Clinical efficacy of neoadjuvant chemotherapy combined with radical surgery for elderly patients with locally advanced gastric cancer / 中华普通外科杂志

Objective:To evaluate the safety and feasibility of neoadjuvant chemotherapy (NACT) combined with radical surgery for elderly patients with locally advanced gastric cancer (LAGC).Methods:One hundred and fourty eight patients with LAGC after NACT and gastrectomy between 2012 and 2020 were retrospectively reviewed. They were divided into two groups: (1) <65 years old (111 cases) and (2) ≥65 years old (37 cases) and their clinicopathological and prognostic data were compared.Results:There was no significant difference between the two groups in the incidence of hematological complications such as anemia ( χ2=0.235, P=0.628), leukopenia ( χ2=0.613, P=0.434), neutropenia ( χ2=0.011, P=0.918) and thrombocytopenia ( χ2=0.253, P=0.615) and non-hematological complications such as nausea ( χ2=0.092, P=0.762), vomiting ( χ2=0.166, P=0.683), diarrhea ( χ2=0.015, P=0.902) and mucositis ( χ2=0.199, P=0.766) due to NACT. There were no statistical differences between the older patients and the younger in operation duration ( t=0.270, P=0.604), intraoperative bleeding ( t=1.140, P=0.250) and R 0 resection rate ( χ2=0.105, P=0.750). The incidence of postoperative complications was 25.2% and 37.8% in the younger patients and the olders ( χ2=2.172, P=0.141). Pleural effusion ( χ2=7.007, P=0.008) and pulmonary infection ( χ2=10.204, P=0.001) was significantly higher in the older patients than in the youngers. The 3-year progression-free survival rate ( t=0.494, P=0.482) and 3-year overall survival rate ( t=0.013, P=0.908) were comparable between the two groups. Conclusions:NACT combined with radical surgery is safe and effective in elderly patients with LAGC, except for higher perioperative pulmonary-related complications.

Urological, vascular, and infectious implications of kidney transplant: a single-center experience / Complicaciones urológicas, vasculares e infecciosas del trasplante renal: experiencia en un solo centro

Introduction: Kidney transplant has improved in the last decades due to new technologies and surgical techniques. However, there are still multiple complications associated with this procedure, which can affect the function and viability of the kidney graft. Our aim was to describe the incidence of urological, vascular, and infectious complications in the 1st month after the procedure. Methods: A cross-sectional and retrospective study was carried out. Records of all patients who underwent kidney transplant from 2007 to 2017 were reviewed and data of demographic and surgical variables as well as information of vascular, urological, and infectious complications during the 1st post-operative month were registered and analyzed. Results: A total of 243 patients that required kidney transplant were assessed. The most common chronic kidney disease etiologies were: idiopathic (25.5%), glomerulopathies (24.7%), and hypertension (23.5%). Seventy patients (28.8%) presented a complication, of which 31 were urological, 27 were infectious, and 12 were vascular. In each category, the most frequent complications were the perirenal hematoma, the urinary tract infection, and renal artery stenosis, respectively. Conclusions: The prevalence of complications found in our center is similar to that reported in the literature and it is significant. It is important for medical personnel to be aware of this data to have a high level of suspicion and make an active search, as an early diagnosis and treatment of these pathologies are crucial to avoid graft loss

Introducción: El trasplante renal ha mejorado en las últimas décadas gracias a las nuevas tecnologías y técnicas quirúrgicas. Sin embargo, aún existen múltiples complicaciones asociadas a este procedimiento, que pueden afectar la función y viabilidad del injerto renal. Nuestro objetivo fue describir la incidencia de complicaciones urológicas, vasculares e infecciosas en el primer mes tras el procedimiento. Métodos: Se realizó un estudio retrospectivo de corte transversal. Se revisaron los expedientes de todos los pacientes que se sometieron a trasplante renal desde 2007 hasta 2017 y se registraron y analizaron datos de variables demográficas y quirúrgicas, así como información de complicaciones vasculares, urológicas e infecciosas durante el primer mes postoperatorio. Resultados: Se evaluaron un total de 243 pacientes que requirieron trasplante renal. Las etiologías de enfermedad renal crónica (ERC) más frecuentes fueron: idiopática (25,5%), glomerulopatías (24,7%) e hipertensión arterial (23,5%). 70 pacientes (28,8%) presentaron alguna complicación, de los cuales 31 fueron urológicos, 27 infecciosos y 12 vasculares. En cada categoría las complicaciones más frecuentes fueron el hematoma perirrenal, la infección del tracto urinario y la estenosis de la arteria renal respectivamente. Conclusiones: La prevalencia de complicaciones encontrada en nuestro centro es similar a la reportada en la literatura y es significativa. Es importante que el personal médico conozca estos datos para tener un alto nivel de sospecha y realizar una búsqueda activa, ya que el diagnóstico y tratamiento precoz de estas patologías es fundamental para evitar la pérdida del injerto.

Replacement of Percutaneous Endoscopic Gastrostomy Tube with Low Profile Button Percutaneous Endoscopic Gastrostomy: First Indian Experience

Background: Percutaneous endoscopic gastrostomy (PEG) is a common procedure employed for patients with swallowing disorders with a functioning gastrointestinal tract. Replacement of PEG with a conventional PEG tube by ‘pull technique’ is considered to be the standard of care. Low profile or button PEG, an alternative that obviates the need for endoscopy, is less explored in the Indian setting. Methods: Records of all the patients, who underwent PEG replacement with a low-profile PEG (MIC-KEY by Halyard, U.S.A.) for three years, were reviewed. Complications and other relevant details were recorded. Result: Twenty four low profile PEG tubes were placed in 16 patients; [male 12 (75%); median age(range) 67 (25-85) years]. The indications of PEG placement were stroke in 10 patients, other neurologic illnesses in 5 patients and laryngeal malignancy in 1 patient. Perforation peritonitis and skin induration developed in one patient each. None of the patients had any procedure-related fatal complication. Conclusion: Although PEG exchange with low profile PEG is considered safe, it has potential complications. Thus, utmost care is required to recognize and treat them early.

Risk factors and prevention of lower extremity lymphedema after treatment for cervical cancer / 中国医师杂志

Cervical cancer is a common malignant tumor of female reproductive system. The treatment of cervical cancer is based on surgery and radiotherapy (or concurrent chemoradiation). Lower extremity lymphedema (LEL) is a frequent complication after cervical cancer treatment, which significantly affects the quality of life of patients. Both pelvic surgery and radiation for cervical cancer can lead to LEL. The risk factors for LEL are complicated and involving characteristics regarding patient (age, comorbidities, lifestyle, etc.), tumor [International Federation of gynecology and Obstetrics (FIGO) stage, lymph node metastasis, etc.], and treatment (number of resected lymph nodes, removal of circumflex iliac nodes, adjuvant therapy, etc.). Comprehensive measures are proposed to prevent cervical cancer patients from LEL, and further investigations in terms of effectiveness are warranted.

Diagnosis, early treatment and prevention of urinary complications after radical hysterectomy for cervical cancer / 中国医师杂志

Urinary system complication is one of the common and serious complications in radical operation of cervical cancer. Timely detection and treatment is the key to improve the outcome. This article mainly introduces the latest progress in the early diagnosis, treatment and prevention of ureter injury, bladder injury and postoperative urinary retention during radical operation of cervical cancer, in order to improve our ability to detect and treat urinary system complications in time, reduce the occurrence of serious complications and minimize the harm to patients.

Vascular injury and treatment in gynecological tumor surgery / 中国医师杂志

During gynecological tumor surgery, the incidence of iatrogenic vascular injury increases unabated due to the proximity of the operative area to important vessels in the pelvic and abdominal cavity, and the tumor growth is invasive and often adheres or oppresses the surrounding blood vessels. Intraoperative bleeding is related to many factors. Adequate preoperative evaluation, surgical field exposure, and skilled operation can effectively reduce intraoperative vascular injuries. Immediate recognition and prompt action at the occurrence of hemorrhage can significantly minimize life-threatening complications. This article reviews the common vascular injuries and treatment methods in gynecological tumor surgery.

The role of energy devices in reducing the complications of gynecological tumor surgery / 中国医师杂志

Energy devices have been widely used in gynecological surgeries. From the overall development trend, energy devices improve the efficiency of surgery. The continuous updating and upgrading of energy devices also reduces surgical complications and improves the safety of surgery. The injury caused by energy devices is not only related to the complexity of the operation or the disease itself, but also closely related to whether the operator can reasonably choose and master the use of energy instruments, as well as the surgical skills and experience of the operator. Surgeons should establish the concept of " prevention is better than remedy" when using energy instruments. We should take the initiative to learn and master the working principle of different energy devices, understand the design characteristics of each product and improve the skills of device use, so as to minimize the complications caused by various energy instruments and bring real benefits to doctors and patients.

The influence of trained surgeons′ learning curve on the complications of laparoscopic radical surgery for early cervical cancer / 中国医师杂志

Objective:To study the effect of minimally invasive surgery training on the complications of laparoscopic radical surgery for early cervical cancer.Methods:72 cases of continuous surgery were retrospectively included. According to the learning curve and order of the chief surgeon, they were divided into two learning stages (the first stage and the second stage). The clinicopathological characteristics and surgical complications of the two stage group were compared.Results:The proportion of patients with previous abdominal surgery in the second stage group was higher (55.6% vs 31.1%, P=0.041), and the proportion of patients with local advanced clinical stage was also higher (29.6% vs 6.7%, P=0.022). There was no significant difference in the pathological characteristics between the two groups (all P>0.05). In all 72 cases of laparoscopic radical surgery, there were 4 cases of serious surgical injury (3 cases in the first stage group and 1 case in the second stage group), and 36 cases of postoperative complications (20 cases in the first stage group and 16 cases in the second stage group). There was no significant difference in the incidence of serious surgical injury and surgical complications between the two stage groups ( P=1.000, 0.224). Multivariate logistic regression analysis showed that age >51 years old was an independent risk factor for surgical complications after laparoscopic radical resection of early cervical cancer ( HR=3.404, 95% CI: 1.132-10.234, P=0.029). Conclusions:The incidence of complications in laparoscopic radical hysterectomy of cervical cancer for trained operators is low, and the impact of surgical learning curve on complications is small, but its impact on serious surgical injury cannot be ruled out.

Minimizing complications during surgical management of cervical cancer / 中国医师杂志

Radical hysterectomy combined with pelvic lymphadenectomy is the mainstream management for early-stage cervical cancer. However, the high radicality of such procedures is accompanied by high risk for complications. How to reduce the complications while ensuring the extent of surgical resection represents a dilemma faced by gynecological oncologists. Besides surgical techniques, multiple aspects during patient management should be involved in the measures for preventing surgery-associated complications in cervical cancer patients. By strictly grasping the surgical indications, being familiar with the use of instruments, paying attention to the application of surgical operation details and skills, strengthening postoperative management, and paying attention to the learning curve of surgeons, the incidence of surgical injury can be controlled at a low level.

Estadía abreviada poscirugía bariátrica: una posibilidad real sin incrementar complicaciones ni readmisión de pacientes / Abbreviated Hospitalization after bariatric surgery

Resumen Introducción: Nuevas técnicas en cirugía bariátrica han permitido disminuir las complicaciones y la mortalidad quirúrgica. Estas mejoras han hecho posible disminuir la estadía hospitalaria y acelerar el proceso de recuperación permitiendo un potencial protocolo de alta temprana. Objetivos: Describir la experiencia en la utilización de un protocolo diseñado de estadía abreviada, en pacientes posoperados de cirugía bariátrica. Materiales y Método: Estudio analítico, retrospectivo de cohorte. Se consideró una cohorte de pacientes en que se realizó cirugía bariátrica, en Clínica Santa María, por un solo cirujano, entre julio de 2014 y abril de 2019, sometidos a un protocolo diseñado de alta temprana. Fueron registradas la morbilidad, la mortalidad, las readmisiones y reintervenciones en el periodo de tiempo registrado. Resultados: Se incluyeron un total de 775 pacientes, 654 pacientes sometidos a gastrectomía en manga laparoscópica (GEM) y 101 pacientes sometidos a bypass gástrico en Y de Roux (RYGB). Hubo 8 complicaciones, sin mortalidad registrada. La tasa de readmisión/reintervención fue de 4,13%/2,27% para GEM y 4,55%/3,53% para RYGB. Conclusiones: En este grupo de pacientes pudimos demostrar una baja tasa de complicaciones, lo que apoya la idea de que un protocolo de alta temprana en pacientes sometidos a cirugía bariátrica es una alternativa factible y segura.

Introduction: New techniques in bariatric surgery have allowed to reduce complications and surgical mortality. These improvements have made it possible to reduce the hospital stay and accelerate the recovery process, allowing a potential early discharge protocol. Aim: To describe the experience in the use of a protocol designed for an abbreviated stay, in post-operated bariatric surgery patients. Materials and Method: Analytical, retrospective cohort study. A cohort of patients who underwent bariatric surgery, at the Santa María Clinic, by a single surgeon, between July 2014 and April 2019 and submitted to a designed early discharge protocol was considered. Morbidity, mortality, readmissions, and reoperations were recorded in the established period of time. Results: A total of 775 patients were included, 654 patients undergoing laparoscopic sleeve gastrectomy (GEM) and 101 patients undergoing Roux-en-Y gastric bypass (RYGB). There were 8 complications, with no recorded mortality. The readmission/reoperation rate was 4.13%/2.27% for GEM and 4.55%/3.53% for RYGB. Conclusions: In this group of patients we were able to demonstrate a low rate of complications, which supports the idea that an early discharge protocol in patients undergoing bariatric surgery is a feasible and safe alternative.

Posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa / Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption

Introducción: El posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa < 4mm es una técnica quirúrgica sensible que disminuye los tiempos operatorios. Sin embargo, es considerada cirujano-dependiente y en caso de no darse el manejo adecuado puede generar complicaciones. Objetivo: Evaluar, luego de 24 meses de carga funcional, la estabilidad de los tejidos periimplantares del implante dental que se posicionó simultáneo a la elevación de seno maxilar en un reborde alveolar con reabsorción ósea severa < 4mm. Presentación de caso: Paciente masculino de 62 años con reabsorción ósea severa en zona de primer molar superior derecho. Luego de analizar los medios diagnósticos y la evidencia científica; se logró posicionar un implante dental simultáneo a la elevación de seno maxilar técnica de ventana lateral; cuatro meses después se realizó la segunda fase quirúrgica y finalmente fue rehabilitado con una corona en zirconio. Tuvo un periodo de seguimiento de 24 meses. Conclusiones: Un buen diagnóstico, manejo quirúrgico adecuado, la colaboración del paciente y los controles periódicos, resultan en una técnica segura, que proporciona estabilidad de los tejidos periimplantares(AU)

Introduction: Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption < 4 mm is a sensitive surgical technique that shortens the duration of interventions. However, it is considered to be operator dependent, and may cause complications if not appropriately managed. Objective: After 24 months of functional load, evaluate the stability of the peri-implant tissue of a dental implant placed simultaneously with maxillary sinus lifting on an alveolar ridge with severe bone resorption. Case presentation: A case is presented of a male 62-year-old patient with severe bone resorption in the area of the first upper right molar. Analysis of the diagnostic means and scientific evidence involved led to placement of a dental implant simultaneous with maxillary sinus lifting (lateral window technique). The second surgical stage was performed four months later. A zirconium crown was finally placed, and a 24-month follow-up period was started. Conclusions: With a good diagnosis, appropriate surgical management, patient cooperation and periodic controls, it is a safe technique that ensures the stability of peri-implant tissue(AU)

Epidemiology of Dupuytren disease and Patients Undergoing Selective Fasciectomy / Epidemiologia da doença de Dupuytren e de pacientes submetidos a fasciectomia seletiva

Abstract Objective To describe the epidemiological and clinical profile of patients with Dupuytren disease treated by selective fasciectomy and the factors associated with the severity of the disease. Methods Retrospective descriptive observational study involving 247 patients with Dupuytren disease, from 2013 to 2019. Multivariate logistic regression was performed for data analysis. Results Most patients were male (83.8%), self-declared white (65.2%), alcoholics (59.6%) and 49% were smokers, with a mean age of 66 ± 9 years old, with 77.2% presenting symptoms of the disease after the age of 51 years old. Approximately 51.9, 29.6 and 17.3%, respectively, had arterial hypertension, diabetes mellitus and dyslipidemia comorbidities. Bilateral involvement of the hands was observed in 73.3% of the patients. The rate of intra- and post-selective fasciectomy complications was of 0.6 and 24.3%, respectively, with 5.2% of the patients needing reintervention after 1 year of follow-up. After multivariate analysis, males were associated with bilateral involvement of the hands (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.03-4.31) and with a greater number of affected rays (OR = 3.41; 95% CI: 1.66-7.03). Dyslipidemia was associated with reintervention (OR = 5.7; 95% CI = 1.03-31.4) and bilaterality with a higher number of complications (35.7 versus 19.7%). Conclusion A low rate of reintervention and operative complications was observed in patients with Dupuytren disease treated by selective fasciectomy. Male gender was associated with severe disease (bilaterality and more than two affected rays), and dyslipidemia with reintervention.

Resumo Objetivo Descrever o perfil epidemiológico e clínico dos pacientes com doença de Dupuytren tratados por fasciectomia seletiva e os fatores associados com a gravidade da doença. Metodologia Estudo observacional descritivo retrospectivo envolvendo 247 pacientes com doença de Dupuytren, no período de 2013 a 2019. Foi realizada regressão logística multivariada para análise dos dados. Resultados A maioria dos pacientes era do sexo masculino (83,8%), autodeclarados brancos (65,2%), etilistas (59,6%), e 49% eram tabagistas. A média de idade foi de 66 ± 9 anos, sendo que 77,2% apresentaram os sintomas da doença após os 51 anos. Aproximadamente 51,9, 29,6, e 17,3%, respectivamente, apresentaram hipertensão arterial, diabetes mellitus e dislipidemia. O acometimento bilateral das mãos foi observado em 73,3% dos pacientes. A taxa de complicações intra- e pós-fasciectomia seletiva foi de 0,6 e 24,3%, respectivamente, sendo que 5,2% dos pacientes necessitaram de reintervenção após 1 ano de acompanhamento. Após análise multivariada, o sexo masculino foi associado com acometimento bilateral das mãos (odds ratio [OR] = 2,10; intervalo de confiança [IC] 95%: 1,03-4,31) e com maior número de raios acometidos (OR = 3,41; IC 95%: 1,66-7,03). A dislipidemia foi associada com a reintervenção (OR = 5,7; CI 95%: 1,03-31,4) e a bilateralidade com maior número de complicações (35,7% versus 19,7%). Conclusão Foi observada uma baixa taxa de reintervenção e complicações operatórias nos pacientes com doença de Dupuytren tratados por fasciectomia seletiva. O sexo masculino foi associado com o quadro grave da doença (bilateralidade e mais de dois raios acometidos), e a dislipidemia com a reintervenção.

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery was 5 days in group1 and 42 days in group 2. Peri operative outcomes were not significant between two groups (p=0.6). About 14 (09.63%) patients were converted to open surgery in group1 and 17 (10.53%) in group 2. Postoperative complications were also not significant between two groups (p=1.0). Group 1 had small total length of stay as compared to group 2 (p=0.006). Recurrent biliary events occurred in 63 (42.12%) patients in total with no event in group 1.Conclusions: Patients with mild to moderate ABP having early laparoscopic cholecystectomy present with reduced recurrent biliary events and the total length of hospital.

Post operative complications of double-J ureteral stenting: a prospective study

Background: Placement of indwelling ureteral stents has become routine in the management of variety of urinary tract infections. Despite the advances and technology, the ideal stent is not available yet. A double-J stent is never without potential complications which may be minor in form of hematuria, dysuria, frequency, flank and suprapubic pain to major complications such as vesicoureteric reflux, migration, malposition, encrustation, stent fracture etc.Methods: One hundred urological patients who had undergone double-J ureteral stenting attending surgery department were taken. Patients were subjected to detailed history and clinical examination and other routine investigations and symptoms of any complications were recorded starting at the time of placement of double-J ureteral stent till its removal.Results: Majority of the patients in our study had only minor complications related to double-J ureteral stenting like flank or suprapubic pain, dysuria, hematuria and urgency which were managed conservatively. Major complication like stent migration was seen only in 1 patient which was managed with removal of stent.Conclusions: At the end of study, we concluded that double-J stents have become an essential part of many endourological and open urological procedures and their use cannot be completely avoided.

Riesgo coronario en pacientes con enfermedad arterial periférica tributarios de tratamiento quirúrgico / Coronary risk in patients with peripheral arterial disease undergoing surgical treatments

Introducción: Los pacientes con enfermedad arterial periférica sometidos a cirugía vascular no cardíaca programada presentan un riesgo significativo de complicaciones cardiovasculares, debido a la enfermedad cardíaca sintomática o asintomática subyacente. Objetivo: Valorar el riesgo coronario en los pacientes tributarios de cirugía vascular no cardíaca. Métodos: Estudio descriptivo prospectivo en 35 pacientes del Servicio de Angiología y Cirugía Vascular del Hospital Clínico Quirúrgico Hermanos Ameijeiras. El período de estudio osciló entre octubre de 2013 y mayo de 2016. Las variables cualitativas se expresaron como frecuencias absolutas y relativas. Se evaluó la asociación entre las variables mediante el test de Fischer, se usó el coeficiente de Pearson para relacionar los valores del índice de presiones tobillo brazo y los niveles del calcio score. Resultados: Predominó el sexo masculino y la edad menor de 60 años. El tabaquismo y la hipertensión arterial fueron los factores de riesgo de mayor frecuencia. A pesar de no existir diferencia significativa (p = 0,563) al asociar el calcio score y el índice de presiones tobillo-brazo, sí existió una correlación lineal negativa entre ellos. Las complicaciones perioperatorias presentadas en el grupo de moderado-alto riesgo quirúrgico fueron la fibrilación ventricular, el infarto agudo de miocardio y el paro cardíaco. Conclusiones: La valoración del riesgo coronario es una herramienta útil en la detección de lesiones coronarias significativas que pueden favorecer la aparición de complicaciones perioperatorias en los pacientes que son tributarios de tratamiento quirúrgico revascularizador no cardíaco(AU)

Introduction: Patients with peripheral arterial disease undergoing scheduled non-cardiac vascular surgery present a significant risk of cardiovascular complications due to underlying symptomatic or asymptomatic heart disease. Objective: To assess coronary risk in patients eligible for non-cardiac vascular surgery. Methods: A prospective descriptive study was carried out in 35 patients of the Angiology and Vascular Surgery service in Hermanos Ameijeiras Hospital. The study was conducted between October 2013 and May 2016. Qualitative variables were summarized as absolute and relative frequencies. It was assessed the association between the variables using the Fischer´s test; Pearson´s coefficient was used to relate the values of the index of ankle- arm pressure and the levels of calcium score. Results: Male sex predominated; and ages less than 60 years. Smoking habit and high blood pressure were the most common risk factors. Although there is no significant difference (p= 0,563) when associating the calcium score and the ankle-brachial pressure index, there was a negative linear correlation between them. The peri-operative complications presented in the moderate to high surgical risk group were ventricular fibrillation, acute myocardial infarction and cardiac arrest. Conclusions: Identification of coronary risk is a useful tool in the detection of significant coronary lesions that may favor the emergence of peri-operative complications in patients who are scheduled for non-cardiac revascularization's surgical treatment(AU)

Comparative study of intra and post-operative complications between total abdominal hysterectomy and laparoscopic assisted vaginal hysterectomy

Background: Vaginal hysterectomy is preferable due to faster recovery, decreased morbidity and absence of an abdominal incision. The aim was to compare the risks and complications of laparoscopy assisted vaginal hysterectomy and total abdominal hysterectomy in terms of intra-operative and post-operative complications.Methods: A retrospective observational study was conducted in the Gynaecology ward at Vinakaya Mission’s Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu, India. The data for the past 1-year record was taken for analysis. A total of 80 subjects were included in the study and were divided into two groups with 40 patients under TAH (total abdominal hysterectomy) group and 40 under LAVH (Laproscopic assisted vaginal hysterectomy) group. The primary outcome of the present analysis was incidence of perioperative complications like blood loss and the secondary outcomes were operating time, blood loss, urinary tract injury, rate of conversion to laparotomy, postoperative pain, and length of postoperative stay.Results: The mean intra-operative blood loss was measured among both the groups and it was found to be very high among TAH group (201 ml) compared to LAVH group (149.8 ml) and the difference was found to be statistically significant (p <0.05). Similarly, the duration of operative procedure was found to be less in LAVH group (57.9 mins) compared to TAH group (72.6 mins) and the difference was found to be statistically significant (p <0.05). Post-operative wound infection (14 vs 0) was found to be more among the patients in TAH group than that of the LAVH group and the difference was found to be statistically significant (p <0.05).Conclusions: LAVH is a safe and effective surgical treatment for benign gynaecological diseases and should be offered whenever possible, taking into account the low rate of complications and cost-effectiveness.

Summary and treatment of special situations in subxiphoid uniportal VATS surgery / 中华胸心血管外科杂志

Objective@#To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies.@*Methods@#In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al.@*Results@#Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death.@*Conclusion@#Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known.

Summary and treatment of special situations in subxiphoid uniportal VATS surgery / 中华胸心血管外科杂志

Objective To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies.Methods In September 2014,the subxiphoid uniportal VATS surgery was carried out.Up to now,our research team has completed more than 300 subxiphoid uniportal VATS operations,especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection.Some special situations were encountered during the operation,including cardiac arrest,pericardial tamponade,innominate venous injury,severe arrhythmia,difficulty in positioning the lung segment,and difficulty in positioning the small nodule et al.Results Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia,heart problems,intraoperative bleeding.Postoperative complications mainly included thoracotomy and hemostasis,continuous air leak after operation,pulmonary hematoma,arrhythmia,and no perioperative death.Conclusion Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest.It is safe and feasible to select suitable cases,master the thoracoscopic technique and special surgical techniques.Special situations during subxiphoid uniportal VATS surgery should be known.

Clinical follow-up study on the treatment of middle cerebral artery stenosis with balloon-expandable stent: 67 cases analysis / 中国实用内科杂志

OBJECTIVE: To discuss the clinical efficacy and safety of balloon-expandable stent in the treatment of symptomatic atherosclerotic cerebral artery stenosis in the middle cerebral artery(MCA), and to assess the appropriate methods of postoperative follow-up auxiliary examination. METHODS: A total of 67 patients with symptomatic atherosclerotic cerebral artery stenosis in the MCA were treated with balloon-expandable stent. The clinical data and follow-up data were collected and then analyzed retrospectively.RESULTS: the success rate of the surgical treatment with balloon-expandable stent was 98.51%(66/67). The incidence of symptomatic perioperative complications was 4.48%(3/67). All patients received clinical follow-up, and the auxiliary examination methods of the internal condition lesion of the stent included transcranial Doppler(TCD) or digital subtraction angiography(DSA). The incidence of in-stent restenosis or occlusion was 8.96%(6/67), and the consistency rate of stent restenosis or occlusion between TCD and DSA was75.00%, and the incidence of symptomatic in-stent restenosis or occlusion was 2.99%(2/67). It was found that there were two patients with recurrent stroke in cerebrovascular stent related region but without in-stent restenosis, and within 1 year of follow-up, the incidence of symptomatic stroke in stent-associated areas after operation was 10.44%(7/67). CONCLUSION: The treatment with balloonexpandable stent for symptomatic MCA stenosis has good clinical effect. The incidence of perioperative complications is low and the incidence of stroke in stent-associated areas after operation is low. TCD is an effective way of follow-up after the arterial stenting in the brain, which can play a role in the early detection of the in-stent restenosis, and its consistency with DSA is high.

Comparative study of complications following laparoscopic TEP versus TAPP versus open hernioplasty in inguinal hernia repair

Background: Hernia repairs, both inguinal and ventral/ incisional, are some of the most common surgeries performed in the world. Over the last 5 years, the field of hernia surgery has had a significant transformation thanks to many new and innovative surgical techniques as well as exponential growth in mesh and mesh technology. The aim of the study: To compare the intraoperative complications of TEP vs TAPP vs open hernioplasty in terms of operative time, major visceral or vessel injury and conversion rates. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, and Chennai in 2018. 75 patients (25 cases of open hernioplasty, 25 cases of TAPP, 25 cases of TEP). Post-operative pain was recorded based on Visual Analog Scale and requirement of analgesics. Post-operative complications like urinary retention, wound seroma, wound hematoma, wound infection, port site infection, recurrence, mesh infection, bowel complication was collected with clinical examination and complications recorded. Results: The study involved 75 male patients who satisfied the inclusion criteria. 25 patients were subjected to Lichtenstein tension-free open hernioplasty, 25 treated with TEP, and another 25 subjected to TAPP. Among the 75 cases studied 21 cases were found to have left sided inguinal hernia, whereas 54 cases were having right sided hernia. Intraoperative complications like major vessel injury or bladder injury were observed. No intraoperative complications were encountered Rosy Adhaline Selvi, Manimegalai. Comparative study of complications following laparoscopic TEP versus TAPP versus open hernioplasty in inguinal hernia repair. IAIM, 2019; 6(3): 223-230. Page 224 during the study period in any of the groups. Post-operative urinary retention was found only in two cases of Lichtenstein tension-free open hernioplasty and this required bladder catheterization. All cases of laparoscopic hernioplasty were catheterized intraoperatively and catheter retained till postoperative day 1, hence urinary retention could not be assessed. The post-operative pain was measured using the Visual Analog Scale (VAS) 6 hours after the surgery. The patient was given a dose of Injection Tramadol 100mg in after the surgery. The pain scores were analyzed with Chi-square and the difference found to be statistically significant. Lichtenstein tension-free open hernioplasty was found to have increased postoperative pain when compared to laparoscopic repair. Among the laparoscopic repair, TAPP was found to have increased postoperative compared to TEP. The postoperative hematoma was observed in a single case of Lichtenstein open hernioplasty. The hematoma was in the subcutaneous plain and required drainage. Conclusion: Primary unilateral inguinal hernia without complications can be treated with Lichtenstein tension-free open hernioplasty or laparoscopic transabdominal preperitoneal hernioplasty or laparoscopic totally extraperitoneal hernioplasty. Lichtenstein open hernioplasty has an advantage over laparoscopic repair in terms of shorter duration of surgery and learning curve.