P-266. Effect of previous lower abdominal surgical intervention on laparoscopic complication rate

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraplegia. Methods: Data of 118 patients with active thoracic spinal TB and paraplegia who had undergone surgeries at an early stage (within three weeks of paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects. Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for complete paraplegia patients was 14.3%, significantly lower than the rate (91.3%) for incomplete paraplegia patients. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 months Conclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB with and paraplegia, with surgical intervention being more beneficial for incomplete paraplegic recovery compared with that of complete paraplegia.

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Impact of HIV and AIDS on Surgical Practice

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x183436 ◽

2007 ◽

Vol 89 (4) ◽

pp. 354-358 ◽

Cited By ~ 22

Author(s):

RS Dua ◽

SA Wajed ◽

MC Winslet

Keyword(s):

Complication Rate ◽

Surgical Intervention ◽

Medical Problem ◽

Hiv And Aids ◽

Tertiary Referral Centre ◽

Common Component ◽

Surgical Practice ◽

Emergency Procedures ◽

The Impact ◽

Hiv Aids

INTRODUCTION Surgical intervention has become a common component in the management of patients infected with the human immunodeficiency virus (HIV) or suffering from the clinical consequences of acquired immunodeficiency syndrome (AIDS). We investigated the evolution of this involvement at a tertiary referral centre for this condition over a 16-year period. PATIENTS AND METHODS Detailed retrospective examination of the medical records of HIV-positive patients treated at the Royal Free Hospital between 1986 and 2002 was undertaken. Clinical, pathological and operative details of those patients who underwent surgical intervention were recorded. RESULTS Of the 2100 cases reviewed, 477 patients underwent a combined total of 772 surgical procedures. Of the 772 operations, 95 (12.3%) were performed as emergencies. Anorectal surgery represented the highest group with a total of 195 procedures (25.26%) being undertaken. The majority of patients (59%) had AIDS at the time of surgery, and 27.04% had a significant co-existing medical problem. Overall postoperative complication rate was 10.1%, with the risk being significantly greater in those undergoing intra-abdominal surgery and emergency procedures. CONCLUSIONS This is the largest study to audit the impact of HIV/AIDS in general surgical practice in the UK retrospectively. Surgery for HIV patients can be safely conducted with a low complication rate for the diagnostic and anorectal procedures that comprise the vast majority of surgery in HIV/AIDS patients. Medical treatment for patients with HIV/AIDS has developed dramatically over the last two decades. In parallel, this has resulted in a heavy, new and varied workload for general surgeons, who have also had to adapt in order to deal with the challenging spectrum of this disease.

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Surgical treatment of refractory incontinence in the bitch

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v89i3.16540 ◽

2020 ◽

Vol 89 (3) ◽

pp. 177-183

Author(s):

J. Timmermans ◽

B. Van Goethem ◽

H. De Rooster

Keyword(s):

Urinary Incontinence ◽

Surgical Treatment ◽

Complication Rate ◽

Surgical Intervention ◽

Urethral Sphincter ◽

Common Condition ◽

Injection Port ◽

Inflatable Cuff ◽

Proximal Urethra ◽

Sphincter Mechanism

Urinary incontinence is a common condition in spayed, female dogs with a reported prevalence between 3.1% and 20.1%. In the majority of dogs with acquired urinary incontinence, urethral sphincter mechanism incompetence is the underlying cause. Approximately 15% of bitches that initially respond to medical therapy ultimately become refractory. Surgical intervention is indicated when patients do not respond or become refractory to medical treatment. Based on the current literature, placement of an artificial urethral sphincter, i.e. an inflatable cuff around the proximal urethra connected to a subcutaneous injection port, provides a very reliable and longterm incontinence resolution in bitches and has a low complication rate.

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Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraparesis and Paraplegia

10.21203/rs.3.rs-48848/v2 ◽

2020 ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Complication Rate ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraparesis and paraplegia.Methods: Data of 118 patients with active thoracic spinal TB and paraparesis and paraplegia who had undergone surgeries at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects.Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for patients with paraplegia was 14.3%, significantly lower than the rate (91.3%) for patients with paraparesis. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 monthsConclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB and paraparesis or paraplegia, with surgical intervention being more beneficial for paraparesis recovery compared with paraplegia recovery.

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Trigger Finger

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0095 ◽

2019 ◽

pp. 963-968

Author(s):

Rajiv Sood ◽

Joshua M. Adkinson ◽

Brett C. Hartman

Keyword(s):

Complication Rate ◽

Surgical Intervention ◽

Trigger Finger ◽

Flexion Deformity ◽

Rheumatoid Disease ◽

Operative Site ◽

Significant Pain ◽

Flexor Tenosynovitis

Stenosing flexor tenosynovitis of the digits, commonly known as trigger finger, is one of the most common conditions affecting the hand. It is characterized by a painful locking or clicking of the finger during flexion or extension. This can lead to significant pain or eventual flexion deformity. Treatment varies based on the duration, severity, and etiology and can be either conservative or operative. The complication rate of surgical intervention remains low, with the most common being pain at the operative site. Treatment of trigger finger in the patient with rheumatoid disease should be approached with caution. Overall management of trigger finger, whether conservative or operative, is routinely successful with the final result of a satisfied patient.

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Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x106504 ◽

2006 ◽

Vol 88 (4) ◽

pp. 405-407 ◽

Cited By ~ 24

Author(s):

P Pietzik ◽

I Qureshi ◽

J Langdon ◽

S Molloy ◽

M Solan

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Complication Rate ◽

Retrospective Review ◽

Fast Track ◽

Surgical Intervention ◽

Length Of Hospital Stay ◽

Ankle Fractures ◽

Track System ◽

Operative Fixation

INTRODUCTION Ankle fractures are common and many require surgical intervention. It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h). PATIENTS AND METHODS A retrospective review of all ankle fractures managed by open reduction and internal fixation over a 12-month period was undertaken. A protocol was then agreed to openly reduce and fix these fractures at the earliest possible opportunity over the next 6-month period. We then collected the data on all ankle fractures that needed open reduction and internal fixation over this 6-month period. The pre-protocol and post-protocol groups were then compared for total hospital length of stay and complication rate. RESULTS In the 12-month retrospective review, there were 83 ankle fractures that required surgical intervention. Sixty-two of these had surgery within 48 h (mean length of stay, 5.4 days), and 21 had surgery after 48 h (mean length of stay, 9.5 days). There were 39 ankle fractures in the post-protocol group who all had surgery within 48 h (mean length of stay, 5 days). There was no increase in complication rate after implementation of the fast-track system. CONCLUSIONS This study shows that early operative intervention for ankle fractures reduces the length of hospital stay. Intensive physiotherapy and co-ordinated discharge planning are also essential ingredients for early discharge. Early operative fixation for unstable ankle fractures has substantial cost-saving implications with no increase in complication rate.

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Transradial approach for pediatric interventions: A review and analysis of the literature

The Journal of Vascular Access ◽

10.1177/1129729820948688 ◽

2020 ◽

pp. 112972982094868

Author(s):

Derrek Schartz ◽

Emily Young ◽

Stephen Guerin

Keyword(s):

Complication Rate ◽

Pediatric Patients ◽

Surgical Intervention ◽

Pediatric Population ◽

Adult Population ◽

Pooled Analysis ◽

Transradial Access ◽

Lower Complication ◽

Lower Complication Rate ◽

Pediatric Interventions

Background: Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population. Methods: We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic. Results: Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01). Conclusion: Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.

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Hand Corticosteroid Injections in Patients on “Blood Thinners”

Hand ◽

10.1177/1558944719831379 ◽

2019 ◽

Vol 15 (6) ◽

pp. 837-841

Author(s):

Ajith Malige ◽

Kristofer S. Matullo

Keyword(s):

Complication Rate ◽

Treatment Modality ◽

Chart Review ◽

Adverse Reactions ◽

Surgical Intervention ◽

Corticosteroid Injection ◽

Retrospective Chart Review ◽

Complication Rates ◽

Corticosteroid Injections

Background: Our study aims to identify any influence that anticoagulation and antiplatelet (“blood thinner”) medications have on hand and wrist corticosteroid injection complication rates. Methods: This retrospective chart review looked at patients between the ages of 18 and 89 years who received corticosteroid injections in the hand or wrist between 2013 and 2017, noting anticoagulation and antiplatelet use, demographics, injection placement, and surgical intervention. Results: Only 152 (20.9%) of the 726 diagnoses that were treated needed eventual surgical intervention. There were 12 overall reported complications after 1473 injections (0.8%). There were 6 complications after 433 injections (1.6%) placed in patients on blood thinners and 6 complications after 1040 injections (0.6%) placed in patients not on blood thinners. Conclusions: With the complication rate of corticosteroid injections being so low, even in patients taking “blood thinners,” the fear of adverse reactions should not preclude a physician from using this treatment modality to prevent surgical intervention.

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Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

10.32592/ircmj.2021.23.4.251 ◽

2021 ◽

Keyword(s):

High Risk ◽

Blunt Trauma ◽

Complication Rate ◽

Clinical Observation ◽

Surgical Intervention ◽

Meta Analysis ◽

Low Risk ◽

Quality Data ◽

Trauma Patients ◽

Surgical Exploration

Context: Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI. Evidence Acquisition: Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones. Results: Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01). Conclusions: The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

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One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery

Obesity Surgery ◽

10.1007/s11695-020-04536-x ◽

2020 ◽

Vol 30 (9) ◽

pp. 3287-3294 ◽

Cited By ~ 2

Author(s):

Nathan Poublon ◽

Ibtissam Chidi ◽

Martijn Bethlehem ◽

Ellen Kuipers ◽

Ralph Gadiot ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Complication Rate ◽

Weight Regain ◽

Surgical Intervention ◽

One Anastomosis Gastric Bypass ◽

Procedure Time ◽

Insufficient Weight Loss ◽

Restrictive Surgery

Abstract Background Failure occurs in up to 60% of the patients that were treated with primary restrictive bariatric operations such as Laparoscopic Adjustable Gastric Banding (LAGB), or restrictive/metabolic operations like Laparoscopic Sleeve Gastrectomy (LSG). Insufficient weight loss and weight regain are the most commonly reported reasons of failure. The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity. Methods 491 patients operated on between 2012 and 2017 for failed restrictive surgery were included in this study (OAGB (n=185) or RYGB (n=306)). Failure was defined as total weight loss (TWL) less than 25%, excess weight loss (EWL) less than 50% and/or a remaining body mass index (BMI) larger than 40 kg/m2 at two years of follow up. Primary outcome measures were %TWL and % excess BMI loss (EBMIL) at 12, 24 and 36 months of follow-up. Secondary outcomes were procedure time, reduction of comorbidity, early and late complication rate, and mortality. Results %TWL was significantly larger in the OAGB group at 12 months (mean 24.1±9.8 vs. 21.9±9.7, p = 0.023) and 24 months (mean 23.9±11.7 vs. 20.5±11.2, p = 0.023) of follow-up. %EBMIL was significantly larger in the OAGB group at 12 months (mean 69.0±44.6 vs. 60.0±30.1, p = 0.014) and 24 months (mean 68.6±51.6 vs. 56.4±35.4, p = 0.025) of follow-up. Intra-abdominal complications (leakage, bleeding, intra-abdominal abscess and perforation) occurred less frequently after revisional OAGB (1.1% vs. 4.9%, p = 0.025). Surgical intervention for biliary reflux (5.4% vs. 0.3%, p < 0.001) was more prevalent in the OAGB group. Surgical intervention for internal herniation (0.0% vs. 4.9%, p = 0.002) was more prevalent in the RYGB group. Conclusions This study suggests that OAGB is superior to RYGB as a remedy for insufficient weight loss and weight regain after failed restrictive surgery with more weight loss and a lower early complication rate. To substantiate these findings, further research from prospective randomized controlled trials is needed.

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