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A sinus tract is an abnormal channel that communicates between the skin and the joint, and meets one of the major criteria that is diagnostic of periprosthetic joint infection (PJI). The purpose of this study was to compare the risk factors and the microorganism profile of PJI of the knee with an overlying sinus tract to PJI without a sinus tract. This was a retrospective case-control study of PJI following total knee arthroplasty with and without the presence of an overlying sinus tract from 1996 to 2020. There were 2,685 unique cases of chronic PJI following total knee arthroplasty, of which 405 cases (15.1%) had a sinus tract and 2,280 cases (84.9%) did not. Univariate and multivariate analyses were performed to evaluate risk factors and the microorganism profiles of the 2 groups. Odds ratios with 95% confidence intervals were reported. After adjusting for potential confounders in the multivariate analysis, the presence of a sinus tract was associated with a history of severe liver disease (P =.039; odds ratio: 1.99; 95% confidence interval: 1.04 to 3.84). Polymicrobial infections comprised 41.7% of PJI in the sinus tract group, compared to 29.1% in patients who did not have a sinus tract (P <.001). Of the monomicrobial PJI, Staphylococcus aureus (P <.001), Enterococcus faecalis (P <.001), Enterobacter cloacae (P =.002), Corynebacterium species (P =.037), Proteus mirabilis (P =.028), coagulase-negative Staphylococci (P =.019), and Candida albicans (P =.029) were more common in patients who had a sinus tract. The microbiology profile is significantly different in patients who have PJI of the knee with a sinus tract. These findings can guide the surgeon with surgical planning and selecting the appropriate antibiotic-loaded bone cement and empiric antibiotic treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVES: to determine the outcomes of hypospadias correction using the Snodgrass (tubularized incised plate) technique, specifically examining the impact of patient age and surgery duration on overall results and to evaluate cosmetic outcomes based on parent and patient satisfaction scores. METHODS: This prospective cohort study was conducted between January 2021 and July 2022 in the Pediatric Surgery Department of Lady Reading Hospital, Peshawar-Pakistan. Children aged 6 months to 16 years with distal penile hypospadias repaired using the Snodgrass technique were included. Exclusion criteria were previous hypospadias repairs, proximal hypospadias, and loss to follow-up. All patients were monitored for 3 months’ post-surgery for complications and cosmetic outcomes, assessed using the pre-validated Pediatric Penile Perception Scale. RESULTS: One hundred & thirty-six patients were divided into three groups: Group-A (6–18 months) with 27 patients (19.8%), Group-B (18 months–3 years) with 51 patients (37.5%), and Group-C (>3 years) with 58 patients (42.6%). The most common complication was urethrocutaneous fistula (9.6%), followed by meatal stenosis (5.1%) and bleeding (3.7%). Group-A had the highest rates of urethrocutaneous fistula (25.9%) and skin necrosis (7.4%) with p-values of 0.004 and 0.017, respectively. Patients with surgical durations ≤74 minutes had a significantly higher incidence of residual chordee. Over two-thirds of parents and patients reported satisfaction with cosmetic outcomes after 3 months. CONCLUSION: Snodgrass technique effectively corrects hypospadias, with both patient age and surgical duration significantly impacting outcomes. Delayed surgery, combined with careful technique, led to fewer complications and improved cosmetic results, contributing to high satisfaction among families.

Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Abstract Background This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). Methods Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. Results All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. Conclusions This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.

Uterocutaneous fistula is a rare pathology that commonly occurs following uterine surgeries, endometriosis, chronic infection, malignancy, and foreign bodies. Many diagnostic and management strategies have been practiced. In this case series, we describe three cases of uterocutaneous fistula following cesarean and myomectomy, which was diagnosed clinically, confirmed by magnetic resonance imaging, and managed successfully by surgery with fertility preservation.

Vipul D Yagnik,1 Kaushik Bhattacharya,2 Pankaj Garg,3 Prema Ram Choudhary,4 Mrunal Sadhu,5 Sushil Dawka6 1Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India; 2Department of Surgery, MGM Medical College, Kishanganj, BR, India; 3Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, HR, India; 4Department of Physiology, Banas Medical College and Research Institute, Palanpur, India; 5Final Year MBBS Student, Pramukhswami Medical College, Karamsad, GJ, India; 6Department of Surgery, SSR Medical College, Belle Rive, MauritiusCorrespondence: Vipul D Yagnik, Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India, Email vipul.yagnik@gmail.comAbstract: This article explores the potential benefits and challenges of incorporating Patient-Generated Images (PGIs) into the clinical practice for perianal conditions. PGIs refer to photographs (and video) captured by patients themselves of affected areas of their own bodies to illustrate potential pathologies. It facilitates remote patient assessments and swift evaluation for coloproctologist. They potentially reduce the need for in person follow-up particularly after operation if the patient is asymptomatic. However, concerns with PGI include quality of images, risk of misinterpretation, ethical, legal, and practical problems, especially when imaging private or sensitive body regions. Any platform transmitting and storing PGIs should prioritize data protection with advanced encryption. Comprehensive guidelines should be developed by collaboration between healthcare administrators, regulators, and professionals, and a thorough framework formulated to ensure that quality care is delivered always while respecting patient privacy and dignity. It should be considered as complementary to, rather than a replacement for, traditional clinical consultations. However, patient awareness and education regarding the limitations are key to ensuring that this modality is not misinterpreted or misused.Keywords: fistula, haemorrhoids, fissure in ano, telemedicine, patient generated images

Background. Obtaining accurate data on the epidemiology of periprosthetic joint infection (PJI) of the hip in the Russian Federation is a challenging task, which is associated with the peculiarities of statistical registration of complications and the lack of approved routing schemes. The aim of the study — to provide the results of primary analysis of the data from the local registry of hip periprosthetic infection, which reflects all the treatment cases from 01.01.2020 to 31.12.2020. Methods. Since 2021, the Center has been working on retrospective input of the data on patients PJI of the hip treated at the clinic into the electronic version of the registry. The information was collected by studying archived medical records and a medical information system, by examining patients in the outpatient clinic, and by interviewing patients via mobile phone and e-mail. During the period, we treated 449 patients with hip periprosthetic infection. The mean patients’ age was 55.6±12.6 years (Ме — 57; 95% CI: 54.4-56.8). Male patients accounted for 61.6% (n = 277). Results. We were able to evaluate the treatment results in 84% (n = 377) of patients. The mean follow-up period was 5.92±2.55 years (Me — 6; 95% CI: 2.39-2.73). In more than 90% (n = 407) of cases, the infection was classified as chronic (more than 3 weeks of manifestation). At the admission 76,8% (n = 345) of patients had a fistula communicating with the joint cavity. The percentage of lethal outcomes due to sepsis was 1,7% (8/449); recurrences of hip PJI was observed in 6.2% (28/ 449) of cases. Resolution of infection has been achieved in 67% (300/449) of cases. Conclusions. The primary analysis of the data from the local registry of hip periprosthetic infection of the national Ilizarov Center of Traumatology and Orthopedics showed that the average age of patients with hip PJI in our country is significantly lower than in the known national registries. At the same time, the infectious agents were similar: Gram-positive microorganisms accounted for more than 55%. The analysis of the registry data shows a significant decrease in the PJI recurrence rate over the last 5 years.

Abstract Background Studies on fertility desires among fistula patients in the Democratic Republic of Congo (DRC) have been conducted on fewer patients. Furthermore, these studies have adopted a univariate descriptive approach. This study aims to examine the determinants of fertility desires among patients with fistula in the DRC. Methods This cross-sectional study included women aged 15–49 whose fistulas were repaired by the Panzi Hospital mobile team in seven DRC regions between 2013 and 2018. Univariate and bivariate descriptive analyses were performed using the frequency distribution table and the chi-square test. Adjusted odds ratios with their 95 confidence intervals from logistic regression were used to analyze factors associated with fertility desire after fistula repair. All analyses were stratified by parity level for all women aged 15–49 and 20–34 years. Results Of the 1,646 women aged 15–49 and 808 aged 20–34, 948 (57.6%) and 597 (73.8%), respectively, wanted to have children after fistula repair. Among women aged 15–49 and 20–34 years, the desire to have children was parity-specific. It was negatively associated with age at all parity levels. In women with low parity, the desire for children was significantly negatively associated with a high number of surgeries, abortions, and fistula duration. It tended to decrease with time, but was particularly high in 2014 and 2017. It was high among the Protestant women. Among medium-parity women, it was significantly lower in urban areas and among widows, but higher among women who had more than two abortions. Among high-parity women, it was negatively associated with education level. Conclusion To help women with fistula achieve or approach their desired number of children, our findings suggest that (1) counseling is needed for women with a high desire for children; (2) the human, material, and financial resources needed to eliminate fistula in the DRC should be made available; and (3) medical and nursing staff should be sufficiently and effectively trained to minimize the number of unsuccessful surgeries performed on women with fistula.

Stenosis of the portal vein is one of the main complications after hepatobiliar and pancreatic surgery, with a reported incidence of 19.6% after pancreaticoduodenectomy and 3% after liver transplant. It is associated with the intraoperative resection of the portal vein, local recurrence of the primary tumor and radiotherapy. The portal lesion secondary to bile drainage catheter insertion is extremely rare or unusual, with few cases described in the literature. This article describes 2 cases: the first of a male patients 49 years old post-operative to liver transplant with partial portal thrombosis and stenosis of the mesoportal joint, and the second a female patient 50 years old with history of cholecystectomy, exploration of the bile duct and placement of Kehr “T” tube with secondary portal lesion. The 2 cases were successfully treated through minimally invasive procedures by an interventionist radiologist.

Introduction: Urethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery. Methods: A retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires. Results: Among 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8). Discussion: Our study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention. [ABSTRACT FROM AUTHOR]