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Objective: This study seeks to explore the impact of fast track surgery (FTS) with three-port in patients treated with laparoscopic radical cystectomy and ileal conduit on postoperative recovery, hospital stay and the complications. Methods: This retrospective study analyzed 230 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy at the Second Hospital of Anhui Medical University between December 2011 to January 2023. 50 patients received conventional surgery (CS) and 180 patients received FTS with three-port. Patients were assessed for time to normal diet consumption, time to passing first flatus, number of postoperative recovery days and complications. Trends of serum C-reactive protein levels were monitored preoperatively and on postoperative days 1, 3 and 7. Results: Patients who underwent FTS with three-port had a shorter duration to first flatus (P < 0.05). And number of postoperative hospital days and the length of hospital stay were notably shorter in contrast to the CS group (P < 0.05). Serum CRP levels on postoperative day 7 were markedly reduced in those of the FTS group compared to the CS group (P < 0.05). Those of the CS group experienced more frequent rates of complications compared to those of the FTS with three-port group (P < 0.05). Conclusion: Our findings demonstrate that the FTS with three-port program hastens postoperative recovery and reduces duration of hospital stay. It is safer and more effective than the CS program in the Chinese population undergoing laparoscopic radical cystectomy. [ABSTRACT FROM AUTHOR]

Abstract Objective This study seeks to explore the impact of fast track surgery (FTS) with three-port in patients treated with laparoscopic radical cystectomy and ileal conduit on postoperative recovery, hospital stay and the complications. Methods This retrospective study analyzed 230 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy at the Second Hospital of Anhui Medical University between December 2011 to January 2023. 50 patients received conventional surgery (CS) and 180 patients received FTS with three-port. Patients were assessed for time to normal diet consumption, time to passing first flatus, number of postoperative recovery days and complications. Trends of serum C-reactive protein levels were monitored preoperatively and on postoperative days 1, 3 and 7. Results Patients who underwent FTS with three-port had a shorter duration to first flatus (P

Purpose: Early stage lip squamous cell carcinoma (lip SCC) can be treated with conventional excision, Mohs micrographic surgery (MMS), or brachytherapy. The aim of this retrospective study was to describe the medical outcomes, patient‐reported outcomes, and costs of these treatments. Methods: A retrospective cohort study of T1–T2 lip SSCs treated between 1996 and 2019. Medical outcomes, recurrences, and survival were retrieved from medical records. Facial appearance, facial function, and Quality of Life (QoL) were measured with the Face‐Q H&N and EQ‐5D‐5L questionnaires. Costs were also calculated. Results: Of the 336 lip SCCs, 122 were treated with excision, 139 with MMS, and 75 with brachytherapy. Locally, the recurrence rate was 2.7% and regionally 4.8%. There were 2% disease‐related deaths. T2‐stage and poor tumor differentiation were associated with recurrences. Posttreatment QoL, facial function, and appearance were rated as good. Brachytherapy was the most expensive treatment modality. Conclusion: Early‐stage lip SCC has a good prognosis, with a disease‐specific survival of 98.2% after a median follow‐up of 36 months, there was a high QoL and satisfaction at long‐term follow‐up. Based on the costs and the risk of locoregional recurrences, we believe that, for most noncomplex lip SCCs, MMS would be the most logical treatment option. [ABSTRACT FROM AUTHOR]

Varicose veins are the prevalent vascular disorder that has conventionally been managed via risky postoperative wound infections and conventional surgery. While ultrasound‐guided microwave ablation (UMA) has gained attention as a minimally invasive alternative, there is still a lack of research examining its comparative effectiveness. A prospective comparative investigation was undertaken in the Zhejiang region of China from January to November 2023, involving 140 patients who had received the diagnosis of primary varicose veins. An equal number of 70 patients underwent UMA and conventional surgery. Exclusion criteria for the study encompassed adult patients aged 18–65, with the exception of those who had undergone prior venous surgery, deep vein thrombosis or peripheral arterial disease. The demographical characteristics, procedural details and complication profiles of patients who developed postoperative wound infections within 30 days were analysed statistically. The outcomes demonstrated that postoperative wound infections were significantly diminished (5.7%) with UMA in comparison to conventional surgery (17.1%). In addition, the average duration of procedures and length of hospital stay for UMA patients were both reduced, although neither of these differences was found to be statistically significant (p > 0.05). Infection management, age and gender distribution of varicose veins were comparable between the two groups (p > 0.05). A significant inverse correlation was observed between the severity of varicose veins and postoperative outcomes, as determined by the regression analysis (p < 0.05). Using UMA to treat varicose veins showed promise as an alternative to conventional surgery, specifically in minimizing the incidence of postoperative wound infections. Additional research and clinical consideration are needed regarding the potential transition toward minimally invasive techniques in treatment of varicose veins, as suggested by these results. [ABSTRACT FROM AUTHOR]

Introduction: Even though EVLA is increasingly popular and together with other minimally-invasive techniques is rapidly replacing surgical stripping, surgical treatment is still widely used. Our study aimed to compare the clinical outcomes and the quality of life following either endovenous laser ablation (EVLA) or conventional surgery for varicose veins of the lower limbs. Aim and Objective of the study: the present study is aimed to compare the clinical outcomes and the quality of life in varicose veins patients who had undergone endovenous laser ablation or open surgery. Materials and Methods: It is a prospective randomised study. A total of 268 patients were treated for symptomatic varicose veins since the previous year, among them 130 patients underwent open surgery and 138 patients received endovenous laser ablation. Results: Disease-specific quality of life at six weeks was significantly better in the EVLA group. Similarly, VCSS and AVVQ scores at six weeks were also better in the EVLA group. Patients in the EVLA group experienced less postoperative pain and therefore needed fewer supplementary analgesic drugs. In addition, patients in the EVLA group managed to return to work and normal activities sooner than those in the surgery group. However no statistically significant differences were found between groups for clinical recurrence, overall satisfaction, rate of complications and secondary procedures at the end of one year. Discussion and Conclusion: Both techniques -- EVLA and surgery -- yielded similar results in terms of efficacy, clinical recurrence rates and overall patient satisfaction. Although in the present study we did not find EVLA to be superior to surgical stripping in the long term, a significant difference was seen in the immediate post operative period in terms of post operative pain and the duration of time required to return to work. Therefore, we assume that EVLA should be recommended over surgical stripping, especially for patients who need to resume to work in post-operative period. [ABSTRACT FROM AUTHOR]

Background: The diabetic foot constitutes one of the major diabetes-related morbidity. Diabetic foot ulcers (DFUs) are a disastrous consequence of the illness's course and are brought on by peripheral neuropathy, peripheral vascular disease, immunosuppression, and loss of glycemic control. Chronic ulcers must be treated surgically to prevent recurrences in cases with DFU. Every surgeon has to deal with this condition from very early in his career. Objectives: To investigate the various forms of traditional and modern DFU procedures and their consequences, this study can provide very fruitful guidance to the surgeons. Methods: In this study, we searched Google Scholar, PubMed, Embase, Cochrane Library, Web of Science, and Scopus from 2013 to 2023. The inclusion criteria were patients with DFUs, and patients with a known history of diabetes mellitus (type I or type II); the parameters included in the study were the occurrence of adverse responses, the rate of amputation, fatalities, recurrence rate and some other indications. Using the review manager (RevMan version 5.4), the risk of bias evaluation was done in this study, with risk assessment domains classified as high, unclear, or low risk. To check for biases for example reporting bias, performance bias, attrition bias, selection bias, etc., a recommended approach was used. Results: The current review included 8 studies in total, with a total of 888 cases of DFUs. A recurrence rate of 24.51% was noted for the entire patient population. The recurrences noted in none of the three investigations. Overall mortality was 14.26%, according to three investigations. Conclusions: It can be concluded that the patients treated with surgery show a lower recurrence rate of DFU as compared to the patients treated with only drug treatment. It is crucial to implement a new surgical treatment for DFUs to increase their success rate. A recently developed treatment program utilizing a multidisciplinary team approach and cooperation with referral hospitals is urgently required to improve the outcomes of DFU.

Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study’s primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information. Plain language summary Hidradenitis suppurativa is a long-term condition causing boils in skin creases such as the arm pits that are very painful, produce pus and cause scarring in about 1% of the United Kingdom population. The Treatment of Hidradenitis Suppurativa Evaluation Study aimed to understand current hidradenitis suppurativa treatments, to determine what influences treatment choices and to inform the design of future hidradenitis suppurativa randomised controlled trials. Ten UK hospitals took part and 151 people with active hidradenitis suppurativa, mostly moderate in severity, were enrolled and followed up for 12 months. The Treatment of Hidradenitis Suppurativa Evaluation Study offered five treatments chosen by participants with their doctor: doxycycline antibiotic tablets, combined clindamycin and rifampicin antibiotic tablets, laser hair removal treatment, ‘deroofing’ of skin tunnels which form due to hidradenitis suppurativa scarring and standard skin surgery. Laser treatment and deroofing were not available in the United Kingdom for hidradenitis suppurativa previously. We made an information video for deroofing which has been viewed more than 1 million times (https://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/theseus). Laser treatment was most popular, with 69% of participants willing and eligible for treatment, followed by deroofing (58%), standard surgery (54%) and then the antibiotic options. Interviewing participants revealed that willingness and final choice of treatment was most influenced by their doctor. Only about half of participants were still taking their doxycycline tablets after 3 months, due to lack of effectiveness and adverse effects, and the figure was even lower for combined clindamycin and rifampicin. Despite delays in receiving laser treatment and deroofing, switching between treatments was uncommon. Few participants chose standard surgery, perhaps because of long waiting times and the popularity of deroofing. Participants were sent a daily text message for 12 weeks, asking them to score their skin pain out of 10 and this worked well for 2 weeks and then rates of reply dropped. We hosted a workshop to discuss the Treatment of Hidradenitis Suppurativa Evaluation Study results and decide which treatments to take forward in future trials, with laser and deroofing being recommended. Headline The Treatment of Hidradenitis Suppurativa Evaluation Study introduced deroofing of skin tunnels and laser treatment for hidradenitis suppurativa and found that these are preferred interventions for future trials compared with oral antibiotics or conventional surgery. Scientific summary Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterised by recurrent inflammatory nodules, abscesses and skin tunnels in flexural sites including the axilla and groin. Flares are very painful, may produce pus and scarring and have a large impact on quality of life. Prevalence is about 1% of the UK population and HS particularly affects young adult women, detrimentally affecting relationships and employment. Multidisciplinary team (MDT) management is recommended, integrating drug treatments that reduce HS inflammation and surgery to manage scarring. A consensus process conducted by the Hidradenitis SuppuraTiva cORe outcomes set International Collaboration (HiSTORIC) defined outcome domains to measure in HS trials and validation of outcome measure instruments (OMIs) to assess each domain is underway. The Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS) addressed several questions prioritised in the James Lind Alliance Priority Setting Partnership (PSP) for HS, including what is the most effective and safe group of oral treatments in treating HS (ranked number one priority), what is the impact of HS and the treatments on people with HS (ranked third) and what is the best surgical procedure to perform in treating HS (ranked sixth). Deroofing is a surgical procedure usually performed under local anaesthetic allowing targeted removal of HS subcutaneous skin tunnels by blunt skin probing followed by removal of the tunnel roof and secondary intention healing of the base. It is routinely performed in several countries but not the UK. Laser treatment targeting the hair follicle is another well-recognised intervention for HS not currently used in the UK. The Treatment of Hidradenitis Suppurativa Evaluation Study was designed as a prospective cohort study to introduce deroofing and laser treatment for HS in the UK and to understand how conventional surgery and oral antibiotics are currently used. Objectives To understand current HS patient pathways and what influences patients’ and clinicians’ treatment choices to inform the design of future randomised controlled trials (RCTs). To determine the feasibility of recruiting individuals with HS into clinical trials. To fully characterise the THESEUS drug and procedural interventions. To test the feasibility and responsiveness of OMIs for HS trials. To explore consensus-agreed recommendations for future RCT study designs. Methods Study design A multicentre prospective observational cohort study, including five treatment options, with nested process evaluation, including participant and clinician interviews, and an end-of-study consensus workshop. Recruitment and follow-up Participants were recruited from 10 hospitals across the UK. Six sites were dermatology-led, two were plastic surgery-led and two had HS MDTs. Initial treatment was for 6 months, during which participants stayed on their chosen intervention, after which intervention switching was permitted, with an additional 6 months of follow-up. Reviews occurred every 3 months after recruitment and a study amendment allowed remote follow-up due to the COVID-19 pandemic. Sites were required to offer at least four of the five THESEUS interventions. Eligibility criteria Adults of at least 18 years with active HS not adequately controlled by current treatment were eligible for the study. Disease definition was a lifetime history of at least five flexural skin boils or two flexural skin boils in past 6 months, confirmed by a recruiting clinician with experience of HS care. Provided at least one of the study interventions was appropriate for the participant, any level of disease severity was acceptable. Exclusion criteria were being unable or unwilling to give informed consent, pregnancy or breasteeding, and being unable to complete outcome questionnaires in English. Participants could continue their current treatment on study entry. Interventions oral doxycycline 200 mg once daily; oral clindamycin and rifampicin both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle: neodymium-doped yttrium aluminium garnet (Nd-YAG) or alexandrite; deroofing; conventional surgery, procedure and closure method as per site’s usual practice. Participants could choose their intervention subject to availability on discussion with their clinician, who advised on the suitability of the interventions, the shared decision-making process mirroring usual clinical practice. Participant choice was supported by a decision grid (https://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/theseus) providing a description and head-to-head comparison of THESEUS interventions. Outcomes Primary outcome Proportion of participants eligible, and hypothetically willing, to use the interventions. Secondary outcomes proportion of participants choosing each study intervention, with reasons; proportion of participants switching treatments, with reasons; treatment fidelity; loss to follow-up over 12 months; efficacy outcome estimates after 6 months’ follow-up, informing OMI responsiveness. Safety As an observational study, investigators followed their usual process for managing adverse events, for example yellow card reporting, and adverse event data were collected at scheduled study visits. Daily pain score For 12 weeks after the intervention was commenced, participants were sent a daily text message to record the magnitude of their current pain due to HS from 0 to 10 using the pain numerical rating scale (NRS). Sample size The target sample size was 150 participants, permitting estimation of the proportion of participants hypothetically willing and eligible to be randomised in a clinical study within a 95% confidence interval (CI) of ±7%. Preliminary survey work ascertained that the sample size should ensure at least 20 participants were recruited for each intervention, sufficient to explore delivery in an IDEAL 2b evaluation. Statistical methods Study participation (screened, eligible, recruited, withdrawals) and completeness of follow-up was illustrated by a Consolidated Standards of Reporting Trials (CONSORT) flow diagram. For the primary outcome, willingness and eligibility data were combined for each intervention. THESESUS was not powered to test hypotheses and most analyses were descriptive. Continuous data were reported as means and standard deviations or medians and interquartile ranges, as appropriate, and categorical data reported as frequencies and proportions. Analysis and results were based on the participants’ final treatment selection. Treatment fidelity was measured by self-reported concordance at each follow-up. Effect over time was estimated for efficacy outcomes for each intervention with 95% CIs. The pattern of missingness of daily pain scores during 12-weeks was examined for levels of completion. Patient and public involvement Patient and public involvement (PPI) representatives were involved in THESEUS from the outset, two leaders of the HS Trust patient advocacy organisation being funding co-applicants and a further two PPI representatives joined the study management group and one joined the study steering group. The creation of a decision grid was requested by THESEUS PPI members and they reviewed all patient-facing study documentation. Specific PPI representative feedback led to chlorhexidine solution being removed as a cotreatment from the doxycycline intervention arm to avoid misconceptions that HS is linked to poor personal hygiene. PPI representatives directed the timing of the daily text messages, requested a patient version of a deroofing information video and advised on flexible remote follow-up to mitigate for COVID-19 pandemic disruption. Following discussion with THESEUS PPI representatives, it was decided to host a combined results reveal meeting for trial participants, clinicians and researchers. THESEUS patient research partners guided logistical arrangements for the end-of-study workshop and led two participant meetings beforehand. Results Between February 2020 and July 2021, 151 participants were recruited. Recruitment was affected by the COVID-19 pandemic and there were two substantial pauses which mirrored two waves of the pandemic in the UK. Outside these periods, a recruitment rate of 15–20 participants per month was achieved. Follow-up rates were 89% and 83% after 3 and 6 months, respectively, decreasing to 42% at 12 months, in part because pandemic recruitment delays prevented all participants from reaching their final study review. Baseline demographics of THESEUS participants were in keeping with secondary care HS patients, with an average age of 36 years, 81% female, two-thirds current or ex-smokers and 86% with a raised body mass index (BMI). There was a slightly higher proportion of non-white participants than the UK average, with 20% being black, Asian or Caribbean. Baseline disease severity again reflects the HS secondary care population, two-thirds having moderate disease, 19% severe disease and 13% mild disease. Regarding THESEUS’s primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), oral clindamycin and rifampicin (44%), and finally doxycycline (37%). Considering participant willingness in isolation, laser was ranked the first choice by the greatest proportion (41%) of participants. Final intervention choice mirrored the primary outcome, except the proportion choosing laser treatment was lower because it was offered by only 6 of the 10 recruiting sites. The cohort study and nested qualitative study results demonstrated participant willingness to receive treatment and final intervention choice were strongly influenced by clinicians. ‘My doctor recommended it’ was the most common reason (59%) given by participants for their final choice. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Continuation of clindamycin and rifampicin after 3 months was affected by the standard course being 10 weeks initially, reflected by only 30% still receiving treatment after 12 weeks. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon, with only five participants switching from laser and nine switching from deroofing. There were no serious adverse events reported. Those receiving doxycycline had modest improvements after 3 months in median International Hidradenitis Suppurativa Severity Score System (IHS4) score from 7 to 6, Dermatology Life Quality Index (DLQI) score from 6 to 3.5 points, Hidradenitis Suppurativa Quality of Life score (HiSQOL) score from 26.5 to 11.5 and pain NRS from 2 to 1. Small effect sizes are in part due to relatively low baseline disease severity in the doxycycline group. Corresponding score changes for clindamycin and rifampicin at 3 months were decreases in IHS4 score from 11 to 5 points, DLQI score from 14 to 10.5 points, HiSQOL score from 34 to 23 and pain NRS from 4 to 2. The variable timing of procedural interventions limited interpretation of efficacy data for these interventions with follow-up reviews fixed in time after recruitment. Daily pain score text messages were initiated in 110 participants and 100 returned at least one score. Daily responses reduced over time and the median duration of concordance was 36 days. A higher level of completion occurred in the first 14 and 28 days. Characterisation of deroofing and laser Deroofing was a popular intervention with both clinicians and participants, reflected by more than 1 million views of the THESEUS study video (https://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/theseus). Deroofing proved straightforward for sites to adopt, both those led by plastic surgery and dermatology departments. The instrument used for incision varied, with needle tip diathermy used more often than loop tip diathermy. However, identification of skin tunnels by blunt probing and removal of the tunnel roof with secondary intention healing were highly conserved. Unintended variation was encountered in the laser group, one-third of treatments being intense pulsed light (IPL) rather than laser treatment. The effect of the two interventions is similar because both target the hair follicle and there is evidence supporting IPL for HS. The THESEUS laser protocol specified double pulse treatment for HS lesions and single pulses for neighbouring unaffected skin; however, considerable variation was observed. It was not possible to characterise conventional surgery due to the low number of participants in this group, in part reflecting preference for deroofing. Process evaluation The qualitative studies aimed to understand participants’ and clinicians’ perspectives on treatment choices and to identify recruitment barriers and facilitators for future trials. Semistructured participant interviews were conducted by telephone using a topic guide and subsequent thematic analysis. Purposive sampling ensured diversity of participants across the five interventions. Interviews demonstrated that intervention choice was influenced by ‘push’ factors such as lack of efficacy and adverse effects if an intervention had been received previously and ‘pull’ factors such as the novelty of laser treatment and deroofing. Participants supported flexibility in remote compared with in-person follow-up and highlighted the need to minimise questionnaire burden. Consensus workshop In June 2022, a 1-day consensus workshop occurred, informed by THESEUS results. Nineteen individuals attended in person, including six people living with HS. Fourteen individuals attended remotely via videoconferencing. The workshop was preceded by two meetings for patients and a pre-workshop survey asked for initial voting on interventions to investigate in future HS RCTs. Early intervention to prevent HS scarring was agreed upon as a general principle. The workshop prioritised combined laser and medical therapy, which could be compared with laser or medical therapy, potentially in a multiarm study. Combination therapy with biologic treatments such as adalimumab was considered and deroofing was also prioritised, either for chronic lesions or for acute flares. Conclusions Implications for health care Offering medical and non-medical interventions, THESEUS encouraged an MDT approach to optimise HS care. Training and equipment provided by THESEUS established deroofing as a surgical option, bringing the UK in line with other countries. Deroofing is a tissue-sparing treatment for tunnels and can also be adapted for acute flares, the latter being ranked second highest priority in the HS PSP. A need for deroofing is demonstrated by 1 million views of the THESEUS deroofing video. While laser and light hair removal treatment was already available in the UK, it was rarely used for HS therapy and THESEUS showed that it can be provided for HS within existing infrastructure. Use of HiSTORIC-developed OMIs for HS familiarised 10 centres with well-validated tools to monitor patient progress. Several OMIs are suitable for routine clinical care; for example, HiSQOL can be completed in the waiting area before appointments. Implications for research The Treatment of Hidradenitis Suppurativa Evaluation Study was designed to underpin future HS RCTs. The 10 THESEUS sites are well-placed to be recruiting centres in future trials, which, from the THESEUS workshop, are likely to involve laser or deroofing. Whether to allow IPL within a laser and light hair removal treatment intervention in a future RCT will depend on availability of Nd-YAG and alexandrite lasers and whether the study is more explanatory or pragmatic in design. The nested qualitative study provided multiple insights for future trials. A RCT with an active comparator will need to ensure equipoise for participants and clinicians and provide equivalent information, for example study videos, for each intervention. Flexibility should be offered where possible for in-person or remote appointments. OMIs should be minimised and carefully explained. Collection of daily pain scores remotely is feasible, but it should be restricted to short periods. Delivering the planned recruitment of 150 THESEUS participants despite the COVID-19 pandemic demonstrates that future RCTs for HS in the UK are feasible and will be well-supported by patients and health-care professionals (HCPs). Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.

Background: The diabetic foot constitutes one of the major diabetes-related morbidity. Diabetic foot ulcers (DFUs) are a disastrous consequence of the illness's course and are brought on by peripheral neuropathy, peripheral vascular disease, immunosuppression, and loss of glycemic control. Chronic ulcers must be treated surgically to prevent recurrences in cases with DFU. Every surgeon has to deal with this condition from very early in his career. Objectives: To investigate the various forms of traditional and modern DFU procedures and their consequences, this study can provide very fruitful guidance to the surgeons. Methods: In this study, we searched Google Scholar, PubMed, Embase, Cochrane Library, Web of Science, and Scopus from 2013 to 2023. The inclusion criteria were patients with DFUs, and patients with a known history of diabetes mellitus (type I or type II); the parameters included in the study were the occurrence of adverse responses, the rate of amputation, fatalities, recurrence rate and some other indications. Using the review manager (RevMan version 5.4), the risk of bias evaluation was done in this study, with risk assessment domains classified as high, unclear, or low risk. To check for biases for example reporting bias, performance bias, attrition bias, selection bias, etc., a recommended approach was used. Results: The current review included 8 studies in total, with a total of 888 cases of DFUs. A recurrence rate of 24.51% was noted for the entire patient population. The recurrences noted in none of the three investigations. Overall mortality was 14.26%, according to three investigations. Conclusions: It can be concluded that the patients treated with surgery show a lower recurrence rate of DFU as compared to the patients treated with only drug treatment. It is crucial to implement a new surgical treatment for DFUs to increase their success rate. A recently developed treatment program utilizing a multidisciplinary team approach and cooperation with referral hospitals is urgently required to improve the outcomes of DFU. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study is to determine whether patients with acute uncomplicated diverticulitis with micro-perforation should really be treated as patients without perforation and to identify differences in recurrence rates, complications and mode of treatment Material and Methods: A total of 47 patients with a diagnosis of acute diverticulitis were admitted to the hospital for a three-year period from 01.01.2018 to 01.01.2020 in the Department of General, Visceral and Emergency Surgery at UMHATEM "Pirogov". Of those hospitalized, women were 21 (44.68%), men 26 (55.32%). The age in this retrospective analysis varied from 27 to 81 years (average 51.3 years). Results: All patients had leukocytosis, abdominal pain, and tenderness. From the group of 47 patients hospitalized with acute diverticulitis, twenty-five (53.19%) were diagnosed with micro-perforation by pneumoperitoneum data from X-ray and CT or free intraperitoneal fluid from ultrasound. The other three (6.38%) were identified intraoperatively (by laparoscopy or laparotomy) based on an indication of peritoneal irritation. The remaining 19 (40.43%) with mild symptoms for conservative management (38.89%) - through physical examination, laboratory data and imaging diagnostic methods (X-ray, ultrasound and CT). Of the 28 operated, 13 patients had laparoscopy performed lavage and drainage, with the remaining 15 (with laparotomy) - had Hartmann's procedure. Conclusion: Acute diverticulitis with micro-perforation showed no significant differences in the complications and course of antibiotic therapy compared to the group of acute diverticulitis without micro-perforation. Neither group required surgery after one-month discharge. Accordingly, to these outcomes, the mode of treatment should be identical.

Abstract Background There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury. Methods PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery. Results 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders. Conclusions The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations.

Yunpeng Cui, Xuedong Shi, Chuan Mi, Bing Wang, Yuanxing Pan, Yunfei Lin Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xuedong ShiDepartment of Orthopedic, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of ChinaTel +86 10-83575660Email pku_ortho@163.comBackground: This study aimed to evaluate the perioperative safety and efficacy of minimally invasive tubular surgery for patients with spinal metastasis.Methods: A total of 161 consecutive patients with spinal metastasis between June 2017 and June 2020 were retrospectively reviewed. A total of 36 patients were included in this study, 14 patients underwent minimally invasive tubular surgery (M), and 22 patients underwent conventional surgery (C). T-test and chi-square tests were used to evaluate demographic and perioperative data differences between the two groups.Results: Baseline characteristics did not differ significantly between M and C groups except for the SINS (p=0.002) and preoperative Alb (p=0.026). There was no significant difference in operative time and complications between M and C groups (p< 0.05). The M group had less mean blood loss than the C group (1275 vs 718mL, p=0.045). Blood transfusion was comparable between the two groups (p< 0.05). The mean amount and drainage time were lower than the C group (141 vs 873mL, p< 0.001; 3.1 vs 7.0 days, P< 0.001). The mean postoperative hospitalization of the M group was 8.8 days, which was lower than the C group (11.3 days, p=0.045). Sub-analysis showed that for patients with hyper-vascular tumor, the M group had less mean amount and time of drainage compared with the C group (p< 0.05); for patients with hypo-vascular tumor, the mean blood loss and amount of blood transfusion were also reduced in M group (p< 0.05). The mean blood loss and drainage time of patients with hypo-vascular tumors were less than patients with hyper-vascular tumors in the M group (p< 0.05).Conclusion: In selected cases, minimally invasive tubular surgery is safe and effective for patients with spinal metastasis. Patients with hypo-vascular tumors were more suitable for this technique with less blood loss, fewer blood transfusions, minor drainage, and shorter postoperative hospitalization.Keywords: spinal metastasis, minimally invasive tubular surgery, minimally invasive spine surgery, conventional surgery, tubular retractor, hypo-vascular tumor

Abstract Background Blood loss in posterior surgery patients with thoracolumbar metastasis posed a significant challenge to surgeons. This study aimed to explore the risk factors of blood loss in posterior surgery for patients with thoracolumbar metastasis. Methods One hundred forty-two patients were retrospectively reviewed. Their baseline characteristics were recorded. The Gross equation was used to calculate blood loss on a surgical day. Multivariate linear regression was used to analyze the risk factors. Results Mean blood loss of 142 patients were 2055 ± 94 ml. Hypervascular primary tumor (kidney, thyroid and liver) (P = 0.017), wide or marginal excision (en-bloc: P = 0.001), metastasis at the lumbar spine (P = 0.033), and the presence of extraosseous tumor mass (P = 0.012) were independent risk factors of blood loss in the posterior surgery. Sub-analysis showed that wide or marginal excision (en-bloc: P

Purpose: To compare the efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma, using a systematic review including traditional pooling and Bayesian network meta-analysis., Materials and Methods: A comprehensive literature search in PubMed, EMBASE, and the Cochrane Library databases identified retrospective studies evaluating the tumor volume change after different thermal ablation or conventional surgery. Studies from the date of their inception to January 6, 2024, were included. A review of 4463 potential papers, including a full-text review of 23, identified 10 eligible papers covering a total of 2658 patients for meta-analysis. The tumor volume change over a 12-month follow-up was compared between different thermal ablations. Tumor diameter change, complications, recurrence, operation and hospitalization time were evaluated by network meta-analysis., Results: Based on the traditional frequentist approach, the overall pooled estimates for the standardized mean difference (SMD) in tumor volume change of radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) were 1.38 (95 % credibility interval (CI), 0.62-2.13), 1.94 (95%CI, 0.78-3.10) and 1.38 (95%CI, 1.01-1.75), respectively. Based on the Bayesian network meta-analysis, in examining the surface under the cumulative ranking area (SUCRA) ranking, RFA (SUCRA, 76.6), MWA (SUCRA, 66.6), and LA (SUCRA, 39.8) were identified as the three interventions that were associated with the greatest reduction in risk for complications compared with conventional surgery (CS), with RFA (SUCRA, 76.6) being ranked as the highest in safety. MWA, SMD 4.43 [95%CI, 2.68-6.17], RFA SMD 4.24 [95 % CI, 1.66-6.82], and LA SMD 4.24 [95 % CI, 1.48-7.00] were associated with the shorter operation time compared with CS. LA SMD 4.61 [95 % CI, 1.79-7.44] and MWA SMD 3.07 [95 % CI, 1.32-4.83] were associated with the shorter hospitalization time compared with CS, with LA (SUCRA, 86.5) yielding the highest ranking. MWA was associated with a reduced risk for tumor recurrence RR 0.02 [95 % CI, -0.44-0.49], compared with CS., Conclusion: We conducted a comprehensive review of the published literature on the effectiveness and safety of different thermal ablation techniques and conventional surgery for papillary thyroid microcarcinoma. Important research gaps persist due to a lack of long-term data and high-quality randomized controlled trials (RCTs)., Competing Interests: Declaration of competing interest The authors received no funding for this work. The authors have no relevant financial disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The aim of the present study is to evaluate and compare healing outcomes, probing pocket depth (PPD) reduction, clinical attachment, and alveolar bone level following Modified Widman Flap (MWF) with and without 4× prismatic loupe in infrabony pockets., Methods: Patients having at least one infrabony pocket with PPD ≥5 mm and angular bone loss ≥3 mm bilaterally were randomly assigned to a microsurgical (test) group with MWF using 4× magnifying loupes and conventional (control) group by MWF only. At baseline, 3 and 6 months plaque index, bleeding index, PPD, and relative clinical attachment level were taken. The healing outcome was evaluated with a healing index by Landry. Pain score was assessed with Visual Analog Scale (VAS). The percentage of defect depth (DD) reduction was assessed by cone beam computed tomography (CBCT) and periapical radiograph. Continuous data between groups were analyzed using an unpaired "t" test. Within-group comparison was done using repeated measures analysis of variance followed by multiple pairwise comparisons and paired "t" test., Results: There was a statistically significant ( P = 0.004) reduction in intrabony DD in each group evaluated through CBCT. The mean VAS score after 1 week of surgical procedure was 3.67 at the conventional site compared to 2.9 at the microsurgical site, which was statistically significant ( P = 0.004). Statistically significant ( P ≤ 0.05) healing scores were observed for microsurgery group (84.6% after 1 week) compared to control group (15.4% after 1 week)., Conclusion: Although blinding of patients and surgeons was difficult and healing indices used are subjective, it can be concluded that microsurgery under 4× magnifying loupe is as effective as conventional MWF in the treatment of infrabony pockets but clinical parameters are greatly enhanced by microsurgery with improved healing and less patient discomfort., Competing Interests: None., (Copyright: © International Journal of Health Sciences.)

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Background: There are a number of clinical disorders that require mandibular reconstruction (MR). Novel three-dimensional (3D) printing technology enables reconstructions to be more accurate and beneficial to the patient. However, there is currently no evidence identifying which techniques are better suited for MR, based on the type of clinical disorder the patient has. In this study, we aim to compare 3D techniques with conventional techniques to identify how best to reconstruct the mandible based on the clinical cause that necessitates the reconstructive procedure: cancerous or benign tumours, clinical disorders, infection or disease and trauma or injury.Methods: PubMed, Scopus, Embase and Medline were searched to identify relevant papers that outline the clinical differences between 3D and conventional techniques in MR. Data were evaluated to provide a clear outline of suitable techniques for surgery.Results: 20 of 2749 papers met inclusion criteria. These papers were grouped based on the clinical causes that required MR into four categories: malignant or benign tumour resection; mandibular trauma/injury and other clinical disorders.Conclusions: The majority of researchers favoured 3D techniques in MR. However, due to a lack of standardised reporting in these studies it was not possible to determine which specific techniques were better for which clinical presentations. [ABSTRACT FROM AUTHOR]

Background: Blood loss in posterior surgery patients with thoracolumbar metastasis posed a significant challenge to surgeons. This study aimed to explore the risk factors of blood loss in posterior surgery for patients with thoracolumbar metastasis.Methods: One hundred forty-two patients were retrospectively reviewed. Their baseline characteristics were recorded. The Gross equation was used to calculate blood loss on a surgical day. Multivariate linear regression was used to analyze the risk factors.Results: Mean blood loss of 142 patients were 2055 ± 94 ml. Hypervascular primary tumor (kidney, thyroid and liver) (P = 0.017), wide or marginal excision (en-bloc: P = 0.001), metastasis at the lumbar spine (P = 0.033), and the presence of extraosseous tumor mass (P = 0.012) were independent risk factors of blood loss in the posterior surgery. Sub-analysis showed that wide or marginal excision (en-bloc: P < 0.001) and metastasis at lumbar spine (P = 0.007) were associated with blood loss for patients with non-hyper vascular primary tumors. Wide or marginal excision (piece-meal: P = 0.014) and the presence of an extraosseous tumor mass (P = 0.034) were associated with blood loss for patients with hypervascular primary tumors.Conclusion: Hypervascular primary tumor (kidney, thyroid, and liver) was an independent risk factor of blood loss in the posterior surgery. The presence of extraosseous tumor mass and wide or marginal excision (piece-meal) were independent risk factors for patients with hypervascular primary tumors. Metastasis at the lumbar spine and wide or marginal excision (en-bloc) were independent risk factors for patients with non-hyper vascular primary tumors. [ABSTRACT FROM AUTHOR]

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role.

Background and Aim: Gliomas are the most common type of brain tumor in the world. Surgical resection is one of the most effective therapeutic methods in terms of patient prognosis. However, it is difficult for neurosurgeons and health-care providers to select which imaging technology to best support the procedure. These technologies included intraoperative magnetic resonance imaging (iMRI), intraoperative ultrasound (iUS), fluorescence guidance with 5-aminolevulinic acid (5-ALA), and intraoperative neuronavigation. Hence, in this study, we compared the gross total resection (GTR), postoperative complications within or outside of the central nervous system, and postoperative clinical improvement by multiple meta-analyses, which allows the integration of data through direct and indirect comparisons.Materials and Methods: The PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, and WanFang databases were searched for publications before April 2018. Randomized controlled trials, two-arm and three-arm prospective studies, and retrospective studies in patients who underwent surgical treatment for glioma were included. The most important outcome measures were the rates of GTR, postoperative complications, and clinical improvement. Results: In terms of GTR, iMRI (odds ratio [OR] = 5.70, 95% confidence interval [CI]: 3.40–9.60), iUS (OR = 2.70, 95% CI: 1.10–6.90), 5-ALA (OR = 2.40, 95% CI: 0.64–8.90), and neuronavigation (OR = 1.90, 95% CI: 1.20–3.10) were found to be more effective than conventional surgery. In addition, iUS (OR = 0.15, 95% CI: 0.04–0.52), iMRI (OR = 0.24, 95% CI: 0.14–0.43), and neuronavigation (OR = 0.34, 95% CI: 0.18–0.56) were more found to result in fewer complications than conventional surgery. Furthermore, patients' clinical improvement was better with iMRI (OR = 8.10, 95% CI: 3.00–25.00), iUS (OR = 4.90, 95% CI: 0.76–33.00), and neuronavigation (OR = 2.60, 95% CI: 1.00–7.20) than with conventional surgery. Conclusions: The developed ranking probability table indicated that iMRI was superior in terms of the GTR and clinical improvement, while iUS was the least likely to result in postoperative complications. Hence, it was concluded that iMRI or iUS is the most advantageous imaging modality.

Purpose: The aim of this study is to present our experience in UMHATEM "Pirogov" in the laparoscopic treatment of perforated peptic ulcer in the last two years. Material and Methods: A total of 37 patients with the diagnosis of perforated peptic ulcer were hospitalized for a period of two years from 1. 1. 2015 to 1. 1. 2017 in the Department of General, Visceral and Emergency Surgery at UMHATEM "Pirogov". Of these, women were 11 (29.73%) and men 26 (70.27%). The age in this retrospective analysis varied from 18 to 71 years (average 47 years.). Results: In 34 cases perforation was localized in the stomach (91.89%) and in three in the duodenum (8.11%). In 6 patients (16.22%), the ulcer was of a chronic nature (broad, raised edges), and in the remaining 31, it was acute (83.78%). Laparoscopic treatment was performed in 33 (89.19%) patients. The surgical methods were primary suture or omentoplastica. Three patients had post-operative infections of the abdominal wounds (morbidity-8.11%). One patient died (2.7%). Conclusions: Laparoscopic treatment of perforated peptic ulcer is a safe method with low morbidity and mortality rates, reduced postoperative pain (hence a decrease in the amount of analgesics) as well as a short hospital stay and early recovery to normal activities.

Aim: Complete mesocolic excision (CME) lacks consistent data advocating operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta‐analysis, analysing population characteristics and perioperative, pathological and oncological outcomes. Methods: D3 extended lymphadenectomy dissection was considered comparable to CME, and D2 and D1 dissection to be comparable to conventional surgery. Outcomes reviewed included lymph node yield, R1 resection, overall complications, overall survival and disease‐free survival. Results: In all, 3039 citations were identified; 148 studies underwent full‐text reviews and 31 matched inclusion criteria: total cohort 26 640 patients (13 830 CME/D3 vs. 12 810 conventional). Overall 3‐ and 5‐year survival was higher in the CME/D3 group compared with conventional surgery: relative risk (RR) 0.69 (95% CI 0.51–0.93, P = 0.016) and RR 0.78 (95% CI 0.64–0.95, P = 0.011) respectively. Five‐year disease‐free survival also demonstrated CME/D3 superiority (RR 0.67, 95% CI 0.52–0.86, P < 0.001), with similar findings at 1 and 3 years. There were no statistically significant differences between the CME/D3 and conventional group in overall complications (RR 1.06, 95% CI 0.97–1.14, P = 0.483) or anastomotic leak (RR 1.02, 95% CI 0.81–1.29, P = 0.647). Conclusions: Meta‐analysis suggests CME/D3 may have a better overall and disease‐free survival compared to conventional surgery, with no difference in perioperative complications. Quality of evidence regarding survival is low, and randomized control trials are required to strengthen the evidence base. [ABSTRACT FROM AUTHOR]

Background/Aim: Osteotomy as the first step in surgery, provides access to the field and its application could influence the outcome. Nowadays, the conventional burr reduction is being challenged by newer sonic and ultrasonic methods. We investigated the bone structural integrity and metal attrition residues both in bone and the irrigation fluid. Materials and Methods: Bovine ribs were cut using three methods. Bone cuts were studied using Environmental Scanning Electron Microscopy (ESEM) for tissue discrepancies and Scanning Electron Microscopy/Energy Dispersion X-Ray Microanalysis (SEM/EDX) for organic and inorganic debris. Results: Better preservation of bone architecture was seen in piezo and sono surgery while metal attrition was not conclusive (p>0.05). Unlike in bone analyses, both bur and ultrasonic osteotomies showed statistically significant higher median inorganic detection per analysis (p=0.021 and p=0.037, respectively). Conclusion: Sono and piezo surgery proved to be less invasive while attrition properties were the same. [ABSTRACT FROM AUTHOR]

Background: Robotic mitral valve surgery continues to become widespread all over the world in direct proportion to the developing technology. In this study, we aimed to compare the postoperative results of robotic mitral valve replacement and conventional mitral valve replacement. Methods: A total of consecutive 130 patients who underwent robotic mitral valve replacement and conventional mitral valve replacement with full sternotomy between 2014 and 2020 were included in our study. All patients were divided into two groups: Group I, with 64 patients who underwent robotic mitral valve replacement and Group II, with 66 patients with conventional full sternotomy. General demographic data (age, gender, body weights, etc.), comorbidities (hypertension, diabetes mellitus, chronic obstructive pulmonary disease, peripheral artery disease, hyperlipidemia, etc.), intraoperative variables (cardiopulmonary bypass times, and cross‐clamp times), postoperative ventilation times, drainage amounts, transfusion amount, inotropic need, revision, arrhythmia, intensive care and hospital stay times, and mortality were analyzed retrospectively. Results: There was no significant difference between demographic data, such as age, gender, body kit index, and preoperative comorbid factors of both patient groups (p >.05). Cardiopulmonary bypass time (204.12 ± 45.8 min) in Group I was significantly higher than Group II (98.23 ± 17.8 min) (p <.001). Cross‐clamp time in Group I (143 ± 27.4 min) was significantly higher than Group II (69 ± 15.2 min) (p <.001). Drainage amount in Group I (290 ± 129 cc) was significantly lower than Group II (561 ± 136 cc) (p <.001). The erythrocyte suspension transfusion requirement was 0.4 ± 0.3 units in Group I; it was 0.9 ± 1.2 units in Group II, and this requirement was found to be significantly lower in Group I (p =.014). While the mean mechanical ventilation time was 5.3 ± 3.9 h in Group I, it was 9.6 ± 4.2 h in Group II. It was significantly lower in Group I (p =.001). Accordingly, intensive care stay (p =.006) and hospital stay (p =.003) were significantly lower in Group I. In the early postoperative period, three patients in Group I and four patients in Group II were revised due to bleeding. In the postoperative hospitalization period, neurological complications were observed in one patient in Group I and two patients in Group II. Two patients in Group I returned to the sternotomy due to surgical difficulties. Two patients died in both groups postoperatively, and there was no significant difference in mortality (p =.97). Conclusion: According to conventional methods, robotic mitral valve replacement is an effective and reliable method since total perfusion and cross‐clamp times are longer, drainage amount and blood transfusion need are less, and ventilation time, intensive care, and hospital stay time are shorter. [ABSTRACT FROM AUTHOR]

Introduction: Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery. Objective: The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies. Materials and Methods: A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively. Conclusion: The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages.

Introduction: The aim of the current study was to evaluate the accuracy of resection a solid lesion in an acrylic lower jaw by young professionals using a dynamic computer-assisted surgical system comparted to conventional surgery technique., Material and Methods: Twenty students performed the removal of the lesion conventionally and twenty students did the operation with a dynamic computer-assisted surgical system. Both groups were compared regarding the defect size, operation time, and surgical complications., Results: The defect size in the jaw was significant smaller with the navigated surgery (p < 0.001). Operation time was shorter without navigation system, but no significance was found (p = 0.137). Without navigation system three young professionals perforated the lingual cortex., Discussion: Navigated surgery can immediately be used by young professionals and support young surgeons in everyday clinical practice, especially in operations with difficult anatomic situations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Abstract Backgroud A meta-analysis was performed to compare the differences in outcomes between sutureless technique and conventional surgery for primary repair of Total Anomalous Pulmonary Venous Connection(TAPVC). Methods Electronic databases, including PubMed, EMbase, Medline, CNKI, Wanfang Data and Weipu Data were searched systematically for the literature aimed mainly at comparing the therapeutic effects for primary repair of TAPVC administered by sutureless technique and conventional surgery. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Seven studies meeting the inclusion criteria were included, involving a total of 1293 subjects. It was observed that sutureless technique entailed a lower occurrence rate of post-operative Pulmonary Veins Obstruction (PVO) (OR, 0.52 95%CI, 0.32–0.86; P = 0.01) and re-operation due to PVO (OR, 0.28;95%CI, 0.09–0.87; P = 0.03). However, meta-analyses of hospitalization time (WMD, 5.92; 95%CI, − 7.97-19.80; P = 0.40) and post-operative mortality (OR, 0.65; 95%CI, 0.41–1.04; P = 0.07) showed no significant differences between sutureless technique and conventional surgery. Meta-analysis of Cardiopulmonary Bypass (CPB) time and aortic cross-clamp time also showed no significant differences between the two surgical approaches (WMD, 5.07; 95%CI, − 9.29-19.42; P = 0.49); (WMD, 5.73; 95%CI, − 7.76-19.23; P = 0.40), but the result remained inconclusive due to pooling result changes after sensitivity analysis. Conclusions Compared with conventional surgery, a lower occurrence rate of post-operative PVO and re-operation due to PVO were associated with sutureless technique. Meanwhile, hospitalization time and post-operative mortality were not statistically different between the two surgical approaches. Pooling result of CPB and aortic cross-clamp time between the two groups remained inconclusive.

Objective: The role of surgery in spontaneous intracerebral hemorrhage (sICH) is still controversial. We aimed to investigate the effectiveness of minimally invasive surgery (MIS) compared to conventional surgery (CS) for supratentorial sICH. Methods: The medical data of 70 patients with surgically treated supratentorial sICH were retrospectively reviewed. MIS was performed in 35 patients, and CS was performed in 35 patients. The surgical technique was selected based on the neurological status and radiological findings, such as hematoma volume, neurological status and spot signs on computed tomographic angiography. Treatment outcomes, prognostic factors and the usefulness of the spot sign were analyzed. Results: Clinical states in both groups were statistically similar, preoperatively, and in 1 and 3 months after surgery. Both groups showed significant progressive improvement till 3 months after surgery. Better preoperative neurological status, more hematoma removal and intensive care unit (ICU) stay =7 days were the significant prognostic factors for favorable 3-month clinical outcomes (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.10-0.96, p=0.04; OR 1.04, 95% CI 1.01-1.08, p=0.02; OR 26.31, 95% CI 2.46-280.95, p=0.01, respectively). Initial hematoma volume and MIS were significant prognostic factors for a short ICU stay (=7 days; OR 0.95; 95% CI 0.91-0.99; p=0.01; OR 3.91, 95% CI 1.03-14.82, p=0.045, respectively). No patients in the MIS group experienced hematoma expansion before surgery or postoperative rebleeding. Conclusions: MIS was not inferior to CS in terms of clinical outcomes. The spot sign seems to be an effective radiological marker for predicting hematoma expansion and determining the surgical technique. [ABSTRACT FROM AUTHOR]

Purpose and objectives. Peritoneal complications of acute appendicitis are inevitable and require a firm attitude both in terms of reducing intraoperative risks but especially in choosing the appropriate therapeutic approach. Material and method. The paper presents a retrospective biostatistical study of appendicular peritonites operated laparoscopically in the General Surgery Clinic of “Sf. Ioan” Emergency Clinical Hospital of Bucharest between January 2008 and December 2016. Results. There were 1,275 cases with various forms of acute appendicitis, of which 278 (21.80%) were complicated forms. Among them, 94 cases (7.37%) presented generalized peritonitis with different degrees of severity and 184 (14.43%) cases were localized peritonitis. Generalized peritonitis of appendicular cause was operated laparoscopically in almost 71.27% of the cases (67 out of 94 generalized peritonitis of appendicular cause). The incidence of postoperative complications was significantly lower in the case of the laparoscopic approach of appendicular peritonitis (p < 0.0001), compared to conventional operations. Conclusions. The indications and limits of the laparoscopic approach in the treatment of appendicular peritonitis are largely dictated by the severity of the lesions, but the experience of the operating team also has an important role. [ABSTRACT FROM AUTHOR]

Background and objective Endovenous laser ablation (EVLA) of the great saphenous vein (GSV) is much more used as an alternative method of treatment instead of conventional surgery procedures. EVLA is thought to decrease postoperative morbidity with rapid recovery and early return to daily activity. The goal of this study was to compare the effectiveness, postoperative pain, complications, and patient satisfaction following either EVLA or conventional surgery for varicose veins of the lower limbs. Patients and methods This is a retrospective study that was conducted on 50 consecutive patients/60 limbs (10 bilateral and 40 unilateral) presented to Kasr Al Aini Hospitals, Cairo University and Asir Central Hospital Saudi Arabia from January 2015 to January 2018 with truncal varicose veins involving GSV. Patients were divided into two groups: group I (30 limbs) who underwent conventional surgery in the form of high ligation and striping and group II (30 limbs) who underwent EVLA. Results The EVLT group was associated with good patient satisfaction with early return to daily activities and work. Pain, paresthesia, ecchymosis, hematoma were significantly higher in group II (P<0.05), with low rate of recurrence in both groups with no statistically significant difference between both groups. Conclusion Both EVLT and conventional surgery techniques were performed well as regards efficacy with low rate of recurrence for incompetent GSV. Less postoperative pain and complications were observed with EVLT as compared with conventional surgery such as ecchymosis, hematoma, superficial thrombophlebitis, and paresthesia. [ABSTRACT FROM AUTHOR]

Background: Varicosis is a common venous condition, which is typically treated surgically. However, selection of the optimal surgical approach can be challenging. Previous studies comparing endovenous laser treatment (EVLT) and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors. In this study, we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins., Aim: To compare the perioperative and postoperative outcomes of EVLT and conventional surgery in patients with great saphenous vein varicosis., Methods: We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019. Among them, 56 patients were excluded owing to additional small saphenous varicose vein involvement, 81 owing to recurring varicose veins, 83 owing to complicated varicose veins (CEAP clinical classification C5-C6), and 6 owing to perioperative phlebitis. Finally, 772 patients were enrolled in this study. Standard demographic and clinicopathological data were collected from the medical records of the patients. For propensity score matching, 522 patients (261 who underwent EVLT and 261 who underwent conventional surgery) were randomly matched 1:1 by age, sex, onset time, smoking status, presence of diabetes, family history, stress therapy, C class, and the affected leg., Results: Of the 772 patients included in the study, 467 underwent EVLT and 305 underwent conventional surgery. There were significant differences in age, onset time, smoking and diabetes status, and family history between the two groups. Following propensity score matching, no significant differences in patients' characteristics remained between the two groups. ELVT was associated with a shorter operation time and hospital stay than conventional surgery, both before and after propensity score matching. There were no differences in complications between the two groups after propensity score matching. Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery (33.33% vs 21.46%, χ 2 = 11.506, P = 0.001), and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure (39.85% vs 19.54%, P = 0.000)., Conclusion: EVLT may not always be the best option for the treatment of great saphenous vein varicosis., Competing Interests: Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom., Objective: To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials., Design: Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop., Setting: Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments., Participants: Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment., Interventions: Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery., Main Outcome Measures: Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness., Results: Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days., Limitations: It was not possible to characterise conventional surgery due to a low number of participants., Conclusion: The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials., Future Work: The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment., Trial Registration: This trial is registered as ISRCTN69985145., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment ; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.

Robotic-assisted surgery is a computer-controlled technique that may improve the accuracy and outcomes of unicompartmental total knee arthroplasty (TKA), a partial knee replacement surgery. The purpose of a meta-analysis about robotic-assisted versus conventional surgery for unicompartmental TKA is to compare the effectiveness of these two methods based on the current evidence. Our meta-analysis can help inform clinical decisions and guidelines for surgeons and patients who are considering unicompartmental TKA as a treatment option. We searched four online databases for studies that compared the two methods until March 2023. We used RevMan software to combine the data from the studies. We calculated the mean difference (MD) and the 95% confidence interval (CI) for each outcome, which are statistical measures of the difference and the uncertainty between the two methods. We included 16 studies in our analysis. We found that robotic-assisted surgery had a better hip-knee-ankle angle, which is a measure of how well the knee is aligned, than conventional surgery (MD = 0.86, 95% CI = 0.16-1.56). We also found that robotic-assisted surgery had a better Oxford Knee score, which is a measure of how well the knee functions, than conventional surgery (MD = 3.03, 95% CI = 0.96-5.110). This study compared the results of conventional and robotic-assisted unicompartmental knee arthroplasty in 12 studies. We concluded that robotic-assisted surgery may have some benefits over conventional surgery in terms of alignment and function of the knee. However, we did not find any significant difference between the two methods in terms of other outcomes, such as pain, range of motion, health status, and joint awareness. Therefore, we suggest that more research is needed to confirm these results and evaluate the long-term effects and cost-effectiveness of robotic-assisted surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghazal et al.)

Introduction: Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery.Objective: The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies.Materials and Methods: A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively.Conclusion: The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages. [ABSTRACT FROM AUTHOR]

A meta-analysis was performed for a comparison of outcomes between sutureless technique and conventional surgery for primary repair for total anomalous pulmonary venous connection (TAPVC). Electronic databases including PubMed, EMbase, Scopus, and Cochrane Library were searched systematically for the single-arm studies regarding sutureless repair or conventional surgery, and two-arm studies compared the outcomes of sutureless repair and conventional surgery for TAPVC. Corresponding data were extracted and the methodological quality was assessed by two reviewers independently. 26 studies were included, involving a total of 2702 patients. It was observed that compared with conventional surgery, sutureless technique was associated with a lower occurrence rate of post-operative pulmonary veins obstruction (PVO) (4.6% vs. 13.5%, OR 0.54 in favor of sutureless technique) and re-operations due to PVO (3.4% vs. 12.4%, 0.25 in favor of sutureless technique). However, meta-analyses of post-operative early (OR 0.57; 95% CI 0.27–1.19; P = 0.13), late (OR 0.37; 95% CI 0.13–1.06; P = 0.13), and overall (OR 0.61; 95% CI 0.36–1.03; P = 0.07) mortality showed no significant difference between sutureless technique and conventional surgery. Compared with conventional surgery, sutureless technique was associated with a lower occurrence rate of post-operative PVO and re-operations due to PVO. Meanwhile, post-operative early, late, and overall mortality were not statistically different between two surgical approaches. Sutureless technique is beneficial in the primary repair of TAPVC regarding post-operative PVO and re-operations due to PVO. However, the level of evidence was low and randomized controlled trials should be designed to evaluate the safety and effectiveness of sutureless technique for TAPVC. [ABSTRACT FROM AUTHOR]

Introduction: Genital warts in young adults aged 18-28 years are very common. Several approaches are routinely used in the treatment of warts, viz., medical treatment (podophyllin and trichloroacetic acid), conventional surgery (excision or electrocautery), cryotherapy, and laser treatment. Because of high recurrence rates after treatment, complications and long duration of treatment, newer modalities have been developed. One of these newer methods is laser, which has been used in several urologic diseases. However, there are only a few studies about use of Holmium laser for treatment of genital warts. This retrospective study compared the success rate of Holmium laser with other available treatments for genital warts. Methods: Between October 2011 and May 2016, 142 patients with genital warts attended the urology clinics at Shohada-e-Tajrish hospital in Tehran, Iran. Out of these, a total of 101 patients were included in this study consisting of 42, 39, 11 and 9 patients treated with cryotherapy, laser, conventional surgery and podophyllin respectively. Results: The most successfully cleared lesions were seen in the holmium laser treatment group (P = 0.001). The lowest recurrence rate was observed in the holmium laser treatment group (P = 0.001). 17 patients had one of these following problems: dysuria, initial hematuria or a change in the force and caliber of their urinary stream that after physical examination showed them to have a meatal wart. These patients then underwent cystoscopy up to urinary sphincter. All of them in addition to the meatus wart had a penile shaft lesion(s). Thirteen patients had meatal lesions, 9 of whom received holmium laser therapy and 4 patients were treated with electrocautery. Based on routine follow up after treatment, none of the patients treated with holmium laser had urinary stricture, but one case treated with electrocautery returned with a penile urethral stricture. Conclusion: This study showed that treatment with Holmium laser has the highest clearance rate (92.2%) and lowest recurrence rate (14.3%) compared to other available treatments in this study. It may be concluded that holmium laser is a safe and effective treatment for genital warts with a low rate of recurrence. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the potential advantages of the ultrasonic scalpel compared with the conventional technique in thyroid surgery. Patients with resectable thyroid cancer and Basedow's disease were assigned to ultrasonic scalpel or conventional technique (knot.tying and electrocoagulation). The present study used the Harmonic FOCUSR (HF) as an ultrasonic scalpel. Between February 2013 and May 2016, 45 patients were enrolled into the study. Duration of the surgery was significantly decreased in the HF group compared with the conventional surgery (CS) group (median 142 vs. 151 min; P=0.0406). Intraoperative blood loss and total volume of drainage fluid were significantly decreased in the HF group compared with the CS group (median 40 vs. 125 ml; P=0.0054, and median 120 vs. 175.5 ml; P=0.0490). Duration of drain placement and length of hospitalization stay were similar in the two groups. Furthermore, the overall incidence of postoperative complications did not differ between the two groups. Overall, the present study suggests that open thyroidectomy using the HF is safe and effective and not associated with any increase in complications. [ABSTRACT FROM AUTHOR]