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Background A variety of methods are available for scalp defect closure and necessitate extensive planning. Superficial temporal artery (STA) based local flaps are widely used in the field of scalp and face reconstruction because of their flexibility and rich vascularity. Rotation and transposition techniques are commonly used in the area, however at times result in excessive tension. V-Y advancement allows tension-free closure with reduced post-operative complications. Case presentation A case of scalp defect post multiple craniectomies for a traumatic head injury complicated with subgaleal collection and poor wound healing in a 29-year-old male, is reported. Due to the nature of defect, with underlying fibrosis and previous artificial duraplasty, along with location in the frontotemporal region, a local STA based flap closed in a rotation, transposition and unilateral V-Y advancement pattern was used. Conclusion The challenges encountered in wound closure of complicated post-traumatic and multiple craniectomy cases can be overcome with a modified combined approach which achieves optimal wound closure. [ABSTRACT FROM AUTHOR]

Purpose: To investigate predictive factors for redislocation in patients with recurrent intraocular lens (IOL) dislocation after secondary scleral-fixated IOL (SF IOL) surgery. Setting: 2 tertiary referral hospitals. Design: Retrospective case series. Methods: Patients undergoing SF IOL surgery were grouped into redislocation and no-redislocation groups. Medical records of consecutive patients who underwent SF IOL surgery between June 2014 and December 2019 at 2 tertiary referral centers were reviewed. Data regarding patient demographics, treatment factors, anatomical and functional outcomes, and postoperative complications were recorded. Results: 237 eyes of 225 patients (169 [75.1%] men) were included. The redislocation group was more likely to have a younger mean age at the initial SF IOL surgery (redislocation vs noredislocation, 55.4 vs 62.0 years, respectively; P = .008), have a prior history of a previous suture break (23 eyes, 52.3% vs 1 eye, 0.5%; P < .001), and have undergone the initial SF IOL surgery using <1 mm-sized side-port incisions (17 eyes, 38.6% vs 32 eyes, 16.5%; P = .002) than was the no-redislocation group. In addition, the redislocation group had a higher occurrence of complications (P < .001). Multivariate regression revealed that younger age, left eye involvement, aphakic status before the surgery, unremarkable primary IOL dislocation cause, need for ocular hypertension treatment and glaucoma surgery, and no large incision during the initial surgery were significantly (all P < .05) associated with redislocation. Conclusions: Younger age, left eye involvement, postoperative complications such as ocular hypertension and glaucoma, and techniques without large incisions increase the risk of redislocation. Conversely, lower risk factors include unremarkable surgery causes and a history of aphakic conditions. [ABSTRACT FROM AUTHOR]

Background: Colpectomy entails the surgical removal of the vaginal epithelium. It may be performed in trans-masculine individuals as gender-affirming surgery. Vaginal colpectomy is a complex procedure with potentially severe complications. As alternative, robotic-assisted laparoscopic colpectomy combined with robotic-assisted laparoscopic hysterectomy and possible bilateral salpingo-oophorectomy (RAC+) can be performed. Aim: To compare surgical outcomes of robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy with a vaginal colpectomy after previous hysterectomy in trans masculine patients. Methods: A single-center retrospective cohort study included 310 transgender men who underwent either robotic-assisted colpectomy combined with a hysterectomy and bilateral salpingo-oophorectomy (RAC+) (n = 140) or vaginal colpectomy (n = 170) between January 2006 and December 2019. Surgical details and clinical outcomes were collected from all patients. Results: The median intra-operative blood loss was 100 mL (50–200) in RAC + and 300 mL (200–450) in vaginal colpectomy (p < 0.01). The median duration of hospital stay was 2 days (1–2) in the RAC + group and 3 days (2–4) in the vaginal group (p < 0.01). In the RAC + group 63 (45%) peri-operative complications were reported, compared to 93 (54.7%) in the vaginal group [OR 0.7 (0.4–1.1)]. The main difference was found in intra-operative complications (RAC+ 0.7% vs. vaginal 10.6%). Furthermore, the total number of complications graded 3a and higher was significantly lower in the RAC + group [OR 0.3 (0.2–0.7)]. Conclusion: Although RAC + entailed a more extensive procedure, compared to vaginal colpectomy, RAC + had a lower risk of severe peri-operative complications, requiring re-intervention; intra-operative blood loss was lower and hospital stay shorter. Both routes of colpectomy are complex procedures with potentially severe complications. Future studies are needed to study whether robot–colpectomy could be a safe alternative to vaginal colpectomy in patients with a previous hysterectomy. [ABSTRACT FROM AUTHOR]

Background: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. Methods: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. Results: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3–1.6 cm), and the mean defect size was 1.2 cm (range: 0.7–1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. Conclusions: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim. [ABSTRACT FROM AUTHOR]

Background: The abdomen is the frequent site of operations in general surgery; consequently, incision and suturing of the abdominal wall is a very important aspect of surgery. Conventionally, the midline incision of a laparotomy wound is closed in various layers anatomically. However, a newer method called the mass closure technique is increasingly being utilized for its advantages. Aim and Objective: To evaluate the outcomes of midline abdominal surgeries using mass closures and layered closure techniques. Material and Method: This prospective study was carried out in the Department of General Surgery, VIMS, Gajraula, UP, India, and they were divided into two groups. Group I patients who were sutured with mass closure technique and Group II patients who had their midline incision closed with conventional layered technique. Result: The most common complication in the group I was found to be a superficial infection in n = 2 (8%) of patients. The other complications were seroma, burst abdomen (wound dehiscence), and suture sinus formation in n = 1 (4%) cases each. In group II, layered closure wound infection was found in n = 2 cases; both were superficial infections that were managed adequately. Burst abdomen and seroma were also found in n = 2 (8%); hematoma was seen in n = 1 (4%) cases each. Conclusion: In comparison with layered closure, the mass closure technique is less time-consuming, associated with fewer postoperative complications, less costly, and a safe and effective method for the closure of midline laparotomy incisions. [ABSTRACT FROM AUTHOR]

Background: Benign adnexal masses represent a significant clinical concern, with diverse etiologies and potential for acute complications. This study aims to provide insights into the surgical management of these masses and associated emergencies in a tertiary care setting. Objectives: To evaluate the outcomes, efficacy, and safety of surgical interventions for benign adnexal masses and related acute emergencies in a cohort of women. Methods: A retrospective review was conducted on 94 women who underwent surgical treatment for benign adnexal masses and related emergencies at a tertiary care center. Patient demographics, clinical presentations, surgical procedures, outcomes, and complications were analyzed. Results: The study population primarily consisted of reproductive age grouped women, with a median age of 35 years. The most common presenting symptoms were abdominal pain and discomfort. Laparoscopy was the predominant surgical approach, used in 70% of cases. The majority of the masses were ovarian cysts. Postoperative complications were minimal, with a low rate of conversion to open surgery. The overall success rate of the surgeries was high, with a significant improvement in symptoms and minimal postoperative morbidity. Conclusion: Surgical management of benign adnexal masses and related emergencies in a tertiary care setting is safe and effective, with minimal complications and favorable outcomes. This study underscores the importance of tailored surgical approaches based on individual patient presentations and emphasizes the role of minimally invasive techniques in enhancing patient recovery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic abdominal surgery is a minimally invasive procedure that requires meticulous preoperative preparation. Advanced methods in Magnetic Resonance Imaging (MRI) provide comprehensive insights, which have the potential to enhance surgical results. The present research assesses the effectiveness of sophisticated MRI techniques in forecasting the outcome of laparoscopic abdominal procedures. Methodology: Prospective research was carried out with 100 patients who were having different laparoscopic abdominal surgeries. Prospective participants were chosen according to predetermined criteria and had preoperative high-resolution MRI, which included functional imaging methods such as diffusion-weighted imaging (DWI). The predictive criteria evaluated were surgical results, duration of surgery, recuperation after surgery, and rates of complications. To assess the precision, sensitivity, and specificity of MRI predictions, statistical studies were performed. Results: Advanced MRI methods demonstrated a high level of accuracy in predicting surgical outcomes in 82% of instances. Surgical procedures with significant complexity had a higher accuracy rate of 90%. A strong correlation was seen between MRI results and intra-operative problems (p < 0.05), successfully predicting difficulties in 24 out of 30 instances. An accuracy rate of 75% was achieved in post-operative recovery forecasts. Achieving 85% sensitivity and 78% specificity, MRI predictions demonstrated high accuracy. Surgeons attested that MRI forecasts were beneficial for pre-operative planning in 88% of instances. Conclusion Advanced MRI methods show outstanding effectiveness in forecasting the results of laparoscopic abdominal procedures. This methodology is very advantageous in intricate scenarios and in predicting difficulties that may arise after surgery. The exceptional prediction precision justifies the use of sophisticated MRI in pre-operative evaluations to enhance surgical planning and patient safety. [ABSTRACT FROM AUTHOR]

Introduction: The stomach is a crucial part of the digestive system, followed by the duodenum, which is 25 cm long and divided into four segments. Duodenal diseases include ulcers, inflammation, diverticula, tumors, polyps, and hookworm infections. Duodenal perforations are life-threatening, with mortality rates of 8-25%. Surgery remains the primary treatment for this common emergency. Methodology: This prospective cross-sectional study was conducted at Navodaya Medical College and Hospital, Raichur. Forty patients with clinical and radiological signs of hollow viscus perforation, diagnosed with duodenal perforation during exploratory laparotomy, were randomly selected. Thorough clinical and radiological examinations were performed. Results: The mean age of participants was 41.70 ± 11.82 years, with 80% being male. Chief complaints included abdominal pain (47.50%), vomiting (37.50%), and fever (15%). Risk factors identified were smoking (42.50%), alcohol consumption (37.50%), family history (17.50%), NSAID use (22.50%), and peptic ulcer disease (7.50%). The mean surgery duration was 43.30 ± 11.53 minutes. Hospital stay was less than 5 days for 52.50% of participants. Post-operative complications occurred in 15% of cases, with 7.50% experiencing anastomotic leaks. Conclusion: The study found that duodenal perforation predominantly affects males, with abdominal pain and vomiting as common symptoms. Identified risk factors included smoking, alcohol consumption, NSAID use, peptic ulcer disease history, and family history. Approximately half of the patients required hospital stays longer than 5 days. Post-operative complications, including anastomotic leaks, were observed in a small percentage of cases. [ABSTRACT FROM AUTHOR]

Background: Postoperative respiratory complications significantly contribute to patient morbidity and healthcare costs. Non-invasive ventilation (NIV) methods, such as Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP), are increasingly used to manage these complications, yet comparative efficacy data between these modalities remains limited. Objective: To compare the effectiveness of CPAP and BiPAP in reducing postoperative respiratory complications in a cohort of 200 surgical patients. Methods: This retrospective study analyzed medical records from 200 patients who underwent major abdominal, thoracic, or cardiovascular surgery and received either CPAP or BiPAP postoperatively. The primary outcomes were the incidence of postoperative respiratory complications, including minor and major complications. Secondary outcomes included the duration of hospital stay and the need for escalation to invasive ventilation. Results: Of the 200 patients, 100 received CPAP and 100 received BiPAP. The incidence of no postoperative complications was higher in the CPAP group (82%) compared to the BiPAP group (75%), but the difference was not statistically significant (OR 1.52, 95% CI 0.82-2.82, p=0.18). Minor and major complications were slightly more common in the BiPAP group, with odds ratios of 1.58 (p=0.27) and 1.28 (p=0.62), respectively. Both groups had similar durations of hospital stays and rates of escalation to invasive ventilation, with no significant differences observed. Conclusion: CPAP and BiPAP are effective in managing postoperative respiratory complications, with no significant differences in the overall efficacy observed between the two modalities. However, CPAP showed a non-significant trend towards fewer respiratory complications. Future prospective studies are warranted to further explore these findings and help refine guidelines for the use of NIV in the postoperative setting. [ABSTRACT FROM AUTHOR]

Introduction: Standard PCNL, where a nephrostomy tube is placed at the end of the surgery, is the predominant modality in the treatment of renal stones at present. With the advancement of techniques however, a new method has developed where tube placement is omitted. More and more studies are being done to evaluate the benefits of tubeless PCNL over the standard PCNL. Objectives: To compare the perioperative characterstics, analgesics requirement(according to VAS score), duration of hospital stay, post surgical complication, to know the which one is more beneficial to patient Methods: The study was done in Muzaffarnagar Medical College and Hospital, Muzaffarnagar, U.P. on indoor patients of the General Surgery department by following inclusion and exclusion criteria, clinical examinations, and interpretation of laboratory results. Results: Tubeless PCNL is better than the standard pcnl in terms of analgesics requirement, duration of hospital stay and complication. Conclusion: Standard PCNL has a longer operating time, that leads to more bleeding and drop in haemoglobin. Tubeless pcnl has a lesser analgesic requirement, lower rates of complications and shorter duration of hospital stay, as well as more cost effectiveness. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to determine the success of endoscopic endonasal dacryocystorhinostomy using powered instrument (microdebrider) and removing the nasal mucosal and posterior saccal flaps. Methodology: A prospective hospital based case study was conducted in patients attending ENT, Head & neck surgery department of Government Medical college hospital between April 2023 to April 2024 with complaint of epiphora including nasolacrimal duct obstruction. A total of 30 cases of epiphora secondary to nasolacrimal duct obstruction were operated using endoscopic endonasal DCR technique. Result: Complete resolution of epiphora was reported in 28 patients of the 30 procedures, (93.3% success rate) with patent ostia on syringing. None of the patients developed recurrence, 2 patients developed synechiae and mucosal overgrowth over the canalicular sight post operatively. There were no intra-operative or post-operative complications. Conclusion: The technique of endoscopic dacryocystorhinostomy with creation of wide bony ostium around the medial aspect of the lacrimal sac by drilling out the bony borders and removing mucosal and posterior saccal flaps with the help of powered instrument (microdebrider and drill) has shown good longterm results comparable with other studies. It also has the additional advantage of less granulation tissue formation, less chance of redundant flap obstructing the ostia and practically no synechiae formation. The technique is relatively easy with favourable outcome. [ABSTRACT FROM AUTHOR]

Background: This retrospective observational study was conducted to study the clinical profile, indications, post-operative complications and long-term outcome of patients having pulmonary aspergilloma. Methods: From January 2013 to October 2023, 25 patients underwent surgery for pulmonary aspergilloma at our tertiary care institute. Patients were broadly classified into simple and complex Aspergilloma based on clinical and CT findings. Results: The group consisted of 16 males and 9 females with a mean age of 41 years for 10 years. The most common indication for surgery was Heomptysis (76%). The underlying lung diseases were tuberculosis (76%), bronchiectasis (8%), and lung abscess (4%). The procedures performed were lobectomy (88%), pneumonectomy (4%), Cavernostomy (4%) and segmental resection (4%). The post-operative mortality was 4% (one patient). Overall complications occurred in 12 (23.07%) patients. The complications included prolonged air leak (32%), bleeding (12%), repeated pneumothorax (4%), and wound dehiscence (4%). Conclusion: Pulmonary aspergilloma, a fungal infection frequently encountered in developing countries like India with high rates of tuberculosis, can be effectively treated through surgical resection. This procedure is considered the gold standard for preventing recurrent symptoms, especially hemoptysis. Early surgical intervention, accompanied by thorough preoperative preparation, meticulous surgical technique, and diligent postoperative chest physiotherapy, can significantly reduce the rate of complications. While complications may still arise, particularly in cases with underlying lung pathology, the long-term prognosis for patients undergoing surgical resection of pulmonary aspergilloma is generally positive. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant immunotherapy plus chemotherapy has ushered in a new era for surgical treatment for patients with NSCLC. This study aimed to examine the efficacy and safety of neoadjuvant immunotherapy plus chemotherapy in NSCLC. Methods: Eligible studies were identified from PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, and conference meeting abstracts. The endpoints included major pathological response (MPR), complete pathological response (pCR), surgical resection rate, R0 resection, treatment‐related adverse events (TRAEs), severe adverse events (SAEs), surgical complications, treatment discontinuation, surgical delay, and treatment‐related death. Stata 18 software was used for statistical analysis, and p < 0.05 was considered statistically significant. Twenty‐two studies including a total of 1108 patients were eligible for this study. Results: Among the patients who received neoadjuvant immunotherapy plus chemotherapy, the pooled MPR rate was 51% (95% CI [0.44–0.58]), and pCR rate was 34% (95% CI [0.28–0.40]). The pooled surgical resection rate was 85% (95% CI [0.81–0.89]), and the pooled R0 rate was 94% (95% CI [0.91–0.96]). The pooled rate of pathological tumor downstaging was 84% (95% CI [0.79–0.88]), and the pooled rate of pathological nodal downstaging was 38% (95% CI [0.23–0.57]). During the treatment of neoadjuvant immunotherapy plus chemotherapy with or without surgery, the pooled rate of TRAEs (any grade) was 84% (95% CI [0.73–0.91]), and the pooled rate of SAEs was 29% (95% CI [0.21–0.38]). Surgical complications pooled rate was 25% (95% CI [0.14–0.41]). The pooled rate of treatment discontinuation (11%, 95% CI [0.09–0.13]), surgical delay (3%, 95% CI [0.02–0.05]), and treatment‐related death (2%, 95% CI [0.02–0.03]) were conducted. Conclusion: Neoadjuvant immunotherapy plus chemotherapy provides a high pathological response, surgical resection rate, R0 resection rate, and pathological downstage rate and has a low risk of increasing the incidence of SAEs, surgical complications, treatment discontinuation, surgical delay, and treatment‐related death. The validation of prospective and large sample studies is needed to confirm this conclusion. [ABSTRACT FROM AUTHOR]

Background: The ventral and distal aspects of the corpora cavernosa are the thinnest, increasing the likelihood of cylinder extrusion or crossover complications pertaining to inflatable penile prosthesis procedures. A double distal corporal anchoring double stitch can be used to robustly secure impending lateral extrusions and crossovers of implant cylinders. It is a novel, effective corrective measure for the uncommon complication of migrated cylinders in inflatable penile prosthesis placement. Aim: To describe the surgical indications and technique for the double distal corporal anchoring fixation stitch for lateral penile implant cylinder extrusion. Methods: We discuss a double-stitch technique that is performed following corporoplasty and capsulotomy. A lateral incision is made subcoronally on the affected side to identify the crossover or lateral extrusion. The cylinder is repositioned properly within the native corpora to prevent further cylinder migration. Two 2-0 Ethibond sutures are threaded through the distal cylinder eyelet, and each suture is delivered through the glans with a Keith needle and tied off. An incision is made in the glans, and 1 arm of each suture is tied with the other to create a bridge between the sutures that can be positioned deep within the skin of the glans. Outcomes: Over the past 4 years, 66 patients with lateral cylinder extrusion underwent the double distal corporal anchoring fixation stitch procedure, with overall improved satisfaction (97%). Only 2 patients had surgical complications. One patient experienced repeated lateral extrusion of the penile implant cylinders 6 weeks following the double-anchoring stitches procedure. The second patient developed a painful suture granuloma that necessitated excision, which resolved this issue, and the penile implant cylinder remained in the proper position over a year later. Clinical Implications: This technique ensures the secure fixation of the affected cylinders in the surgical capsule by creating a bridge between 2 sutures holding each repositioned cylinder in place, and the ensuing fibrotic reaction helps to fixate the extruded cylinder within the midglandular tissue. Strength and Limitations: This surgical technique describes the double distal corporal anchoring stitch for lateral penile implant cylinder extrusion. Further studies are warranted to validate long-term outcomes and satisfaction. Conclusion: The double distal corporal anchoring fixation stitch is a safe and efficacious method to secure cylinders in the proper surgical capsule during revision procedures to correct distal crossovers or laterally extruded penile prosthesis implants. [ABSTRACT FROM AUTHOR]

Background: Surgical audit is key in upholding the standards of surgical care but may be inadequate in capturing morbidity experienced by patients being transferred across different health systems. The aim of this study was to assess the utility of an objective framework in the evaluation of clinical issues surrounding interhospital transfers (IHTs). Methods: A retrospective cohort study was conducted at a Victorian state bariatric hospital. Patients transferred with bariatric surgery related complications between 2014 and 2021 were included. Each case was reviewed by two surgeons using an objective framework developed via a modified Delphi‐process. Key issues and preventability surrounding each transfer were evaluated. Inter‐observer agreement was assessed using weighted Cohen's Kappa coefficient. Results: Seventy‐three patients were included. The most common indication for transfer was proximal staple line leak post sleeve gastrectomy (34/73, 46.6%). Length of stay was 38.3 ± 58.8 days. Cost of care amounted to AUD $110 666.18 per patient. Delay in transfer and complication recognition were present in 20% of cases (Cohen's Kappa 0.51;0.61). Human factors and patient related factors were the most common principal underlying causes (Cohen's Kappa 0.59). A third of the complications (n = 25/73, 34.2%), were potentially preventable (Cohen's Kappa 0.58) and more than half (39/73, 53.4%) did not have documented objective feedback to referring clinicians. Conclusion: IHTs associated with bariatric surgery complications have significant morbidity and costs. A structured framework in reviewing IHT can consistently identify potentially modifiable factors that improve clinical outcomes, and constructive feedback to the referring clinician should be actively facilitated and documented. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES) affects outcomes following surgery for various cancers. There are currently no Australian studies that examine the role of socioeconomic disadvantage on outcomes following oesophagectomy for cancer. This study assessed whether SES was associated with short‐term perioperative morbidity, long‐term survival, and oncological outcomes following oesophagectomy across three tertiary oesophageal cancer centres in Australia. Methods: A retrospective cohort study was performed comprising all patients who underwent oesophagectomy for cancer across three Australian centres. Patients were stratified into SES groups using the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD). Outcomes measured included perioperative complication rates, overall survival, and disease‐free survival. Results: The study cohort was 462 patients, 205 in the lower SES and 257 in the higher SES groups. The lower SES group presented with more advanced oesophageal cancer stage, a higher rate of T3 (52.6% versus 42.7%, P = 0.038) and N2 disease (19.6% versus 10.5%, P = 0.006), and had a higher rate of readmission within 30 days (11.2% versus 5.4%, P = 0.023). There was no difference in overall survival or disease‐free survival between groups. Conclusion: Lower socioeconomic status was associated with more advanced stage and increased risk of early, unplanned readmission following oesophagectomy, but was not associated with a difference in overall or disease‐free survival. [ABSTRACT FROM AUTHOR]

Background: Hashimoto's thyroiditis (HT) is managed with thyroid hormone replacement to maintain a euthyroid state. A subset of patients have refractory symptoms, which improve with thyroidectomy (TT). There remains a reluctance to proceed with surgery due to perceptions of complications, and limited data availability regarding improvements in quality of life (QoL). This retrospective case control study aims to analyse the outcomes and QoL scores for symptomatic euthyroid HT patients who underwent TT. Methods: Thirty euthyroid patients who underwent TT for the management of HT between 2017 and 2022 were identified. An age‐matched control group of patients who underwent TT for symptomatic multinodular goitre (MNG) were randomly selected. Demographics, biochemistry, histology, outcomes, and pre‐ and post‐operative SF‐36 and ThyPRO‐39 scores were compared between groups. Results: There were no surgical complications in the HT group, whilst two MNG patients had complications. There was a similar rate of parathyroid auto‐transplantation in both groups, more glands were transplanted in the HT group. There was a significant difference in pre‐ and post‐operative QoL scores for both groups. Comparison revealed a significant improvement in hyperthyroid symptoms, social life and daily life scores in the HT group. There was a significant difference in pre‐ and post‐operative anti‐TPO, anti‐TG and TSH levels in the HT group. Conclusion: Patients with symptomatic Hashimoto's thyroiditis, despite being euthyroid, may benefit from total thyroidectomy however this remains under‐utilized. This study demonstrated that thyroidectomy was associated with an improvement in validated post‐operative quality of life scores and was not associated with increased complication rates for appropriately selected patients. [ABSTRACT FROM AUTHOR]

Background: Failure to rescue (FTR), defined as death after a major complication, is increasingly being used as a surrogate for assessing quality of care following major cancer resection. The aim of this paper is to determine the failure to rescue (FTR) rate after oesophagectomy and explore factors that may contribute to FTR within Australia. Methods: A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2023 at five Australian hospitals was conducted to identify patients who underwent an oesophagectomy. The primary outcome was FTR rate. Perioperative parameters were examined to evaluate predictive factors for FTR. Secondary outcomes include major complications, overall morbidity, mortality, length of stay and 30‐day readmissions. Results: A total of 155 patients were included with a median age of 65.2 years, 74.8% being male. The FTR rate was 6.3%. In total, 50.3% of patients (n = 78) developed at least one postoperative complication with the most common complication being pneumonia (20.6%) followed by prolonged intubation (12.9%) and organ space SSI/anastomotic leak (11.0%). Multivariate logistic regression analysis was performed to determine any factors that were predictive for FTR however none reached statistical significance. Conclusion: This study is the first to evaluate the FTR rates following oesophagectomy within Australia, with FTR rates and complication profile comparable to international benchmarks. Integration of multi‐institutional national databases such as ACS NSQIP into units is essential to monitor and compare patient outcomes following major cancer surgery, especially in low to moderate volume centres. Failure to rescue (FTR), defined as death after a major complication, is increasingly being used as a surrogate for assessing quality of care following major cancer resection. This study is the first to evaluate the FTR rates following oesophagectomy within Australia. FTR rates and complication profiles were comparable to international benchmarks. [ABSTRACT FROM AUTHOR]

Objective: To predict recurring atrial fibrillation (AF) following radiofrequency catheter ablation by assessing the attributes of the left atrium and the left atrial (LA) appendage (LAA) using transesophageal echocardiography (TEE) and speckle tracking imaging. Methods: The structural and functional indices of the LA and LAA of 80 patients with AF who underwent preoperative transthoracic echocardiography and TEE were measured. Recurrence was recorded postoperatively at 3, 6, and 12 months. The independent determinants of recurring AF were identified by logistic regression, and their optimum cutoff values, sensitivity, and specificity were estimated from the receiver operating characteristic (ROC) curves. Results: The recurrent and nonrecurrent groups comprised 17 and 63 patients, respectively. The LA internal diameter, LA end‐diastolic and end‐systolic volumes, LAA length, diameter and area of the opening of the LAA, and LAA end‐diastolic volume were higher in the recurrent group. The LA strain in the reservoir phase, the ejection fraction and filling velocity of the LAA, the LAA emptying velocity (LAAeV), and the LAA strain (LAAS) reduced considerably. Multifactorial regression analyses demonstrated that the LAAeV and LAAS were independent determinants of recurring AF. ROC curve analysis revealed that the LAAeV and LAAS predicted postoperative recurrence at 34.5 cm/s (area under the curve [AUC]: 0.954, sensitivity: 94.1%, and specificity: 92.1%) and 11.61% (AUC: 0.925, sensitivity: 82.4%, and specificity: 95.2%), respectively, while the AUC, sensitivity, and specificity of the combined predictors (LAAeV + LAAS) were 0.978, 94.1%, and 93.7%, respectively. Conclusion: The LAAeV and LAAS independently influenced the postoperative recurrence of AF. [ABSTRACT FROM AUTHOR]

Introduction: Transthoracic (TTE) follow up guidelines after PFO device closure are vague. The primary goal of this study was to perform a literature search to characterize the timing of complications that occur after PFO device placement to determine the utility of long‐term routine TTE. Methods: A search was performed in Medline (PubMed) with English language and publication date (2000–2023) filters were applied. Studies were included if they reported on patients who underwent a PFO device closure. Studies were excluded if they only reported on ASD device closure patients, were meta‐analysis or review papers, or did not report any outcomes for the PFO device procedure. Results: A total of 305 articles met the criteria (observational cohort study, n = 196; case study, n = 99; and randomized control study, n = 10). Age at the time of PFO device closure was 47.5 ± 9.3 years. The incidence of complications was 6.9% (3358/48 348). Maximum range of follow‐up was 0–17 years. The plurality of complications was due to arrhythmias (46.3%, 1554/3358), followed by residual shunts (29.7%, 999/3358). The majority of complications occurred ≤6 months post‐device placement (57.8%, 1941/3358). Only 0.8% (27/3358) of complications took place >5 years. All patients with complications >5 years of device placement were presented with clinical symptoms related to their complications. Conclusion: The incidence of patients presenting with PFO‐reported complications beyond 5 years post‐procedure diminished. The utility of routine TTE beyond 5 years post‐PFO after device placement should be further assessed. [ABSTRACT FROM AUTHOR]

Background: Tetralogy of Fallot with an absent pulmonary valve is a very rare variant of tetralogy. It is characterized by absent valve tissue, severe pulmonary regurgitation, and secondary aneurysmal dilatation of the pulmonary arteries. Aim: In this study, we aim to investigate the clinical presentations, management strategies, and outcomes of patients with tetralogy of Fallot and absent pulmonary valve. Methodology: We retrospectively reviewed the charts of all patients who presented to the American University of Beirut Medical Center between January 2010 and December 2020 and who were diagnosed with this anomaly. Results: A total of 300 cases of tetralogy of Fallot were identified, of which 18 patients had absent pulmonary valves. They were followed up for an average of 8.2 years. Prenatal diagnoses were made in four patients, while 13 patients were identified in the neonatal period, with an average age of 4.5 days. Genetic testing confirmed DiGeorge syndrome in one patient. Five patients underwent surgical intervention in the neonatal period, while the remaining patients were operated on during their early childhood. While overall there were no surgical mortalities nor any need for reinterventions, a variety of morbidities were encountered. Conclusion: This study provides an overview of this rare anomaly and its management in a developing country. [ABSTRACT FROM AUTHOR]

Objective: We sought to examine possible differences in BCC characteristics and treatment patterns between two matched cohorts of Hispanic White and non-Hispanic White individuals. Methods: In this single institution, retrospective matched cohort study, data from patients with biopsy proven BCC from June 2005 to May 2022 was collected. Demographic, BCC, and treatment characteristics were compared between Hispanic White and non-Hispanic White individuals using a Wilcoxon rank-sum test, for continuous and ordinal variables, and Fisher's exact test, for categorical variables. Results: A total of 604 individuals with a diagnosis of biopsy-proven BCC were matched in a 1:1 fashion by age (± 0 years) and sex, based on self-identified ethnicity as Hispanic or non-Hispanic. Since all patients self-identified as White race, the two cohorts were labeled Hispanic White (n=302) and non-Hispanic White (n=302). The most frequent location for BCC was in the H area, 129 [42.7%] White Hispanic group vs 132 [43.7%] White non-Hispanic group (p = 0.87). In both Hispanic White and non-Hispanic White groups, the predominant subtype of BCC was the nodular (149 [50.2%] vs 164 [54.7%], p = 0.25). The median BCC pre-operative size in the Hispanic White group was 0.9 cm, whereas in the non-Hispanic White group, it was 1.0 cm (p = 0.004). Furthermore, the MMS defect size in the Hispanic White group had a median of 1.3 cm, while in the non-Hispanic White group, it was 1.6 cm (p < 0.001). Limitations: Retrospective design, single-center study, and self-reported race and ethnicity. Conclusion: Both groups had similar demographics, tumor features, treatments, and post-operative complications. Notably, preoperative lesion and MMS defect sizes were larger in non-Hispanic Whites than in Hispanic Whites, contrary to expectations. Despite assumptions of poorer skin cancer outcomes among Hispanics, our findings indicate increased sizes in non-Hispanic Whites. Given the diversity in genetics and clinical traits within ethnicities, especially Hispanics, more research is needed for precise insights into disease outcomes across diverse backgrounds. [ABSTRACT FROM AUTHOR]

Background: Contact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates. Purpose: To evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors. Results: In 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button–related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS. Conclusion: The arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a low recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. Purpose: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné–Postel score, and overall patient satisfaction score. Results: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P =.918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P =.336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. Conclusion: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment. [ABSTRACT FROM AUTHOR]

Arthrofibrosis of the knee is regarded a fateful disease with high recurrence rates and an incidence of 2.5-10 % after total knee arthroplasty. If the diagnosis is missed, there is a high chance of developing a stiff joint with tenderness leading up to chronic pain, or a complex regional pain syndrome (CRPS). Therefore, early diagnosis and treatment are crucial in order to avoid such circumstances. The most important goal is to discontinue painful physiotherapy. In a chronic state with limited pain, surgical revision may be considered. The surgical goal is dependent on the localization of fibrotic tissue. The superior recess must be reopened and a cyclops in the intercondylar notch can be removed. Patella baja can be treated by resection of scar tissue or tibial tuberosity transfer. A Judet procedure is hardly necessary in localized cases. From the German Endoprothetic Register (EPRD) there is evidence that a total knee revision should be avoided whenever possible. Rehabilitation programs must adjust to the pain and stiffness symptoms of the patients. Even with optimum treatment strategies, the long term results of these adverse conditions remain limited. [ABSTRACT FROM AUTHOR]

Objectives Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction. Design/Setting This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction. Participants Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation. Main Outcome Measures MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication. Results Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (p = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4). Conclusion Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication. [ABSTRACT FROM AUTHOR]

Aims: Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A1c (HbA1c) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA1c levels on postoperative outcomes in adults who had undergone major noncardiac surgery. Methods: We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA1c within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA1c as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946). Results: Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA1c levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA1c was associated with increased odds of these complications. No association with reoperations and 30‐day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism. Conclusions: Current evidence suggested that higher preoperative HbA1c levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high‐quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes. [ABSTRACT FROM AUTHOR]

Patients with petrous bone cholesteatoma most commonly present with hearing loss and facial paralysis. Other clinical presentations can include otorrhea, tinnitus, aural fullness, otalgia, and dizziness. Here, we report a patient with petrous bone cholesteatoma who presented with cerebrospinal fluid rhinorrhea. This patient was initially misdiagnosed with rhinogenic cerebrospinal fluid leakage, and was finally diagnosed with the supralabyrinthine type of petrous bone cholesteatoma. During the surgical repair through the transmastoid trans-superior semicircular canal approach, the fistula was found in the superior wall of the internal auditory canal. He had satisfactory outcomes after the surgery, with no recurrent cerebrospinal fluid rhinorrhea. [ABSTRACT FROM AUTHOR]

Purpose: This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. Methods: Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. Results: A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). Conclusion: Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to describe the use of retrograde gentamicin-coated tibial intramedullary nail (ETN PROtect™) in patients with tibial defects who required a tibiotalocalcaneal arthrodesis (TTC). Methods: Consecutive series case review of seven men treated with TTC using retrograde PROtect™ between January 2018 and December 2023. The main outcomes evaluated were fracture union, complications, and the health-related quality of life using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Results: The mean age was 45.3 ± 8.0 years. Six patients had a clinical history of chronic osteomyelitis, and one case underwent TTC for congenital pseudoarthrosis. Fracture union was achieved in 5 of 7 patients between 4 and 11 months after surgery. Three patients developed complications; two patients had fistulas, and one had persistent pain. At the end of the follow-up, a median of 70 points (interquartile range: 60 to 90) on the EQ-5D-3L was reported. No complications directly attributed to the use of the PROtect™ were reported. Conclusion: TTC with retrograde PROtect™ is a prophylactic treatment option in patients with tibial defects treated with external fixation requiring a tibiotalar and subtalar arthrodesis. This novel use of PROtect™ allows simultaneous fixation of the tibiotalocalcaneal joint and protection of the regenerated bone, facilitating earlier rehabilitation in patients at high risk for postoperative infections. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic and sacral bone metastases cause significant morbidity. The primary aim of the study is to thoroughly evaluate the increase in functional capacity resulting from combined RF ablation and cementoplasty surgery applied to malignant bone metastases of the pelvic bones. Methods: Twenty patients who underwent RF ablation and cementoplasty for malign pelvic bone and sacrum metastases between January 2014 and December 2021 were retrospectively identified. The inclusion criteria were having a life expectancy of more than 1 month, being > 18 years old, and having at least 1 month of follow-up. The Visual Anlogue Scale (VAS) pain, Karnofsky Performance Status (KP), and Musculoskelatal Tumor Society (MSTS) scores were calculated. Results: VAS pain values decreased, and KP values increased postoperatively (p = 0.006 and p = 0,013). There was no statistically significant increase in MSTS (p > 0.05). The correlation relationships between lesion filling ratio and VAS pain, KP, and MSTS scores were not statistically significant (p > 0.05). Cement leakage was observed in 5 patients (25.0%), and no symptoms related to this leakage were observed. Conclusion: The pelvic region, given its close proximity to blood vessels, nerves, and joint areas, along with the distinct challenges associated with its surgery, requires separate evaluation. In studies evaluating applications in the isolated pelvic ring region, as in our study, functional gains have been most comprehensively assessed in this study, demonstrating that the procedure results in significant functional improvements. [ABSTRACT FROM AUTHOR]

Purpose: This cohort study aimed to describe the functional outcomes, complications, and mortality of patients over 65 with acute distal femur fractures treated with open reduction and internal fixation (ORIF) or distal femoral replacement (DFR). Methods: We retrospectively analyzed all patients older than 65, operated consecutively for a distal femur fracture treated with ORIF or DFR. We included 75 patients (9 33A, 5 33B, and 61 33C AO/OTA fractures), 55 treated with ORIF, and 20 with DFR. We used Parker's mobility index (PMI) to assess functional outcomes at 1, 3, and 12 months and study closure. We analyzed complications, reoperations, and mortality at 30 days, one year, and at the end of the study. Results: The PMI was significantly higher in the DFR group at months 1 (p = 0.023) and 3 (p = 0.032). We found no significant differences between cohorts at one year and the end of follow-up. Postoperative complications were significantly more frequent in the ORIF group (38.10% vs. 10%, p = 0.022). Reoperations were similar in both cohorts (p = 0.98). Mortality at one month was 4% and 20% at one year, and at the end of follow-up, there were no significant differences between groups. Conclusion: The outcomes of this study suggest that DFR offers a faster functional recovery with lower complication rates than those treated with ORIF. Additionally, both options have similar reoperation and mortality rates. Appropriately designed studies are needed to define the best treatment strategy for this type of patient. [ABSTRACT FROM AUTHOR]

Purpose: To report the functional results of our experience and to describe intraoperative findings and complications due to the techniques used in our service. Methods: From January 2018 to December 2022, 27 Pediatric patients aged from 8 to 16 years underwent surgery to treat proximal humerus fractures. Their demographic characteristics were evaluated, as well as their clinical characteristics on admission, type of reduction (closed/open), presence of interposition in open reductions, type of implant, complications, and functional range of movement according to two shoulder functional scores. Results: Mean age was 11.2 years (8–15), there was a predominance of males, who accounted for 70% of the cases, and sports accidents were the cause of injury in 44% of the cases. Anatomical location was balanced between patients, including 55% of physeal fractures and 45% of metaphyseal ones. Overall, 81.5% of patients required open reduction to achieve axis correction, and that 55.5% of fractures were fixed with Kirschner wires, and 44, 4% with elastic titanium nails. Mean QuickDASH score was 0.58 (0–1.7), and Constant score was 9 (3–24). There were no major complications, but 27% of cases subjected to open reduction presented a hypertrophic scar. Conclusion: Surgical treatment of severely displaced proximal humerus fractures is successful, both with closed and open reduction; type of implant does not play a key role and should be selected based on the characteristics of each case. Surgical training should prevail at the time of decision-making. When these recommendations are followed, results can be excellent and sequelae are infrequent. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess differences in clinical and surgical outcomes associated with the surgical treatment of midshaft clavicle fractures of different complexities based on fragment number. Additionally, the investigation seeks to present the outcomes of a series of patients who underwent surgery at our institution. Materials and methods: A retrospective analysis was conducted on the medical records of patients aged over 18 who underwent midshaft clavicle fracture surgery at our center from November 2009 to May 2021. Patients were categorized based on the number of fracture fragments into groups of two, three, or more than three fragments. Consolidation, implant removal, complications, surgical duration, and functional outcomes (assessed through VAS, ASES, and Constant–Murley scale) were evaluated for each specific group and for the overall cohort. Results: In total, 260 patients were analyzed. There were no significant differences in any of the parameters between the three groups except for surgical time, which was shorter in simple fractures than in those with more than three fragments (68.2 min vs. 75.3 min; p = 0.01). Pseudoarthrosis rate was 2.69%, implant removal rate was 9.61%, and 4.23% of patients presented with complications other than the previous ones. Functional results were excellent, with averages of 97.3 (72.7–100) for the ASES score, 97.5 (75–100) for the Constant score, and 0.6 (0–8) on the VAS. Conclusion: According to our results, there were no differences in postoperative results between simple and multifragmentary midshaft clavicle fractures. Patients across all groups reported satisfactory results. [ABSTRACT FROM AUTHOR]

Purpose: To review surgical complications after fixation of stress-positive minimally displaced (< 1 cm) lateral compression type 1 (LC1) pelvic ring injuries. Methods: A retrospective study at a level one trauma center identified patients who received surgical fixation of isolated LC1 pelvic ring injuries. Surgical complications and additional procedures were reviewed. Results: Sixty patients were included. The median age was 61 years (Interquartile range 40–70), 65% (n = 39) were women, and 57% (n = 34) had high-energy mechanisms. Anterior–posterior, posterior-only, and anterior-only fixation constructs were used in 77% (n = 46), 15% (n = 9), and 8% (n = 5) of patients. Anterior fixation was performed with rami screw fixation in 82% (49/60), external fixation in 2% (1/60), and open reduction and plate fixation in 2% (1/60). There were 15 surgical complications in 23% (14/60), and 12 additional procedures in 17% (10/60). Complications included loss of reduction ≥ 1 cm (8%), symptomatic hematomas (8%), symptomatic backout of unicortical retrograde rami screws (5%), deep infection of the pelvic space after a retrograde rami screw (1.6%), and iatrogenic L5 nerve injury (1.6%). All losses of reduction involved geriatric females with distal rami fractures sustained in ground-level falls. Loss of reduction was found to be more likely in patients with low energy mechanisms (proportional difference (PD) 62%, 95% confidence interval (CI) 18% to 76%; p = 0.01) and 2 versus 1 posterior pelvic screws (PD 36%; CI 0.4% to 75%; p = 0.03). Conclusions: Surgical complications and additional procedures routinely occurred after fixation of LC1 injuries. Patients should be appropriately counseled on the risks of surgical fixation of these controversial injuries. Level of Evidence: Diagnostic, Level III. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of vascular injury associated with knee arthroplasty is scarce, but, when they occur, the consequences are serious. Objectives: Describe the incidence of vascular lesions in our center and evaluate time to diagnosis, resolution and follow-up. Materials and methods: Retrospective cohort during the 2010–2019 period of primary arthroplasties and knee revision. The incidence of vascular lesions and their demographic characteristics were analyzed. Type of lesion, diagnostic method and treatment were recorded. It was evaluated in distant follow-up of pain and functionality. Results: 7.940 primary total knee arthroplasty and revision surgeries were recorded, and a report of 7 emergency cases for vascular lesions was also recorded, with an incidence of 0.088%. 3 vascular lesions were caused by direct laceration of the popliteal artery, 1 case of thrombosis of the popliteal artery and 3 cases of pseudoaneurysmal lesion of the superior genicular artery. Three vascular lesions that occurred in primary arthroplasty were immediately repaired by a vascular surgeon. Pseudoaneurysm lesions and thrombosis were resolved by angiographic procedure. Discussion: Vascular complications around the knee are rare. Time to diagnosis and treatment is essential. Digital angiography is a diagnostic and therapeutic tool. There are various repair techniques, whether it's embolization, cauterization, stenting or endoprosthesis; therefore, digital angiography is a safe method with a low complication rate. Conclusion: The incidence of vascular lesions in knee arthroplasty in our center is very low. The cases were diagnosed and resolved early, without registering subsequent complications with good functional results in distant follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Underweight patients experience poor outcomes after elective orthopaedic procedures. The effect of underweight body mass index (BMI) on complications after acetabular fracture is not well-described. We evaluate if underweight status is associated with inpatient complications after acetabular fractures. Methods: Adult patients (≥ 18 years) presenting with acetabular fracture between 2015 and 2019 were identified from Trauma Quality Program data. Adjusted odds (aOR) of any inpatient complication or mortality were compared between patients with underweight BMI (< 18.5 kg/m2) and normal BMI (18.5–25 kg/m2) using multivariable logistic regression and stratifying by age ≥ 65 years. Results: The 1299 underweight patients aged ≥ 65 years compared to 11,629 normal weight patients experienced a 1.2-times and 2.7-times greater aOR of any complication (38.6% vs. 36.6%, p = 0.010) and inpatient mortality (7.9% vs. 4.2%, p < 0.001), respectively. The 1688 underweight patients aged 18–64 years compared to 24,762 normal weight patients experienced a 1.2-times and 1.5-times greater aOR of any inpatient complication (38.9% vs. 34.8%, aOR p = 0.006) and inpatient mortality (4.1% vs. 2.5%, p < 0.001), respectively. Conclusion: Underweight adult patients with acetabular fracture are at increased risk for inpatient complications and mortality, particularly those ≥ 65 years old. Level of Evidence: Prognostic Level III. [ABSTRACT FROM AUTHOR]

Digital replantation is a challenging and at-time tedious operation, but if approached thoughtfully and with reasonable expectations can be a reliable and rewarding undertaking. This article summarizes technical considerations for digital replantations involving flexor tendon zone II. The article has been ordered according to the recommended sequence of a structure-by-structure repair in a non-thumb digit. Special considerations are described for thumb, multiple digits, and heterotopic replantation. [ABSTRACT FROM AUTHOR]

Purpose: To determine union and displacement metrics following percutaneous screw fixation (antegrade or retrograde) of superior pubic rami fractures. Methods: This is a retrospective cohort study from a single level 1 trauma center. Skeletally mature patients with at least one superior pubic ramus fracture present as part of a lateral compression-type pelvic ring injury were included. Results: Eighty-five (85) patients with 95 superior pubic rami fractures met the study's inclusion criteria. LC1, LC2, and LC3 injuries occurred in 76.5%, 15.3%, and 8.2% of patients, respectively. The majority of patients underwent concurrent posterior pelvic ring fixation (94.1%). Superior ramus screw placement occurred predominantly via retrograde technique (81.1%) with cannulated screws of size 6.5 mm or larger (93.7%). Of the 95 eligible fractures, 90 (94.7%) achieved union at a mean of 14.0 weeks (7–40 weeks). Of these united fractures, 69 (76.7%) healed with no measurable displacement, while the remaining 23.3% healed with residual mean displacement of 3.9 mm (range: 0.5–9.0 mm). Multivariable analysis demonstrated a positive association between age (p = 0.04) and initial displacement (p = 0.04) on the final degree of residual displacement at union. A Kaplan–Meier survival analysis identified increased age to be significantly related to increased time to union (X2 (2) = 21.034, p < 0.001). Conclusions: Union rates following percutaneous screw fixation of superior pubic rami fractures associated with lateral compression-type pelvic ring injuries approach 95%. Though minimal in an absolute sense, increasing age and a greater degree of initial displacement may influence the final degree of residual displacement at union. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Introduction: Obesity remains a global epidemic. The effect of obesity on the risk of complications after acetabular fracture is unknown. Here, we evaluate the effect of BMI on early complications and mortality after acetabular fracture. We hypothesize that the risk of inpatient complications and mortality will be greater in patients with high BMI when compared to those with normal BMI. Methods: Adult patients with acetabular fracture were identified via the Trauma Quality Improvement Program data from 2015 to 2019. The primary outcome was overall complication rate with reference to normal-weight patients (BMI = 25–30 kg/m2). The secondary outcome was rates of death. The association of obesity class on the primary and secondary outcomes was assessed using Bonferroni-corrected multiple logistic regression models considering patient, injury, and treatment covariates. Results: A total of 99,721 patients with acetabular fracture were identified. Class I obesity (BMI = 30–35 kg/m2) was associated with 1.2 greater adjusted relative risk (aRR; 95% confidence interval (CI) 1.1–1.3) of any adverse event, without significant increases in adjusted risk of death. Class II obesity (BMI = 35–40 kg/m2) was associated with aRR = 1.2 (95% CI 1.1–1.3) of any adverse event and aRR = 1.5 (95% CI 1.2–2.0) of death. Class III obesity (BMI ≥ 40 kg/m2) was associated with aRR = 1.3 (95% CI 1.2–1.4) of any adverse event and aRR = 2.3 (95% CI 1.8–2.9) of death. Conclusion: Obesity is associated greater risk of adverse events and death following acetabular fracture. Obesity severity classification scales with these risks. [ABSTRACT FROM AUTHOR]

Purpose: Patient-reported minimal clinically important differences (MCID) provide a standard to compare clinical outcomes. The purpose of this study was to calculate the MCID of PROMIS Physical Function (PF), Pain Interference (PI), Anxiety (AX), and Depression (DEP) scores in patients with pelvis and/or acetabular fractures. Methods: All patients with operatively treated pelvic and/or acetabular fractures were identified. Patients were categorized as either only pelvis and/or acetabular fractures (PA) or polytrauma (PT). PROMIS PF, PI, AX, and DEP scores were evaluated at 3-month, 6-month, and 12-month intervals. Distribution-based MCID and anchor-based MCID were calculated for the overall cohort, PA, and PT groups. Results: The overall distribution-based MCIDs were PF (5.19), PI (3.97), AX (4.33), and DEP (4.41). The overall anchor-based MCIDs were PF (7.18), PI (8.03), AX (5.85), DEP (5.00). The percentage of patients achieving MCID for AX was 39.8–54% at 3 months and 32.7–56% at 12 months. The percentage of patients achieving MCID for DEP was 35.7–39.3% at 3 months and 32.1–35.7% at 12 months. The PT group had worse PROMIS PF scores than the PA group at all time points [post-operative, 3-month, 6-month, and 12-month scores, (28.3 (6.3) vs. 26.8 (6.8) P = 0.016), (38.1 (9.2) vs. 35.0 (8.7) P = 0.037), (42.8 (8.2) vs. 39 (9.6) P = 0.015), (46.2 (9.7) vs. 41.2 (9.7) P = 0.011)]. Conclusion: An overall MCID for PROMIS PF was 5.19–7.18, PROMIS PI 3.97–8.03, PROMIS AX of 4.33–5.85, and PROMIS DEP of 4.41–5.00. The PT group had worse PROMIS PF at all time points. The percentage of patients achieving MCID for AX and DEP plateaued at 3 months post-operatively. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background: The SYNCHRONOUS-study investigates simultaneous ASV-ablation with great saphenous vein (GSV) treatment in endovenous laser ablation (EVLA) for preventing varicose vein recurrence. This sub-study examines complication rates associated with prophylactic ASV-ablation. Methods: Among 1173 patients with refluxing GSV, 604 underwent GSV-ablation only, and 569 received additional ASV-ablation. Complication rates were compared over 6 months. Results: Approximately 80% of patients were complication-free with minor bruising and dysesthesia being most common complications. After 6 months, additional prophylactic ASV-ablation did not increase the rate of complications compared to GSV-only treatment. Conclusion: The 6-months follow-up data suggests that prophylactic ASV-closure, alongside GSV-treatment, is safe, with similar complication rates to GSV-only EVLA. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Robot-assisted radical nephroureterectomy (RANU) has emerged as a valid alternative to open or laparoscopic nephroureterectomy in recent years. However, different types of robotic platforms can limit surgical maneuvers in various ways. This study aimed to describe the surgical procedure and demonstrate RANU's technical feasibility and safety using the Hugo robot-assisted surgery (RAS) system. Materials and Methods: Using the Hugo RAS system, we reported data from the first five consecutive patients who underwent RANU at Tottori University Hospital. We adjusted the docking angles of the four independent arm carts in each case and performed a complete RANU via a transperitoneal approach. We collected patients' sociodemographic and perioperative data, including complications, and compared them retrospectively with data obtained using the da Vinci surgical system. Results: Arms positions were modified after the first patient to be placed all at the back of the patient. Median overall operative time was 283 minutes (203–377) and the median time using the robotic system was 187 minutes (121–277). The median estimated blood loss was 20 mL (5–155). None of the patients required a blood transfusion and none suffered postoperative complications of Clavien–Dindo grade ≥3. These outcomes were similar to those obtained with the da Vinci Xi system. Conclusion: This series represents the first report of RANU executed using the novel Hugo RAS system. Our proposed arm-setup will assist other surgeons and help ensure safe implementation of RANU on the Hugo platform. [ABSTRACT FROM AUTHOR]

Aim: To describe the operative technique and outcome of one trocar-assisted retroperitoneoscopic ureteroureterostomy (OTAU) in 40 cases of complete ureteral duplication in children. Patients and Methods: From September 2016 to December 2020, 40 patients (12 male and 28 female) less than 10 years of age underwent OTAU. A transverse skin incision of 12 mm in length was created approximately 1 cm above the iliac crest. Muscle was spared and retracted with stay sutures to expose the retroperitoneal space. Subsequently, a balloon trocar was then inserted, and pneumoperitoneum was achieved. A 10 mm operating laparoscope (Stema, Germany) with a Maryland was used to dissect and isolate the ureters from surrounding tissues. The ureters were then exteriorized and end-to-side ureteroureterostomy was performed using Polydioxanone (PDS) 6/0 running sutures. Patient's demographic, operative, and follow-up data were collected prospectively. Results: The mean age of patients was 25.2 months (range: 1–105 months). The mean operating time was 81.9 ± 11.3 minutes. There were no intraoperative conversions or complications. After a median follow-up time of 47.5 months, the differential renal function of the pathological upper pole moiety (UPM) was preserved in all patients. Ultrasound revealed a significant reduction in UPM's renal pelvis anterior–posterior diameter from 19.6 ± 9.1 mm preoperatively to 11.1 ± 6.7 mm postoperatively (p < 0.05), accompanied by a reduction in ureter's diameter from 10.8 ± 4.4 mm to 4.8 ± 1.2 mm (p < 0.05). Overall, all 32 patients with preoperative symptoms experienced complete symptom resolution. Conclusion: OTAU is a safe and feasible approach that yields excellent outcomes for complete ureteral duplication. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to report our experience in the treatment of children with retrocaval ureter (RCU) using laparoscopic ureteral reconstruction surgery. Patients and Methods: We retrospectively collected clinical data from 10 pediatric patients with RCU who underwent laparoscopic surgery at our hospital from April 2010 to April 2022. All patients underwent comprehensive preoperative radiological assessment and were diagnosed with RCU, subsequently undergoing laparoscopic ureteral reconstruction. Patient demographics, surgical data, and postoperative outcomes were recorded. Regular follow-ups were conducted postoperatively, evaluating clinical symptoms and radiological results. Results: The median age of the 10 patients was 8.8 years (range, 6–14 years). All surgeries were successfully performed laparoscopically without the need for open conversion, with an average surgical time of 153.3 minutes (range, 120–243 minutes). Intraoperative bleeding was minimal and no blood transfusions were required. No intraoperative complications were observed. The average hospital stay for the patients was 5.3 days (range, 4–7 days) and the Double-J (D-J) stent was removed 6 weeks postoperatively. Follow-up ultrasound results at 3 and 6 months postoperatively showed a reduction in renal pelvic dilatation, and all patients experienced significant relief of clinical symptoms related to flank and abdominal discomfort. Conclusion: Laparoscopic reconstruction for RCU demonstrates good feasibility and effectiveness in pediatric patients, offering a minimally invasive treatment option for the management of RCU in children. [ABSTRACT FROM AUTHOR]

The relationship between meningiomas and gonadal steroid hormones has been the subject of debate, and there is limited understanding of the connection between patient, tumor characteristics, and progesterone receptor (PGR) status. This retrospective observational study aims to explore the prognostic correlation between PGR+ and PGR-meningiomas in terms of various clinical, radiological, and surgical predictors. The analysis included 270 patients, divided into 2 groups: group A (PGR-, 194 patients), and group B (PGR+, 76 patients). The analysis showed no significant differences in terms of age, sex, clinical debut, postsurgical complications, total resection, and grading between the 2 groups. However, a significant difference was observed in the mean Karnofsky performance status at all stages of follow-up. Peritumoral edema measured in preoperative magnetic resonance imaging significantly influences the value of Karnofsky performance status in both preoperative (ANOVA, P = 0.05) and postoperative evaluation (postoperative ANOVA, P = 0.014) only in group A. In the multivariate analysis, there are no significant factors related to the clinical, biological, and surgical parameters previously examined for each measurement time (P = 0.826). The study found that PGR + meningioma patients tend to have better postoperative recovery and earlier clinical debut without any association with age prevalence or grading. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the efficacy and safety of preoperative embolization, used 48 hours before surgery to reduce tumor size and surgical complications in carotid body paragangliomas. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Cochrane Handbook. A comprehensive literature search was performed in Medline, Embase, Web of Science, and Cochrane databases. The inclusion criteria were: 1) observational studies, 2) reporting on diagnosed carotid body paragangliomas, 3) undergoing preoperative embolization procedures, and 4) with ethylene-vinyl alcohol as an embolic agent. The study analyzed 106 patients, aged 18–79, using primarily Onyx 18 for embolization, with treatment intervals ranging from 24 hours to 2 weeks. Efficacy outcomes showed near-total devascularization in 67% of cases (95% confidence interval [CI]: 0.47–0.87; I² = 74%), subtotal devascularization in 33% (95% CI: 0.12–0.54; I² = 43%), and total devascularization in 97% (95% CI: 0.88–1.00; I² = 41%), indicating significant heterogeneity across outcomes. The mean estimated blood loss was 184.46 ml (95% CI: 116.72–252.20 ml). Postembolization complication rate was exceptionally low at 1% (95% CI: 0.00–0.06; I² = 0%). In conclusion, preoperative embolization of carotid body tumors achieved high rates of devascularization with minimal blood loss and a very low incidence of complications, highlighting its effectiveness and safety as a treatment strategy. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the prevalence and treatment of osteoporosis in patients undergoing long spinal fusion for adult spinal deformity (ASD) and compare the impact of osteoporosis treatment on surgical and radiographic outcomes. We conducted a retrospective study of adult patients aged ≥40 years who underwent thoracolumbar ASD surgery at a single academic center between 2015 and 2021. We recorded demographic information, procedural details, and pharmacologic treatments. Primary outcomes included preoperative and postoperative sagittal vertical axis, pelvic incidence-lumbar lordosis mismatch, and postoperative complications such as surgical site infection, pseudarthrosis, proximal junctional kyphosis (PJK), and proximal junctional failure. Patients with osteoporosis were compared to those without. Among 168 patients, the prevalence of osteoporosis was 28.6%. Osteoporotic patients were older and predominantly female. At the time of surgery, 70.8% of osteoporotic patients were receiving pharmacologic treatment. Preoperative pelvic incidence-lumbar lordosis mismatch and sagittal vertical axis did not differ significantly between osteoporotic and nonosteoporotic cohorts. Both cohorts showed similar postoperative improvements. The osteoporotic cohort had a higher rate of PJK (35.4% vs. 17.5%, p=0.01), but no significant difference in proximal junctional failure rates. No significant differences were found between monotherapy and combination therapy outcomes for osteoporotic patients. Osteoporotic patients undergoing ASD surgery exhibited similar surgical outcomes and alignment improvements compared to nonosteoporotic patients, despite a higher rate of PJK. Pharmacological treatment appears beneficial in managing osteoporosis-related surgical risks. These findings highlight the importance of identifying and treating osteoporosis in ASD patients to minimize complications. [ABSTRACT FROM AUTHOR]