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Background: A common complication of bicanalicular intubation is dislocation of the silicone tube. Methods: Eleven patients with prolapsed silicone tubes who had undergone bicanalicular nasal intubation were injected with a 2 per cent lidocaine solution to infiltrate the lacrimal duct mucosa. A memory wire probe was used to pull a 4-0 suture through the lacrimal passage retrogradely, allowing the suture to grab the silicone tube. Paraffin oil was applied to the contact part of the rope and the silicone tube, then the distal end of the silk thread was removed from the nostril until the tube was pulled into place. Results: The prolapsed silicone tubes were restored by surgery in nine patients, with the drainage tube in the correct position in the eye and the lacrimal duct irrigation unobstructed. Conclusion: The optimisations made in this study are considered effective adjustments of reduction surgery for a prolapsed silicone tube. [ABSTRACT FROM AUTHOR]

Background: Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy. Methods: In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively. Results: The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61–46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9 mm; OR, 8.22; 95% CI, 2.50–27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development. Conclusions: Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP. [ABSTRACT FROM AUTHOR]

Background: Accidental injuries sustained during helocasting remain unexamined. Methods: Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed. Results: Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome. Conclusions: Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/ speed and adherence to their ideal limits, at despatch, may avert such injuries. [ABSTRACT FROM AUTHOR]

Objective • This study was to analyze and compare the clinical efficacy of open reduction and internal fixation through posterolateral and the posterior medial approach to treat Haraguchi Type II posterior malleolar fracture. Methods • The clinical data of 91 patients with trimalleolar fractures sent to our hospital from January 2018 to January 2020 were analyzed. All of the patients were the result of traumatic injuries, such as sprains or car accidents. All patients were treated with open reduction and internal fixation and divided into control group and observation group according to different surgical approaches. Forty-five cases were treated with the posterolateral approach(control group) and forty-six cases treated with the posteriormedial approach(observation group) . The operation status of the two groups (operating time, intraoperative blood loss, postoperative drainage, and hospital stay), postoperative status (visual analogue scale (VAS) before the operation, 1d, 3d and 7d after operation), the score of patient’s American orthopedic foot and ankle society (AOFAS) at the time of discharge, fracture healing time and full weight-bearing time), efficacy and safety were recorded. Results • All cases underwent surgery, with no significant difference in the time from fracture to surgery between the control and observation groups (P > .05). Compared to the control group, the operating time, intraoperative blood loss, postoperative drainage, and hospital stay in the observation group were significantly reduced (P < .05). One day after the operation, no significant difference was shown in VAS between 2 groups (P > .05), while AOFAS score in the observation group was significantly increased (P < .05). Three and 7 days after the operation, VAS, fracture healing time, and full weight-bearing time were significantly decreased in both groups (P < .05). In the control group, the cases with excellent, good, fair, and poor efficacy were 26, 8, 5, 6, with an acceptable rate of 86.67% (39/45). In the observation group, the cases with excellent, good, fair, and poor efficacy were 29, 10, 5, and 2, with an acceptable rate of 95.65% (44/46). There was no significant difference in efficacy between the 2 groups (P > .05). During the follow-up time of 12~27 months (the median time of 18.5 months), all patients showed first-stage grade A healing, and osseous union with good fixation position and no fracture, deformation, loosening or prolapse, and no sural nerve injury or incision infection occurred. Conclusion • Both the posterolateral approach and posterior medial approach open reduction and internal fixation can be used to treat Haraguchi type II posterior malleolus fractures, with good efficacy and safety. The posterior medial approach showed faster recovery and less damage than the posterolateral approach. Overall, the posterolateral approach is more dominant in the treatment of Haraguchi Type II posterior malleolar fracture. [ABSTRACT FROM AUTHOR]

Background: Coatis are mammals of the order Carnivora, Procyonidae family. Despite the animals being widely distributed in Brazil, the species is classified as threatened in the Rio Grande do Sul state. The main threat factor for the species is deforestation and fragmentation of forests, as well as hunting and being run over on highways. Captivity coatis are subject to nutritional disorders, with adipose tissue accumulation in the abdominal region and obesity. In addition, procionids can present ectoparasites, such as fleas, lice, and ticks. Since there is a lack of information regarding diseases in captivity animals, this report aimed to describe a case of rectal prolapse in a coati. Case: An approximately 2-year-old captivity ring-tailed coati (Nasua nasua) male, 1.7 kg of body mass, was restless and uncomfortable when sitting down after fighting with other animals in the group. Physical examination revealed a 5 cm prolapse, initially managed by manual reduction and purse-string suture around the anus. The copro-parasitological exams using the Willis-Mollay and Faust techniques were negative. Complete blood count showed mild normochromic normocytic anemia, hypoproteinemia, thrombocytopenia, and leukocytosis due to neutrophilia and monocytosis. Biochemical examination revealed hypocalcemia, and the animal was treated with calcium. Rectal prolapse recurred even after the purse-string suture. Therefore, incisional colopexy was performed through a ventral midline celiotomy to promote a permanent adhesion between the colon and abdominal wall. The animal evolved uneventfully and returned to its original enclosure 30 days after surgery. However, the coati was kept separate from the others until complete readaptation. In the last evaluation 6 months after colopexy, the animal showed no signs of recurrence and had a total integration into the group. Discussion: Several factors may contribute to the development of complete rectal prolapse in domestic dogs and cats, such as prostatic diseases, cystitis, urolithiasis, constipation, rectal foreign bodies, and perineal surgeries. However, these factors have not been identified in the current case. Furthermore, the lesion may occur secondary to colitis, enteritis, or endoparasitism in young domestic dogs and cats. In the present case, the animal was an adult whose coproparasitological examination was negative, eliminating these causes. On the other hand, 2 factors may have contributed, including the fight with other individuals of the same species and hypocalcemia. Although these 2 factors resolved with the separation of the animal and calcium replacement treatment, the prolapse recurred even after the purse-string suture. It is also worth mentioning that the animal had no clinical signs related to hypocalcemia, which is associated with several diseases in domestic dogs and cats, including traumatic processes. Colopexy was the 2nd treatment option in the current case. The technique promotes a permanent adhesion between the colon and abdominal wall, thus preventing caudal movement of the colon and rectum. Colopexy has been used in domestic dogs and cats with recurrent rectal prolapse without the identification of predisposing factors, which include the present case. In conclusion, the present case showed a good evolution of the incisional colopexy technique in the recurrence of rectal prolapse in the ring-tailed coati, whose underlying cause could not be established. To the best of the authors' knowledge, this is the 1st report of the condition in coatis. [ABSTRACT FROM AUTHOR]

Background: Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case presentation: A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. Conclusion: This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required. [ABSTRACT FROM AUTHOR]

Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoidal problems are common causes of patient complaints. Most of the hemorrhoid-related issues can be managed conservatively; however, some patients with grade III and IV hemorrhoids are referred for surgical management. Several techniques including classic hemorrhoidectomy and dearterialization with or without Doppler guidance have been described. Although not as frequently performed, the Whitehead procedure remains occasionally utilized. Objectives: The goal of this study is to assess the short- and long-term outcomes of the Whitehead procedure in comparison to the Milligan–Morgan procedure. Design: Retrospective review. Patients and Methods: A review of all patients undergoing surgical treatment for grade III and IV hemorrhoids at 7th city hospital in Kyiv, Ukraine, between 2015 and 2021 was conducted. The rates of perioperative complications of the Whitehead procedures and overall outcomes were compared to the Milligan–Morgan techniques. Main Outcome Measures: Primary outcome included postoperative pain and secondary outcomes included short- and long-term postoperative complications. Sample Size: Three hundred and twenty-three patients were included in the study. Results: One hundred and seventy-three patients underwent the Whitehead procedure and 140 patients underwent the Milligan–Morgan procedure. There was no difference in age, sex, and comorbidities between the groups. There were no statistical differences between short-term complications, but the Whitehead group experienced less pain throughout the 14 days after surgery. All the patients were seen and examined 6 months after surgery; the patients who underwent the Whitehead procedure showed less prolapse when compared to those in the Milligan–Morgan group without increase in other complications. Conclusions: Whitehead hemorrhoidectomy is safe and shows less pain during recovery without remarkable increase in long-term complications. Limitations: This was a retrospective review and non-validated instruments were used in surveys. Conflict of Interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Background: Vaginally assisted laparoscopic sacrocolpopexy (VALS) refers to the placement of synthetic meshes through the vagina in addition to traditional laparoscopic sacrocolpopexy. In this study, we aimed to investigate the medium- to long-term efficacy and safety of VALS for treating stage III–IV pelvic organ prolapse (POP). Methods: The study was designed as a case series at a single center. Patients with stage III–IV POP in our hospital from January 2010 to December 2018 were included. Perioperative parameters, objective and subjective outcomes, and complications were assessed. Results: A total of 106 patients completed the follow-up and were included in our study. Within a median follow-up duration of 35.4 months, the objective cure ratio of VALS reached 92.45% (98/106), and the subjective success rate was 99.06% (105/106). Patients reported significant improvements in subjective symptoms. In eight patients suffering anatomic prolapse recurrence, two posterior POP cases were treated by posterior pelvic reconstruction surgery, while six anterior POP cases did not need surgical therapies. The reoperation rate was 1.89% (2/106). No intraoperative complications occurred. Three patients (2.83%) had postoperative fever, and one (0.94%) had wound infection during hospitalization. Six patients (5.66%) had mesh exposure on the vaginal wall, and de novo urinary incontinence occurred in two patients (1.89%) during the follow-up period. Conclusion: VALS is an effective and safe surgical method for treating severe POP. Therefore, VALS should be considered in the treatment of severe POP due to its favorable subjective and objective outcomes, relatively low rate of infection and acceptable rate of mesh exposure. [ABSTRACT FROM AUTHOR]

Objectives: As in Greek settings there is a need to develop validated patient-reported outcomes (PROs) for pelvic floor dysfunction, this study's aim was to cross-culturally adapt and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse and sexual function.Study Design: Cross-cultural translation was completed through official multistage forward and back-translation process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting Greek community-based healthcare settings. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered. Comparison between women with and without pelvic floor dysfunction (symptomatic versus control) was also undertaken for exploring discriminatory validity. Test-retest reliability was explored by re-administering APFQ_GR 10-15 days following initial testing and internal consistency was explored against each domain separately as well as total items' score.Results: Greek APFQ translation was successfully performed and piloted to a women sample with varying levels of education for comprehensibility, thus, satisfying the questionnaire's face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic. There were no ceiling effects. Floor effects were detected for women without symptoms. Moderate to very strong correlations were yielded between APFQ_GR total score and bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403-0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate correlations were yielded for the sexual function domain with APFQ_GR total score and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire's scores (p < 0.001), indicating good discriminatory validity between symptomatic and asymptomatic women. Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items' score (Cronbach's α = 0.714-0.924).Conclusions: The Greek APFQ was proven appropriate, comprehensible, valid and reliable for women with urinary incontinence and can thus, be used across Greek healthcare settings. Prolapse and bowel domains merit further research. [ABSTRACT FROM AUTHOR]

Background: Anterior mitral leaflet prolapse repair is a highly effective procedure, but despite excellent operative results still has an inferior long-term durability when compared to posterior leaflet repair.Methods: We analysed mitral repair durability in 74 consecutive patients operated for anterior leaflet prolapse between 2010 and 2021. Their pre- and postoperative clinical, echocardiographic data and repair durability as well, were compared with 74 randomly assigned posterior leaflet prolapse patients who underwent valve repair during the same period.Results: While groups were of similar age, patients with anterior leaflet prolapse had an inferior preoperative status in terms of functional reserve, atrial fibrillation, operative risk, ejection fraction and had more dilated left heart chambers as well. 1, 5, and 10-year freedom from repair failure was 87.1 ± 4.6%, 79.8 ± 6.5% and 50.7 ± 12.5% in the anterior, and 98.5 ± 1.5% respectively in the posterior leaflet group. Atrial fibrilation (hazard ratio [HR] 5.365; 95%; confidence interval [CI] 1.093-26.324 p = .038) and left ventricle end-systolic diameter (HR 1.160 95%; CI 1.037-1.299 p = .010) independently predicted anterior leaflet repair failure. Receiver Operating Curve analysis established left ventricle end-systolic diameter ≤42 mm as a cut-off value associated with improved anterior leaflet repair durability. Accordingly, 10-year repair durability in a subset of patients, with preserved left ventricle end-systolic diameter (≤42 mm) was 86.4 ± 7.8%.Conclusion: Better long-term repair durability in patients with anterior mitral leaflet prolapse and preserved sinus rhytm and left-ventricle diameters justifies early reconstructive approach. [ABSTRACT FROM AUTHOR]

Introduction and Aim Of the Study: Urinary incontinence and prolapse are debilitating conditions significantly affecting quality of life. They are extremely prevalent, affecting a significant number of women attending gynaecology clinics with complex symptoms. ePAQ-PF offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation which is an advantage over history and may enhance the clinical episodes detection as well as the quality of care for women with pelvic floor disorders. The aim of the study is to compare effectiveness of ePAQ-PF against history for diagnosis in complex urogynaecology patients.Materials and Methods: Data was collected retrospectively from ePAQ-PF and history in a tertiary level urogynaecology unit and collated onto microsoft excel. 40 patients were selected randomly from 56 eligible (administered and succeessfully completed ePAQ-PF) patients attending Urogynaecology and PEARL (combined urogynaecology and colorectal) clinics between July 2018 and July 2021. Fisher's exact test was used for inferring on statistical significance in the comparative analysis. The software used for this analysis was SAS version 9.4.Results: Thirty-four out of the forty patients were eligible for analysis for overactive bladder and stress urinary incontinence; twenty-four for prolapse and twenty-six patients for voiding difficulty. Patients were between 18 and 80 years of age with highest participants between 40 and 69 years. Four scored symptom domain was chosen for statistical analysis due to adequate power of comparative data in these domains. The additional diagnostic yield by ePAQ-PF for overactive bladder (OAB), stress urinary incontinence (SUI), voiding difficulty (VD) and prolapse was 26.47%, 0%, 67% and 16.67% respectively. P value for OAB, VD and prolapse was 0.0294, 0.0031 and 0.01 respectively. Apart from these four symptoms ePAQ-PF contributed additional symptoms over and above history in all 40 patients due to its wide range of symptom domains. History provided additional symptoms in 3 women with recurrent urinary tract infection which was not identified on ePAQ-PF.Interpretation Of Results: ePAQ-PF has shown significant additional diagnostic yield for overactive bladder, voiding difficulty and prolapse. P value for each has supported this statement. Although there was no additional diagnostic yield for stress urinary incontinence by ePAQ-PF, it has shown an accuracy of 96.97% (n = 33) for diagnosing the cases like history taking for SUI. ePAQ-PF enabled us to identify more symptoms in 100% cases (n = 40) which includes body image, general sex life, pain and altered sensation of vagina, reduced capacity of vagina etc, in comparison to history, for complex urogynaecology patients. History contributed to additional symptom diagnosis such as recurrent urinary tract infection in 7.5% (n = 40) of cases.Conclusion: ePAQ-PF is a useful diagnostic tool providing additional benefit for the diagnosis of the complex urogynaecology patient. Overall recommendation is to implement a policy of using ePAQ-PF evaluation in all complex urogynaecology patients in addition to history. Further studies are needed to assess the pattern of the yield across age, parity, disease severity related to complex urogynaecology symptoms. [ABSTRACT FROM AUTHOR]

Background: There is still much controversy about whether transforaminal or interlaminar fully endoscopic spine surgery can better treat lumbar 4/5 disc herniation. Therefore, this study intends to compare the clinical efficacy of fully endoscopic spine surgery through transforaminal and interlaminar approaches in the treatment of lumbar 4/5 disc herniation. Methods: Seventy-six patients with lumbar 4/5 disc herniation admitted from March 2019 to June 2020 were divided into the transforaminal approach group (endoscopic transforaminal lumbar discectomy, ETLD; 54 cases) and the interlaminar approach group (endoscopic interlaminar lumbar discectomy, EILD; 22 cases) according to different surgical methods. The general clinical data and clinical evaluation scale of the patients were compared. Results: The post-operative ODI and VAS scores were significantly better in the EILD group (P < 0.05). The VAS and ODI scores of patients with upper-shoulder and sub-axillary types in the EILD group were superior to those in the ETLD group (P < 0.05), while the VAS and ODI scores of patients with the pre-radicular type were better when they underwent ETLD rather than EILD (P < 0.05). Patients with Lee zone III type in the EILD group had better post-operative ODI scores than those in the ETLD group (P < 0.05), but there was no significant difference in VAS scores (P > 0.05). Patients with Lee zone IV type who underwent EILD had better VAS and ODI scores than those who underwent ETLD (P < 0.05). Conclusions: For patients with a prolapsed intervertebral disc that belongs to the upper-shoulder type, sub-axillary type, or Lee III or IV type, EILD can achieve better outcomes. [ABSTRACT FROM AUTHOR]

A 58‐year‐old male patient was admitted with chest pain and was diagnosed with coronary heart disease. He was scheduled for coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Intraoperative real‐time transesophageal echocardiography (TEE) showed that the tricuspid valves were well‐aligned and subtle regurgitation. Real‐time TEE after separation from CPB showed severe tricuspid regurgitation and prolapsed chordae tendineae. The tricuspid chordae tendineae rupture due to a right atrial venous return cannula. The use of negative pressure to improve venous drainage during CPB may result in the tricuspid valve being adsorbed to the cannula, increasing the likelihood of injury to the tricuspid valve. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Health literacy underpins informed consent and shared decision-making. In gynaecology, this includes understanding of normal anatomy and urogenital disease. This study evaluated public knowledge of external female genital anatomy and pelvic organ prolapse (POP). Methods: A questionnaire study asked participants for their demographics and to label a female external genitalia diagram and included free-text questions on POP, its symptoms and treatment. Questionnaires were distributed at general outpatient (OPD) and urogynaecology (UG) departments at a UK teaching hospital. Differences in the number of correct anatomy labels between participant genders were assessed via chi-squared tests and, within female participants, multivariable linear and logistic regressions assessed associations with increasing correct anatomical labels and an understanding (versus no understanding) of POP, respectively. Results: Within 191 (n = 160 OPD, n = 31 UG), 9/103 (9%) labelled all anatomical structures correctly. Females had more correct labels (median 1, IQR 0,3) versus males (median 0, IQR 0,1), P = 0.022). Higher education (vs. < secondary) and white ethnicity were associated with greater numbers of correct labels [coefficient (95% CI): 1.05 (0.14, 1.96), P = 0.024, 1.45 (0.58, 2.33), P = 0.001 respectively]. Fifty-three per cent understood POP. POP understanding increased with increasing age, white ethnicity (OR: 4.38, 95% CI: 1.36, 14.08, P = 0.013) and more correct anatomy labels (OR: 1.43, 95% CI 1.14, 1.79, P = 0.002). Of those who understood POP, only 35% identified "bulge" as a symptom and 7% physiotherapy as a treatment option. Conclusion: There was poor public understanding of external female genital anatomy and POP, which may have significant implications for health-seeking, shared decision-making and informed consent. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old male patient with a congenital Gerbode defect and aortic valve non-coronary cusp prolapse. Topics discussed include the association between a direct Gerbode defect and aortic valve prolapse, emphasizing the rarity of this occurrence, and highlighting the anatomical factors contributing to the relationship between these conditions, providing valuable insights for clinicians.

Background: Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare neutrophilic dermatitis characterized by pyrexia, neutrophilia and painful papulonodular lesions with a neutrophilic dermal infiltrate.Case Presentation: We presented a case report of classical SS associated with ulcerative colitis (UC) and mucosal prolapse polyps (MPPs) in a male patient.Conclusions: The particularity of this case is the occurrence of MPPs in a male patient with UC and classical SS. We also discussed whether this patient with concurrent Epstein-Barr virus infection could be treated with corticosteroids. [ABSTRACT FROM AUTHOR]

Background: The incidence of early complications after stoma formation (within 30 days of surgery) is difficult to determine and has been reported to be in a range of 3%–82%. Aim: The aim of this study was to analyse the onset of stomal, peristomal and skin complications one month (30 days) after ostomy creation. Method: This review analysed enteral stoma therapy nurse reports on patients who had an ostomy created between January 2016 and December 2020. Findings: Complications were analysed according to ostomy type: colostomy, ileostomy and urostomy. There were 1292 incidences of complications: skin complications were the most common (26%), and abscess the least common (0%). Conclusion: A majority (63%) of patients experienced at least one or more complications within 30 days of surgery. Haemorrhage was reported as a complication (2%) but the authors found no data on its incidence in the literature. In addition to early complications, late complications were detected. [ABSTRACT FROM AUTHOR]

Background: Pediatric mitral regurgitation (MR), especially with bileaflet prolapse, is relatively rare, of high complexity, and frequently associated with other congenital cardiac abnormalities. It remains a major therapeutic challenge for surgeons. This study reports our experience of surgical treatment of this mitral disease and midterm follow-up results.Methods: Between January 2016 and April 2020, nine pediatric patients, six females and three males, age ranged from 3 to 12 years (median age was 6 years) with a weight range of 12-36 kg (median weight was 25 kg), who all had over moderate regurgitation caused by bileaflet prolapse with mean distance of leaflet coaptation beyond annular plane 5.89 ± 1.66 mm (4-9 mm), received mitral valve (MV) repair. Various surgical techniques were used to repair MV.Results: The median follow-up period was 23(6-51) months, only one patient had moderately severe recurrent of MR, no patient developed systolic anterior motion (SAM) or mitral stenosis. Freedom from reoperation was 100% during the follow-up period. Compared to preoperation, the left atrial (LA) diameter and left ventricular end-diastolic diameter (LVEDD) decreased significantly from 2.94 ± 0.49 cm to 2.37 ± 0.38 cm (LA, p < .01) and from 4.13 ± 0.73 cm to 3.62 ± 0.49 cm (LVEDD, p < .01) respectively, ejection fraction (EF) decreased significantly (p < .05) from 68.56 ± 3.98% to 62.89 ± 4.48% before discharged.Conclusion: We share our experience of surgical repair of mitral valve bileaflet prolapse in pediatric patients. Several surgical methods are considered to be used to repair the MV due to the high complexity of lesions. Anatomic correction or functional correction in our reports almost reaches the same result, while functional correction means simpler operation. [ABSTRACT FROM AUTHOR]

Background: Large prolapse-related lesions (LPRL) of the sigmoid colon have been documented histologically but may not be readily recognized endoscopically.Methods: Colonic lesions referred for endoscopic mucosal resection (EMR) were enrolled prospectively. Endoscopic features were carefully documented prior to resection. Final diagnosis was made based on established histologic criteria, including vascular congestion, hemosiderin deposition, fibromuscular hyperplasia, and crypt distortion.Results: Of 134 large ( ≥ 20 mm) sigmoid lesions, 12 (9.0 %) had histologic features consistent with mucosal prolapse. Distinct endoscopic features were: broad-based morphology; vascular pattern obscured by dusky hyperemia; blurred crypts of varying size and shape; and irregular spacing of sparse crypts. Focal histologic dysplasia was identified in 6 of 12 lesions (50.0 %).Conclusions: LPRL of the sigmoid colon exhibit a distinct endoscopic profile. Although generally non-neoplastic, dysplasia may be present, warranting consideration of EMR. [ABSTRACT FROM AUTHOR]

To determine the frequency of symptoms (bleeding, pain, rectal swelling, itching, soiling, constipation) in subjects consulting for hemorrhoidal disease and assess the possible concomitance between hemorrhoids and chronic venous disease (CVD). CHORUS is a multinational cross-sectional survey carried out in seven countries. Consecutive patients consulting for hemorrhoidal disease were screened to confirm the presence of chronic venous disease. Data collected exclusively from India is analyzed here. Of the 2511 eligible patients, 63.8% were male and the mean age was 43.3 ± 12.2 years. Overall, 95.7% patients had physician-confirmed hemorrhoidal disease. Bleeding, swelling, prolapse, and fecal incontinence were significantly associated with the presence of hemorrhoidal disease (p < 0.0001). About one third of patients (37.5%) had reported simultaneous occurrence of hemorrhoidal disease and CVD and the occurrence of hemorrhoidal disease was significantly correlated with the presence of CVD (p = 0.004). Moreover, 70.4% patients with CVD had recurrent hemorrhoidal disease (p < 0.0001). Venoactive drug was the most commonly (95.7% cases) prescribed treatment; micronized purified flavonoid fraction was the most widely used (86.2%) venoactive drug. More than one third individuals with hemorrhoidal disease in our study had CVD, which highlights the importance of investigating signs of CVD in patient with hemorrhoids during daily clinical practice which could help better understand the disease and optimize the management. [ABSTRACT FROM AUTHOR]

Among Australian females, sexual assault affects 1 in 5 Australian women [1], and 1 in 10 girls [2]. While it is well known that females who experience sexual assault have an increased risk of future pelvic pain, there is limited knowledge regarding the occurrence of other gynaecological morbidity. We performed systematic review and meta-analysis for the relationship between sexual assault and gynaecological morbidity. We searched online electronic databases for observational studies on the subject published between 1993 and 2018. Search terms included variants of 'sexual abuse', 'sexual assault' and a range of gynaecological morbidity. Two independent reviewers completed study selection, quality assessment and data extraction. For each gynaecological symptom we calculated common odds ratios and 95 % confidence intervals in relation to sexual abuse history. Our search identified 1846 studies, of which 38 studies were included. A history of sexual assault was significantly associated with overall gynaecological morbidity (RR 1.42; 95%CI, 1.27-1.59), pelvic pain (RR 1.60; 95%CI, 1.36-1.89), 'dyspareunia' (pooled RR 1.74, 95%CI, 1.50-2.02); 'dysmenorrhea' (pooled RR 1.20; 95%CI, 1.11-1.29); 'abnormal menstrual bleeding' (pooled RR 1.29; 95%CI, 1.12-1.49)) and 'urinary incontinence' (pooled RR 1.31; 95%CI, 1.12-1.53)), while association was not statistically significant for 'vaginismus'(pooled RR 1.71; 95%CI, 0.87-3.36) and 'vulvodynia' (pooled RR 1.49; 95%CI, 0.76-2.91). There was no relation with 'prolapse' (pooled RR 1.10; 95%CI, 0.53-2.30). Females with a history of sexual assault have a significantly increased risk of different gynaecological disorders later in life. [ABSTRACT FROM AUTHOR]

We here describe a case of the prolapse of pedunculated submucosal leiomyoma through the cervix during the treatment of a gonadotropin‐releasing hormone (GnRH) antagonist relugolix. We also present the literature review of the cases of leiomyoma prolapse during GnRH modulators. A 55‐year‐old woman with atypical vaginal bleeding diagnosed submucosal uterine fibroid 6 cm in diameter, and daily oral administration of relugolix was conducted. On the 35th day of the administration, heavy vaginal bleeding suddenly occurred due to leiomyoma prolapse. Finally, she underwent abdominal hysterectomy to treat heavy bleeding. To date, six cases of leiomyoma prolapse during GnRH modulators have been reported, in which all the previous cases were treated with GnRH agonists. This is the first case report of leiomyoma prolapse during GnRH antagonist treatment. Notably, leiomyoma prolapse is a possible common adverse effect of GnRH modulators for the treatment of submucosal leiomyoma, which is caused by rapid decrease in its volume. [ABSTRACT FROM AUTHOR]

Purpose: We compared the efficacy of modified Shirodkar and McDonald rescue cerclage techniques in women with singleton pregnancies.Methods: The study sample included 47 women who presented at two tertiary hospitals in Turkey from 2008 to 2017 and underwent rescue cerclage due to cervical incompetence and cervical dilatation with fetal membranes prolapsed into the vagina. The outcomes were compared by cerclage technique used, Shirodkar or McDonald.Results: The McDonald cerclage was applied in 27 cases, and modified Shirodkar cerclage in 20 cases. A longer cerclage-to-birth interval (83.8 ± 37.6 vs. 63.7 ± 38.9 days) and later gestational age at delivery (33 vs. 31 weeks) were observed with the Shirodkar cerclage, although these differences were not statistically significant (p = .08 and .63, respectively). Both groups had similar delivery rates after 28, 32, and 37 weeks (p = .20, .15, and .25, respectively), whereas the modified Shirodkar technique resulted in a higher rate of live births although these differences were not statistically significant (85% vs. 63%, p = .09).Conclusion: The effects of the McDonald and modified Shirodkar cerclage procedures on prolonging pregnancy and improving the live birth rate were similar. Therefore, either technique can be applied to prevent neonatal loss due to advanced prematurity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal decompression therapy (SDT) has recently been used as a conservative treatment for lumbar disc prolapse (LDP). The effectiveness of SDT when compared with other conservative techniques with a well-designed randomized controlled trials is lacking. OBJECTIVE: To find the efficacy of SDT and core stabilization exercises (CSE) on pain and functional disability in individuals with chronic LDP, and to compare with CSE alone. METHODS: This single blind randomized controlled trial included thirty-one participants with a mean age of 38.68 ± 8.79 having chronic LDP with or without radiating symptoms were included in the study. The study group received SDT with CSE and control group received CSE alone along with interferential therapy for both groups. Pain and disability were estimated by Numerical Rating Scale (NRS) and Modified Oswestry Questionnaire (mOQ). RESULTS: The results demonstrated significant within-group improvements in all outcomes in both groups, the mean differences between pre to post intervention in SDT with CSE group were (NRS: 4.75, t = 12.81, p ⩽ 0.001) and (mOQ: 45.13, t = 29.34, p ⩽ 0.001), while in CSE group (NRS: 2.60, t = 13.67, p ⩽ 0.001) and (mOQ: 27.67, t = 24.52, p ⩽ 0.001). CONCLUSIONS: A combination of SDT with CSE has proven to be more significant when compared with CSE alone to reduce pain and disability in subjects with chronic LDP. [ABSTRACT FROM AUTHOR]

Background: Prolapse can occur in up to 20% of newborn end colostomies and may be associated with significant morbidities that require operative intervention. Prolapse repair is traditionally performed through an open parastomal or laparotomy incision. We report on 2 cases that utilized a novel laparoscopic transabdominal colopexy technique, which offered a minimally invasive solution uniquely suited to neonates and infants while obviating the morbidity of open reoperative surgery. Materials and Methods: Retrospective review of 2 patients at a single center undergoing a laparoscopic transabdominal colopexy for end colostomy prolapse. The primary outcome measure was prolapse recurrence. Secondary outcomes included intraoperative or immediate postoperative complications. Results: Both patients who underwent the laparoscopic transabdominal colopexy procedure had prolapsed end colostomies. There were no intraoperative or immediate postoperative complications. Both patients had no additional episodes of recurrence during the follow-up period. One patient has since had their colostomy reversed without complications. Conclusion: We present our initial results in the utilization of a novel technique for repair of a newborn end colostomy prolapse-laparoscopic transabdominal colopexy. Our technique thus far has demonstrated success in preventing recurrent prolapse through a minimally invasive technique with no significant morbidity. [ABSTRACT FROM AUTHOR]

Gynaecologists have been at the receiving end of much regulatory intervention in recent years, some of it inappropriate and heavy‐handed such as the recent ban on midurethral slings in the National Health Service, others appropriate and, if anything, occurring too late. Regulatory agencies have failed, and so have individual doctors and their organisations. An example of individual and systemic failure involves the Tissue Fixation System. It is an Australian story that is not yet widely known, which is why the author has decided to acquaint the readers of ANZJOG with the situation in this country, where the Tissue Fixation System was invented, manufactured and used on thousands of patients over a period of eight years before its manufacture, sale and export from Australia ended in 2014. [ABSTRACT FROM AUTHOR]

Although motor vehicle accidents (MVAs) in children are common, pediatric rectal perforations secondary to MVAs leading to transanal evisceration of the small bowel are very rare. Herniation of bowel through breach in the rectal wall seen eviscerating through the anus is a surgical emergency requiring laparotomy and necessary surgical procedure. We report case of a 3-year-old boy, victim of run-over MVA accident, presenting with bilateral fracture shaft femur, fracture of the left humerus, and transanal small bowel evisceration. About 30–40 cm long, gangrenous, small bowel loop was hanging outside the anal canal. Two consecutive surgeries were performed to manage this unusual and complex case with an excellent outcome. This report is presented for an extremely rare presentation of MVA injury in a child. [ABSTRACT FROM AUTHOR]

Introduction: Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in previous transient testing by this group. It was shown that a single suture, yielding an ultimate load of 35 N, was equivalent to continuous suturing. This was demonstrated in an in vitro cadaver study. This transient data were used to establish an elastic stress-strain envelope. It was now possible to proceed to dynamic in vitro analysis of this surgical method to establish time to functional stability.Methods: Cyclic testing of this fixation method was performed on human female embalmed cadaver (cohort 1) and fresh, non-embalmed cadaver (cohort 2) pelvises. The testing envelope was 5-25 N at a speed of 1 mm/s. 100 load regulated cycles were applied.Results: 100 cycles were completed with each model; no overall system failure occurred. Steady state, i.e., functional stability was reached after 14.5 (± 2.9) cycles for the embalmed group and after 19.1 (± 7.2) cycles for the non-embalmed group. This difference was statistically significant p = 0.00025.Conclusion: This trial showed in an in vitro cyclic testing of the pectopexy method that functional stability may be achieved after no more than 19.1 cycles of load exposure. When remaining within the established load envelope of below 25 N, patients do not need to fear global fixation failure. Testing did demonstrate differences in non-embalmed and embalmed cadaver testing. Embalmed cadaver testing tends to underestimate time to steady state by 26.3%. [ABSTRACT FROM AUTHOR]

Subconjunctival prolapse of orbital fat is an uncommon clinical entity in which intraconal orbital fat herniates into the subconjunctival space. Its diagnosis is mainly clinical in character and usually based on palpation, patient clinical history, and lesion features along with a slit lamp examination. Its pathophysiology remains unclear. Although frequently asymptomatic, clinical features may simulate conditions such as a prolapsed lacrimal gland, orbital lymphoma or dermolipoma and may worsen over time. In such cases, surgical removal or repositioning of the herniated fat may be necessary. While several surgical techniques have been described, no reports exist of a customized approach to manage this condition. This paper reviews the diagnosis and management of subconjunctival orbital fat prolapse. [ABSTRACT FROM AUTHOR]

Purpose: Neonatal exploratory laparotomies are often performed with a transumbilical incision in our institution, so umbilical ostomy placement has become more common. The purpose of our study is to evaluate the outcomes of neonates with ostomy placement at the umbilicus in comparison to more traditional stoma locations.Material and Methods: Retrospective study of neonates that underwent an exploratory laparotomy with ostomy creation between January 2010 and September 2015. Demographics, presentation, feedings, ostomy position, postoperative complications, and outcomes were collected. Comparative analysis was performed in STATA with P-value <.05 determined as significant. Results reported as means ± standard deviation and medians with interquartile ranges.Results: Fifty-four children were included, 37% (n = 20) had stomas at the umbilicus. Most common other stoma location was the right lower quadrant (63%, n = 34). Necrotizing enterocolitis (NEC) was the most common indication for surgery in both groups. Days to stoma output were similar between the two groups, [3 (1, 6) versus 2 (1, 5), P = .96]. Days to initiation of feeds were delayed in the umbilical ostomy group [15 (9.5, 23.5) versus 6 (4, 10), P = .02]. Comparing only NEC patients, initiation of feeds was similar [22 (14, 56) versus 15.5 (8, 43), P = .73]. Umbilical ostomies had an increase in prolapse/peristomal hernias (7 versus 3, P = .01), but no patients required operative revision.Conclusion: Umbilical ostomies had similar time to stoma function compared to other sites, but a delay in initiation of oral feeds likely secondary to a higher percentage of patients with NEC. [ABSTRACT FROM AUTHOR]

Highlights • 1% of sows were removed due to prolapses. • 60% of prolapse cases were removed during first 0–4 weeks after farrowing. • Sows with gestation of 113 days or less were at risk of having a prolapse. • High parity sows were at high risk of having uterine prolapses. • Sows farrowing two or more stillbirths were at risk of having rectal prolapses. Abstract Prolapses in sows are an emerging concern in pig production. The objectives of this study were to estimate the incidence rate of prolapses and to determine risk factors associated with prolapse occurrences. Data included 905,089 service records in 819,754 parity records of 155,238 sows from 144 swine herds in Spain. Producers were required to record a removal reason, including type of prolapse. A 1:4 matched case-control study was carried out to investigate prolapse risk factors, and piecewise exponential models were applied to the data. The following factors were assessed: parity, number of services, service season, weeks after service, prior gestational length, total number of piglets born, and number of stillborn and mummified piglets. Almost 1% of sows (0.8%) were removed due to prolapses (95% confidence interval: 0.76, 0.85), and the annualized incidence rate for all prolapse cases was 3.8 cases per 1000 sow-years (95% confidence interval: 3.59, 4.01). Significant factors were the 16th week after service, being in parity 3 or higher, re-service, servicing in summer, autumn or winter, shorter gestational length, fewer piglets born and more stillborn piglets (P ≤ 0.04). For example, the prolapse incidence was 30.6 times higher at 16 weeks after service than during the first 14 weeks (P < 0.01). Also, 60.9% of 1198 prolapses occurred during the first 0 to 4 weeks after farrowing. The prolapse incidence was 1.5–1.8 times higher in parity 3 or higher sows than in parity 0 sows (P < 0.01), and 1.3 times higher in re-serviced sows than in first serviced sows (P = 0.02). It was also 1.3–1.5 times higher in sows serviced in summer, autumn or winter than in those serviced in spring (P ≤ 0.02), and 1.3–1.5 times higher in sows with a prior gestational length of 113 days or less than in sows with 114 days or more gestational length (P < 0.01). Lastly, the prolapse incidence rate was 1.2 times higher in sows with 11 or fewer piglets born than in sows with 12–16 piglets born (P = 0.04), and was also 1.4 times higher in sows with two or more stillborn piglets than in sows with no stillborn piglets (P < 0.01). However, there was no association between prolapse incidence and mummified piglets (P = 0.54). Consequently, producers should pay more attention to sows exposed to high risks, while trying to identify prolapse cases at an early stage. [ABSTRACT FROM AUTHOR]

Objectives: Pelvic Organ Prolapse (POP) is a multifactorial disease with ageing as a most notable risk factor. Advanced Glycation End products (AGEs), biochemical markers of ageing are increased in prolapsed tissues. It is however unclear if AGEs are a cause or outcome of prolapse. By combining analysis of clinically relevant parameters in women with prolapse and POP tissues biochemically, this study aims to bridge the gap between existing clinical and biochemical research on the cause of POP.Methods: Following national and local ethical approval, a case study of 49 POP and 16 control tissues was carried out. The AGEs' marker, pentosidine, was quantified via High Performance Liquid Chromatography. Oestrogen (ER-α) and glyoxalase I (GLO-I) expression of the tissues were studied. Age, obstetric factors and co-morbidities (hypertension, smoking, diabetes mellitus) were recorded and compared with biochemical findings.Results: Lower expressions of ER-α and GLO-I were observed in POP tissues in the comparison to the control, which also had significantly higher pentosidine content. Prolapsed tissue population had more notable age-dependent increase in pentosidine with significant differences between the 6th and 7th decade. Hypertension and smoking, which were more prevalent amongst women with POP, were associated with higher amounts of pentosidine in the vaginal tissues.Conclusion: In the light of recent research regarding the relationship between POP and glycation, the present study shows that age-related oestrogen decline is a key player in glycation accumulation in prolapsed vaginal tissues and that glycation is a cause rather than an effect of prolapse. Hypertension is a significant POP association which is linked to high glycation level. [ABSTRACT FROM AUTHOR]

Goal: This manuscript evaluates atrioventric-ular valve regurgitation (AVVR) in babies born with an already very challenging heart condition, i.e., with single ventricle physiology. Although the second surgery that single ventricle patients undergo is thought to decrease AVVR, there is much controversy in the clinical literature about AVVR treatment. Methods: The effect of AVVR on Stage 1 haemodynamics and resulting acute changes from conversion to Stage 2 circulation in single ventricle patients are analyzed through lumped parameter models. Several degrees of AVVR severity are analyzed, for two types of valve regurgitation: incomplete leaflet closure and valve prolapse. Results: The models show that increasing AVVR in Stage 1 induces the following effects: first, higher stroke volume and associated decrease in ventricular end-systolic volume; second, increase in atrial volumes with V-loop enlargement in pressure-volume curves; third, pulmonary venous hypertension. The Stage 2 surgery results in volume unloading of the ventricle, thereby, driving a decrease in AVVR. However, this effect is offset by an increase in ventricular pressures resulting in a net increase in regurgitation fraction (RF) of approximately 0.1 (for example, in severe AVVR, the preoperative RF increases from $\sim$ 60% to $\sim$ 70% postoperatively). Moreover, despite some improvements to sarcomere function early after Stage 2 surgery, it may deteriorate in cases of severe AVVR. Conclusion: In patients with moderate to severe AVVR, restoration of atrioventricular valve competence prior to, or at the time of, Stage 2 surgery would likely lead to improved haemodynamics and clinical outcome as the models suggest that uncorrected AVVR can worsen across Stage 2 surgery. This was found to be independent of the AVVR degree and mechanisms. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Women have a lifetime risk of undergoing pelvic organ prolapse (POP) surgery of 11-19%. Traditional native tissue repairs are associated with reoperation rates of approximately 11% after 20 years. Surgery with mesh augmentation was introduced to improve anatomic outcomes. However, the use of synthetic meshes in urogynaecological procedures has been scrutinised by the US Food and Drug Administration (FDA) and by the European Commission (SCENIHR). We aimed to review trends in pelvic organ prolapse (POP) surgery in England.Methods: Data were collected from the national hospital episode statistics database. Procedure and interventions-4 character tables were used to quantify POP operations. Annual reports from 2005 to 2016 were considered.Results: The total number of POP procedures increased from 2005, reaching a peak in 2014 (N = 29,228). With regard to vaginal prolapse, native tissue repairs represented more than 90% of the procedures, whereas surgical meshes were considered in a few selected cases. The number of sacrospinous ligament fixations (SSLFs) grew more than 3 times over the years, whereas sacrocolpopexy remained stable. To treat vault prolapse, transvaginal surgical meshes have been progressively abandoned. We also noted a steady increase in uterine-sparing, and obliterative procedures.Conclusions: Following FDA and SCENIHR warnings, a positive trend for meshes has only been seen in uterine-sparing surgery. Native tissue repairs constitute the vast majority of POP operations. SSLFs have been increasingly performed to achieve apical support. Urogynaecologists’ training should take into account shifts in surgical practice. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: There is considerable variation in the clinical management of pessaries. This study was aimed at exploring the efficacy of the continuous use of ring pessaries without support for the treatment of advanced pelvic organ prolapse (POP) in nonhysterectomized postmenopausal women.Methods: We conducted this prospective study of fitted pessaries between January 2013 and June 2015 in the Department of Obstetrics and Gynecology at Macarena Hospital, Seville University, Spain. A total of 171 nonhysterectomized postmenopausal patients with symptomatic POP (stages III and IV) were counseled for two treatment options: either surgery or vaginal pessary. A total of 94 patients who agreed to use the vaginal ring pessary were included. A successful fitting was defined as the continued use of the device until the end of the study (a median 27-month follow-up). The data were analyzed with continuity correction tests, Mann-Whitney U tests, and Fisher’s exact test.Results: Pessary use was continued by 80.8% of the patients. Most discontinuations (50.0%) occurred within the first week after device insertion. The adverse events rate was 31.6%, and all adverse events were Clavien-Dindo grade I. The complications were extrusion of the pessary (18.4%), bleeding or excoriation (10.5%), and pain or vaginal discharge (2.6%). No major complications occurred.Conclusions: The ring pessary without support was successfully fitted in patients with advanced POP, resulting in a high success rate. There were few side effects and complications associated with continuous use of this pessary without periodic removal or replacement. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy.Methods: All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score.Results: One hundred and ninety four patients were identified and 171 completed the questionnaire. The mean follow-up was 12 ± 0.8 years (range 11-13 years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases.Conclusions: The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effect of hysterectomy with or without concomitant prolapse surgery on subject-reported pelvic floor disorders (PFD) with a 5-year follow-up.Study Design: This prospective longitudinal study was carried out in two Finnish central hospitals among 286 women who had undergone hysterectomy for benign reasons. The presence of urinary incontinence, urinary frequency, feeling of vaginal bulging, constipation and anal incontinence was evaluated at baseline, 1 and 5 years postoperatively. Analysis was performed on 256 (895%) patients who answered at least one of the follow-up questionnaires.Results: Hysterectomy with concomitant native tissue prolapse surgery significantly reduced urinary incontinence, urinary frequency, constipation and the feeling of vaginal bulging, and the results were maintained over the following five years. Plain hysterectomy reduced urinary frequency and the feeling of vaginal bulging but did not relieve urinary incontinence. Hysterectomy had no effect on anal incontinence. The total subsequent prolapse and/or incontinence operation rate was 2,7%, and was higher among patients who underwent hysterectomy for pelvic organ prolapse.Conclusions: During a 5-years follow-up a hysterectomy alone or with native tissue prolapse surgery did not worsen pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify factors associated with pessary fitting, continued use of pessary and satisfaction of patients with pelvic organ prolapse.Methods: A retrospective study was conducted in patients who received an initial pessary fitting. The clinical characteristics of these patients were recorded. The Pelvic Floor Disability Index PFDI-20 and PFIQ-7 were used to assess pelvic floor dysfunction and quality of life. Complications, satisfaction degree, and reasons for abandonment were recorded during the follow-up. T test and Chi square test in SPSS version 20 were used to analyze the data.Results: Three hundred women with symptomatic prolapse were selected for pessary fitting, whose average age was 67.8 ± 10.7 years. For two hundred and forty-nine (83%) women, the fitting was successful, of whom 162 used ring pessaries and 87 used Gellhorn pessaries. Forty-seven patients abandoned using a pessary at the end of our study. Most clinical characteristics were not significantly different between the successful and unsuccessful fitting groups (P > 0.05). The average score of CRADI-8 was lower in successful fitting group (11.9 ± 15.9) than that in unsuccessful fitting group (18.8 ± 19.9) (P < 0.05). 162 patients with successful pessary fitting completed the satisfaction survey, 79% of whom were satisfied or very satisfied. Erosions (24.4%) were the most common complication. Difficulty in inserting or removing (30.4%) and erosions (22.8%) were the main factors, which affected the satisfaction degree.Conclusions: Patients with obvious symptoms of posterior pelvic prolapse are more likely to fit failure. Difficulty in inserting or removing and erosions are the main factors, which lead to the discontinuation of pessary use and decrease in the satisfaction degree. [ABSTRACT FROM AUTHOR]

Background: Ileostomy prolapse has a cumulative risk of 11% and represents a significant complication with associated morbidity, which may result in multiple admissions and procedures requiring a general anesthetic. We have developed a laparoscopic technique for managing stoma prolapse-so-called laparoscopic enteropexy for prolapsing stoma (LEPS).Methods: Retrospective analysis of a prospectively maintained departmental surgical logbook was performed alongside clinical case history review for patients undergoing LEPS. Primary outcome was defined as recurrent prolapse. Secondary outcomes were any postoperative complication or complication occurring at the time of stoma closure.Results: A total of 15 LEPS procedures were performed on 14 patients with stoma prolapse-13 were patients with ileostomy and 1 with a loop colostomy. Median operative time was 75 minutes (range 50-95). Median postoperative stay was 1 day (1-4 days). There was one return to theater for a small bowel intussusception on the second postoperative day wherein taking down of the bowel and repeat LEPS were necessary. There was one recurrence of prolapse in a separate patient (1/14 [7%]). Three patients have since had their stoma closed without complication.Conclusion: We describe here the initial case series of our LEPS procedure for managing stoma prolapse. This is a reproducible and technically straightforward laparoscopic procedure with an excellent success rate in preventing further prolapse. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To describe the technique of a modified extraperitoneal retrotransversalis end colostomy as part of a laparoscopic abdominoperineal excision (APR). Method: The colostomy site is preoperatively chosen and used intra‐operatively for a trocar. After the rectum has been mobilized the descending colon is freed. The peritoneal margin is gently grasped and the parietal peritoneum and extraperitoneal together with the transversalis fascia are separated from the transverse abdominal muscle fibres upwards for 3–4 cm aiming at the trocar site to form the extraperitoneal retrotransversalis canal. The stoma site trocar is partially withdrawn and its head is turned laterally until its tip is positioned in the layer between the abdominal wall muscles and underlying transversalis and extraperitoneal fascia together with the parietal peritoneum. The CO2 source can be attached so that the gas helps to separate the layers, after which the colostomy trephine is formed at the site of the trocar, the grasper is inserted to gently deliver the blunt end of the descending colon through the canal and the end colostomy is formed in a usual way. Results: No procedure‐specific complications were noted in 39 patients who had laparoscopic APR with extraperitoneal retrotransversalis end colostomy from 2009 to 2016. In 23 patients who survived for 3.7 ± 1.7 years after surgery there were no clinical or CT signs of parastomal hernia or prolapse. Conclusion: This single‐institution retrospective case series demonstrates that laparoscopic extraperitoneal retrotransversalis end colostomy is feasible, safe and effective in preventing parastomal hernias and stomal prolapse. [ABSTRACT FROM AUTHOR]

Lacrimal gland prolapse is an often ignored and undiagnosed condition in patients seeking blepharoplasty. Recognition and correct treatment can avoid poor outcomes in such cases. Traditional techniques of treating the prolapsed lacrimal gland include light cautery, partial excision, and periosteal suture fixation. A few series of lacrimal gland prolapse have been published in the literature. But a literature search failed to reveal any reports on the recurrence of surgically treated lacrimal gland prolapse. We report the incidence of lacrimal gland prolapse purely based on the external deformity and also report a case of recurrence following surgical lacrimal gland periosteal hitching, in a patient with blepharochalasis syndrome 4 years post the original correction. A new technique of true bony fixation of the recurrent prolapsed lacrimal gland to the lacrimal fossa is described. We call the new technique ‘lacrimoplasty’. An operative video is also included to demonstrate the technique step by step.Level of Evidence: level V, therapeutic study. [ABSTRACT FROM AUTHOR]

Umbilical cord prolapse (UCP) is an uncommon obstetric emergency that can have significant neonatal morbidity and/or mortality. It is diagnosed by seeing/palpating the prolapsed cord outside or within the vagina in addition to abnormal fetal heart rate patterns. Women at higher risk of UCP include multiparas with malpresentation. Other risk factors include polyhydramnios and multiple pregnancies. Iatrogenic UCP (up to 50% of cases) can occur in procedures such as amniotomy, fetal blood sampling, and insertion of a cervical ripening balloon. The perinatal outcome largely depends on the location where the prolapse occurred and the gestational age/birthweight of the fetus. When UCP is diagnosed, delivery should be expedited. Usually, cesarean section is the delivery mode of choice, but vaginal/instrumental delivery could be tried if deemed quicker, particularly in the second stage of labor. Diagnosis-to-delivery interval should ideally be less than 30 minutes; however, if it is expected to be lengthy, measures to relieve cord compression should be attempted. Manual elevation of the presenting part and Vago's method (bladder filling) are the most commonly used maneuvers. Care should be given not to cause cord spasm with excessive manipulation. Simulation training has been shown to improve/maintain all aspects of management and documentation. Prompt diagnosis and interventions and the positive impact of neonatal management have significantly improved the neonatal outcome. [ABSTRACT FROM AUTHOR]

Urethral prolapse (UP) is a condition characterized by circumferential prolapse of the urethral mucosa through the external meatus generally seen in girls. Bleeding, dysuria and an asymptomatic prolapsed mass are the main presenting complaints. UP may be confused with many pathologies that can cause genital bleeding or tumor. Conservative management and surgical resection are the treatment options. We present this case due to its rarity, low rate of accurate diagnosis at the first presentation, as well as the presence of only one reported case from our country and to raise awareness of UP. [ABSTRACT FROM AUTHOR]

Blunt ocular trauma is the one of the commonest cause of anterior dislocation of the crystalline lens. We present a case who presented with anterior dislocation of the crystalline lens, vitreous prolapse, and acute painful vision loss in left eye following blunt trauma. The patient was managed with antiglaucoma medications, automated anterior vitrectomy, and surgical extraction of dislocated lens with a delayed pars plana vitrectomy and transcleral fixation of crystalline lens. [ABSTRACT FROM AUTHOR]

Highlights from the article: Keywords: Levels of support; Pelvic floor; Magnetic resonance imaging (MRI); Pelvic organ prolapse Magnetic resonance imaging (MRI), Pelvic floor, Pelvic organ prolapse, Levels of support.

Purpose: Previously published literature regarding treatment of hemorrhoidal disease (HD) revealed a lack of uniform defined outcomes. These differences between outcomes among studies limit transparency and lead to incomparability of results. The aim of this study was to systematically list the types of outcomes used in HD studies. This list will be used to develop a core outcome set.Methods: We searched Medline (Pubmed), Embase (OVID), and Cochrane for interventional studies for adult patients with HD. Two authors independently identified and reviewed eligible studies. This resulted in a list of outcomes reported by each clinical trial. All outcomes were categorized using the conceptual framework OMERACT filter 2.0.Results: A total of 34 randomized controlled trials and prospective observational studies were included in this study. A total of 59 different types of outcomes were identified. On average, 5.8 different outcomes (range 2-8) were used per study. The outcomes were structured into three core areas and10 ten domains. The most commonly reported core area was pathophysiological manifestations including the domain symptoms, complications, and recurrence. The most frequently reported outcomes were pain (91%), blood loss (94%), prolapse (71%), and incontinence (56%). There was a high variation in definitions of the common outcomes. And often there was no definition at all.Conclusion: This study shows a substantial heterogeneity in the types of outcomes in HD studies. We provided an overview of the types of outcomes reported in HD studies and identified a list of potentially relevant outcomes required for the development of a COS. [ABSTRACT FROM AUTHOR]

Background: The role of the electrophysiologic studies in peripheral nerves and muscles of lower limbs (including paraspinal muscles) in prolapsed lumbar intervertebral discs has been studied with equivocal results. Pre- and post-operative electrodiagnostic studies have not been compared much. Aims and Objectives: To study the role of the electrophysiologic studies in prolapsed lumbar/lumbosacral intervertebral discs for finding the association between clinical findings and electrophysiological changes and to compare the electrophysiologic studies pre- and post-operatively. Materials and Methods: The study was conducted from July 2014 to June 2016 on fifty patients who were admitted in the department of neurological surgery with lumbar disc prolapse and all these patients were subjected to surgery. Both pre- and post-operative (from 1 to 6 months after surgery) electrophysiological studies were conducted and compared. Results: As per the electromyographic (EMG) abnormalities, the most common levels of intervertebral disc prolapse were L4–L5 and L5–S1 accounting for 32% of cases each followed by L5–S1 level which was seen in 28% of patients with L2–L3, L3–L4, and L4–L5 prolapsed intervertebral disc (PIVD) and L3–L4 and L4–L5 PIVD were seen in 4% of cases each. Of the 50 patients, EMG findings correlated with operative findings in 37 (74%) patients, however operative findings did not correlate with EMG findings in 13 (26%) patients. Conclusion: In compressive lesions of nerve roots (due to disc prolapsed), the EMG method has a high degree of accuracy in determining not only the presence of such lesions but also their exact location. EMG is accurate when correlated with the operative findings. [ABSTRACT FROM AUTHOR]

Background: Transapical off-pump mitral valve (MV) repair is a novel minimally-invasive surgical technique, allowing to correct mitral regurgitation (MR) caused by chordae tendineae rupture. While numerical simulation of the MV structure has proven to be useful to evaluate the effects of the MV surgical repair techniques, no numerical simulation studies on the outcomes of transapical MV repair have been done up to now.Objective: The purpose of this study is to evaluate the transapical MV repair using finite element modeling and to determine the effect of the neochordal length on the function of the prolapsing MV.Methods: The reconstruction of the MV geometry based on the patient-specific data was performed. In order to simulate prolapse, chordae inserted into the middle segment of the posterior leaflet (P2) were ruptured. A total of four virtual transapical repairs using neochordae of different length were performed. The function of the MV before and after virtual repairs was simulated.Results: The evaluation of the effect of the neochordal length on post-repair MV function showed that the length of the implanted neochordae has a significant impact on the correction of MR caused by chordae tendineae rupture.Conclusions: The presented results can improve the understanding of the effects of transapical MV repair. [ABSTRACT FROM AUTHOR]