(29.1%). The level of attending surgeons includes consultants 757 (64.8%) while Senior Registrars account for 399 (34.2%). Conclusion: Age alone is no longer a barrier to surgery and anaesthesia. Ageing changes the body’s capacity to cope with the stress of illness and surgery. To reduce morbidity and mortality less invasive technique like Local Anaesthesia (LA) should be used while consultant surgeons and anaesthetists should provide the perioperative care.

Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2–9 days; mean 3.32) preprotocol to a median of 2 days (range 2–3 days; mean 2.16) postprotocol (p

Background Laparoscopy has become the standard of care in the surgical management of deep infiltrating endometriosis (DIE). However, it is a challenging procedure with a high complication rate. Despite the benefits of the minimally invasive approach, DIE resection is often performed by surgeons without adequate training, especially in developing countries like Chile. Objective To asses our experience in the diagnosis and laparoscopic management of DIE during seven years. Methods A retrospective cohort study of data including 137 patients with pathology-proven DIE. Surgical and fertility outcomes were evaluated. Results All procedures were performed laparoscopically without conversion. Dysmenorrhea and dyspareunia were the most common symptoms in 85.4% and 56.9%, respectively. Uterosacral ligaments were the most common DIE location. Endometrioma was present in 48.9% of cases. Median operative time was 140 minutes; however, it was longer in cases requiring bowel surgery (p < 0.0001). The complication rate was 10.9%. Median follow-up was 24.5 months. The pregnancy rate was 58.1% and 90% of patients reported significant symptom relief after surgery. Conclusion Laparoscopic surgical management of DIE is effective and safe but it must be performed in tertiary centers with the availability of multidisciplinary teams.

Study Design A retrospective clinical study. Purpose To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility 70°. However, few studies have evaluated the results of HFT in AIS patients with Cobb angles between 70° and 90° and flexibility

Objective: POP occurs as a consequence of fibromuscular and endofascial weakness. Women with prolapse often have global support defects causing difficulty in identification and repair. Fascial plication and levatorplasty in rectocele repair can cause over-narrowing of vagina and introitus leading to dyspareunia. Mesh reinforcement is used to correct multiple defects while avoiding vaginal narrowing. Although literatures have reported encouraging results of vaginal mesh repair, the use of mesh in posterior compartment is still controversial. Elevate system® has been developed as a minimally invasive method for mesh augmentation. Our objective is to evaluate outcomes of Elevate Posterior and Apical mesh in the posterior and apical prolapse repair. Methods: We conducted a prospective study of 302 women undergoing Elevate Posterior mesh reconstruction between 2009 and 2015. Demographic and peri-operative information were recorded. Pre- and post-operative evaluation included symptom, quality of life and POP-Q assessment. Differences in quality-of-life and POP-Q scores were demonstrated using paired t test. Objective cure rates, symptom resolution, quality-of-life measures and peri-operative morbidities were evaluated. Results: Three-hundred women had posterior vaginal prolapse while 131 had apical descent. Mean operative time was 87±21 minutes. Bleeding complication occurred in 9 while mesh extrusion occurred in 3 women. Significant symptom and quality-of-life improvement were demonstrated at one year. Objective cure rates of Elevate Posterior mesh in the treatment of posterior vaginal and apical prolapse were 93.7% and 92.4% respectively. Conclusion: Elevate Posterior and Apical mesh reconstruction has delivered impressive clinical outcomes for the treatment of posterior vaginal and apical prolapse.

Background: The aim of this study was to examine the utility of the vascular ring connector (VRC) and compare the clinical outcomes to conventional suture technique in the operation for acute type A aortic dissection (AAAD). Methods: We retrospectively enrolled 64 consecutive patients (mean age 57.4 ± 12.7 years, range 24-82 years) with AAAD who underwent emergent surgery in our institution from September 2010 to November 2014. Patients were divided into VRC group (55 patients) and conventional suture group (nine patients) based on the use of VRC during the operation. The preoperative characteristics, operative variables, and postoperative outcomes were collected and analyzed. Results: Male patients predominated in both groups. The mean times of cardiopulmonary bypass and aortic cross-clamp were 200.1 ± 99.9 and 193.6 ± 54.7 min (P = 0.425) and 107.5 ± 56.2 and 112.3 ± 40.8 min (P = 0.404) in the VRC group and suture group, respectively. There were more blood transfusions within 24 h (1513.3 ± 949.2 vs. 841.8 ± 801.1 ml) and more mediastinal drainage amount (1314.4 ± 650.3 ml vs. 942.1 ± 527.2 ml) in the suture group than in the VRC group. In the VRC group, 36.3% of patients did not require blood transfusion. Moreover, the pumping time and cardiac ischemic times were longer in the one-VRC group than in the two-VRC group. Operative mortality did not differ between the two groups (10.9% in VRC and 11.1% in suture group, P = 0.985). No dislodgement of VRC during or after operation and no bleeding from sutureless anastomosis site were noted. Conclusion: Use of VRC is associated with equivalent operative mortality and morbidity compared to suture group in patients with AAAD undergoing an emergent operation. This study demonstrates the clinical safety and efficacy of VRC in reducing the need of blood transfusion within 24 h and mediastinal drainage within 72 h. However, further randomized studies and long-term surveillance of the use of VRC in AAAD are still mandatory.

Background: Single port laparoscopic surgery (SPLS) is an innovative approach that is rapidly gaining recognition worldwide. The aim of this study was to determine the feasibility and safety of SPLS compared to conventional laparoscopic surgery for the treatment of benign adnexal masses. Methods: In total, 99 patients who underwent SPLS for benign adnexal masses between December 2013 and March 2015 were compared to a nonrandomized control group comprising 104 conventional laparoscopic adnexal surgeries that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of ovarian mass, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc. Results: No significant difference was observed between the two groups regarding preoperative baseline characteristics. However, the pathological results between the two groups were found to be slightly different. The most common pathological type in the SPLS group was mature cystic teratoma, whereas endometrioma was more commonly seen in the control group. Otherwise, the two groups had comparable surgical outcomes, including the median operation time (51 min vs. 52 min, P = 0.909), the median decreased level of hemoglobin from preoperation to postoperation day 3 (10 g/L vs. 10 g/L, P = 0.795), and the median duration of postoperative hospital stay (3 days vs. 3 days, P = 0.168). In SPLS groups, the median EBL and the anal exsufflation time were significantly less than those of the conventional group (5 ml vs. 10 ml, P < 0.001; 10 h vs. 22 h, P < 0.001). Conclusions: SPLS is a feasible and safe approach for the treatment of benign adnexal masses. Further study is required to better determine whether SPLS has significant benefits compared to conventional techniques.

In the last 25 years, the number of patients aged ≥75 years undergoing non-cardiac surgery has greatly increased. In elderly patients, frailty is significantly associated with an increased risk of adverse events, functional decline, procedural complications, prolonged hospitalization, and mortality. The relationship between frailty and increased mortality and morbidity requires an appropriate tool of assessment to accurately quantify the patient’s clinical and perioperative conditions. The preoperative evaluation of elderly patients candidate for non-cardiac surgery should include assessment of frailty, sarcopenia and malnutrition, as these are related to high surgical risk. For colon-rectal surgery as also for gastric cancer surgery, especially early gastric cancer, the introduction of laparoscopy has yielded considerable benefits in terms of short-term postsurgical outcomes, e.g. lower rate of intraprocedural bleeding and reduced length of hospital stay. Despite the progress made in preoperative assessment, surgical procedures and postoperative management, the improvement of outcomes after non-cardiac surgery in elderly patients remains a challenge and calls for future, well-designed clinical studies.

Background: Coronary artery disease occurs frequently and is a major cause of morbidity and mortality in patients with chronic renal failure. Because the number of patients requiring dialysis for end-stage renal disease (ESRD) has increased, the number of patients in this population who require coronary artery bypass grafting (CABG) has increased. The aim of this study was to examine the effect of early hemodialysis (HD) on the early surgical outcomes of ESRD patients undergoing CABG. Materials and Methods: Fifty-nine dialysis-dependent patients who underwent isolated CABG with cardiopulmonary bypass (CPB) were enrolled in this study. These patients were divided into two groups based on the timing of the first postoperation HD session. In the early HD group, HD was performed within 6 h postoperation; in the scheduled HD group, HD was performed >6 h postoperation. The preoperative characteristics, operative variables, and postoperative outcomes were retrospectively analyzed. Results: The time to first HD after CABG was 2.43 ± 1.58 h in the early HD group and 20.68 ± 6.98 h in the scheduled HD group (P < 0.001). There were no significant differences in the operative variables, namely duration of operation, CPB time, and aortic cross-clamp time, between the two groups. The incidence of postoperative pneumonia was higher in the scheduled HD group (31.8%) than in the early HD group (2.7%). There was a trend of decreased incidence of postoperative pneumonia in the early HD group with marginal significance from the univariate analysis. The intensive care unit and hospital stay duration of both groups were similar. Nine patients died in the hospital, yielding an overall 30-day mortality of 8.47%. Conclusion: In dialysis-dependent patients who underwent CABG, the short-term outcomes and surgical mortality were acceptable. Dialysis-dependent renal failure should not be considered a contraindication for CABG. Early HD in the postoperative period demonstrated the trend to reduce the incidence of postoperative pneumonia; however, other parameters of surgical outcomes were insignificant.