The impact of surgical approaches for isolated acetabulum fracture on sexual functions

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ibrahim Alper Yavuz ◽  
Can Aykanat ◽  
Cagdas Senel ◽  
Fatih Inci ◽  
Erman Ceyhan ◽  
...  
Keyword(s):  
Surgical Approaches ◽  
Acetabulum Fracture ◽  
The Impact

scholarly journals P129 THORACIC VS. ABDOMINAL APPROACHES FOR DIAPHRAGMATIC HERNIA REPAIR: A NATIONWIDE STUDY OF CLINICAL OUTCOMES

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Andrea Carolina Quiroga Centeno ◽  
Orlando Navas ◽  
Juan Paulo Serrano ◽  
Sergio Alejandro Gómez Ochoa
Keyword(s):  
Hospital Stay ◽  
Diaphragmatic Hernia ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Surgical Approaches ◽  
Multivariate Logistic Regression Model ◽  
Abdominal Repair ◽  
Lower Health ◽  
The Impact

Abstract Aim “To compare the outcomes of different surgical approaches for diaphragmatic hernia (DH) repair.” Material and Methods “Adult patients with a principal admitting diagnosis of uncomplicated DH registered in the National Inpatient Sample in the period 2010-2015 were included. Patients with obstruction, gangrene, or congenital hernias were excluded. The primary outcome was in-hospital mortality. Secondary outcomes were the incidence of complications, length of stay, and hospital charges. A multivariate logistic regression model adjusted by age, sex, elective admission, comorbidities, and hospital characteristics was used to analyze the impact of the surgical approach on the evaluated outcomes.” Results “A total of 14910 patients with DH were included (median age 65 years, 74% women). Abdominal approaches were the most commonly performed (78.9% laparoscopy and 13.6% open). Patients that underwent open abdominal and thoracic repairs had a higher risk of complications (sepsis, pneumonia, surgical site infection, prolonged postoperative ileus, and acute myocardial infarction), longer hospital stay, higher total hospital costs, and a significantly higher risk of mortality (OR 2.62. 95% CI 1.59-4.30 and OR 4.60; 95% CI 2.37-8.91, respectively) compared to patients that underwent laparoscopic abdominal repair. Individuals whose DH repair was performed through thoracoscopy had a similar mortality risk to those who underwent laparoscopic abdominal repair (OR 0.87; 95% CI 0.11-6.43).” Conclusions “Nowadays, laparoscopy has become the most used approach for DH repair. In the present cohort, it was associated with better outcomes in terms of complications, length of hospital stay, and mortality, as well as lower health costs. Additional studies assessing hernia characteristics are required to validate this result.”

The Impact of Computed Tomography on Decision Making in Tibial Plateau Fractures

2018 ◽  
Vol 31 (10) ◽  
pp. 1007-1014 ◽  
Author(s):  
Marcello Castiglia ◽  
Marcello Nogueira-Barbosa ◽  
Andre Messias ◽  
Rodrigo Salim ◽  
Fabricio Fogagnolo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Surgical Approach ◽  
Tibial Plateau ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Plain Radiographs ◽  
Schatzker Classification ◽  
The Impact

AbstractSchatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiographic projections (anteroposterior and lateral), three interactive videos of computed tomography (axial, sagittal, and coronal), and eight pictures depicting tridimensional reconstructions of the tibial plateau. Ten attending orthopaedic surgeons, who were blinded to the cases, were granted access to the homepage and assessed each set of images in two different rounds, separated to each other by an interval of 2 weeks. Each case was evaluated in three steps, where surgeons had access, respectively to radiographs, two-dimensional videos of computed tomography, and three-dimensional reconstruction images. After every step, surgeons were asked to present how would they classify the case using the Schatzker system and which surgical approaches would be appropriate. We evaluated the inter- and intraobserver reliability of the Schatzker classification using the Kappa concordance coefficient, as well as the impact of computed tomography in the decision making regarding the surgical approach for each case, by using the chi-square test and likelihood ratio. The interobserver concordance kappa coefficients after each assessment step were, respectively, 0.58, 0.62, and 0.64. For the intraobserver analysis, the coefficients were, respectively, 0.76, 0.75, and 0.78. Computed tomography changed the surgical approach selection for the types II, V, and VI of Schatzker (p < 0.01). The addition of computed tomography scans to plain radiographs improved the interobserver reliability of Schatzker classification. Computed tomography had a statistically significant impact in the selection of surgical approaches for the lateral tibial plateau.

scholarly journals Adenomyosis and Infertility—Review of Medical and Surgical Approaches

2021 ◽  
Vol 18 (3) ◽  
pp. 1235
Author(s):  
Maria Szubert ◽  
Edward Koziróg ◽  
Olga Olszak ◽  
Klaudia Krygier-Kurz ◽  
Jakub Kazmierczak ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Combined Treatment ◽  
Developed Countries ◽  
High Intensity Focused Ultrasound ◽  
Reproductive Age ◽  
Surgical Approaches ◽  
Gnrh Analogues ◽  
Oral Contraceptive Pills ◽  
The Impact

The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms ’adenomyosis and infertility’ and ’adenomyosis and pregnancy outcomes’, extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin-releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques—ultrasound and MRI—enables the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment mentioned above have not given satisfactory results in women planning pregnancy. For these patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before assisted reproductive techniques can prove beneficial in adenomyosis patients.

scholarly journals Care as Usual: An Acceptable Strategy to Apply During the COVID-19 Pandemic in a French Tertiary Gynecologic Oncology Department

2021 ◽  
Vol 11 ◽  
Author(s):  
Guillaume Blache ◽  
Houssein El Hajj ◽  
Camille Jauffret ◽  
Gilles Houvenaeghel ◽  
Laura Sabiani ◽  
...  
Keyword(s):  
Gynecological Cancer ◽  
Gynecologic Oncology ◽  
Surgical Patients ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Surgical Approaches ◽  
Cancer Center ◽  
Complication Rates ◽  
Oncological Treatment ◽  
The Impact

We describe and analyze a “care as usual” strategy of a French Comprehensive Cancer Center during the COVID-19 pandemic to manage surgical patients with gynecological cancer. We conducted a retrospective analysis evaluating the surgical activity in our gynecologic oncology department between January 21 and May 12, 2020. We compared the surgical activity and surgical and oncologic outcomes during the pre-lockdown period and the pandemic period. The main objective was to evaluate the impact of the COVID-19 pandemic on surgical activity. The secondary objectives were to analyze the surgical and the oncologic outcomes. We compared the surgical activity during the 8 weeks after the national lockdown (85 procedures) to the surgical activity in the 8 weeks preceding the lockdown (127 procedures). We observed a 33% decrease in activity between the two periods. The clinical and epidemiologic characteristics were similar between the two periods. There were no differences between the surgical approaches (p = 0.592), the surgical complexity (p = 0.323), the length of stay (p = 0.85), and even for the complex procedure (p = 0.96) and the perioperative (p = 0.791) and postoperative complication rates (p = 0.102). We observed a significant decrease in the time of return to intended oncological treatment (RIOT) during the lockdown period with an average of 31.9 days compared to 46.9 days in the pre-lockdown period (p = 0.003). During the COVID-19 pandemic, “care as usual” represents an acceptable strategy without impairing the oncologic outcome in a Comprehensive Cancer Center with a patient-centered clinical pathway for gynecologic oncologic surgical patients.

scholarly journals LABYRINTHINE FISTULA IN CHOLESTEATOMA AND ITS MANAGEMENT-A RETROSPECTIVE STUDY

2021 ◽  
Vol Volume 9 (upjohns/volume9/Issue2) ◽  
pp. 1-9
Author(s):  
Surendra Singh Baghel
Keyword(s):  
Retrospective Study ◽  
Ct Scan ◽  
Surgical Approaches ◽  
Labyrinthine Fistula ◽  
Management Protocol ◽  
The Impact

Introduction- Labyrinthine fistula is one of the most common intra-temporal complications of cholesteatoma. Objective of study is (1) to evaluate the role of CT Scan in detecting labyrinthine fistulas, (2)to establish fact that fistula grade and location have no correlation with surgical approaches(CWU Vs CWD mastoidectomy approach),(3) to study the impact on hearing after treatment of labyrinthine fistula and(4) establish a management protocol to deal with labyrinthine fistula.

A Single Institution Propensity Score Weighted Analysis of Time to Chemotherapy After Minimally Invasive Versus Open Colorectal Surgery

2021 ◽  
pp. 000313482110111
Author(s):  
Samik H. Patel ◽  
Michael A. Battaglia ◽  
Beth-Ann Shanker ◽  
Robert K. Cleary
Keyword(s):  
Propensity Score ◽  
Minimally Invasive ◽  
Hospital Length Of Stay ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Time Interval ◽  
Study Objective ◽  
Propensity Score Weighting ◽  
Significant Difference ◽  
The Impact

Background Oncologic outcomes for colon cancer are optimal when chemotherapy is started within 6 to 8 weeks after surgery. The study objective was to investigate the impact of operative modality and urgency on the time interval from surgery to adjuvant chemotherapy. Methods This is a retrospective institutional tumor registry cohort study of open and laparoscopic/robotic colorectal resections for stage II-IV cancer between April 2010 and January 2018. Primary outcome was time from surgery to chemotherapy. Predictor variables were adjusted for imbalances by propensity score weighting. Results A total of 220 patients met inclusion criteria: 171 elective (108 laparoscopic/robotic and 63 open) and 49 urgent colectomies. After propensity score weighting, there was no significant difference in time to chemotherapy between elective minimally invasive and open surgical approaches (48 days vs. 58 days, P = .187). Only 68.9% of minimally invasive and 50.8% of open colectomy patients started chemotherapy within 8 weeks of surgery. There was a significant difference ( P = .037) among surgical sites with rectal resections having the longest (55 days), and right colectomies having the shortest (46 days), time to chemotherapy. Patients who had urgent operations had significantly longer hospital length of stay ( P < .001) and higher post-discharge emergency department visit rates ( P < .001) than the elective operation group. However, there was no significant difference in time to chemotherapy. Discussion Neither operative modality nor operative urgency resulted in a significant difference in postoperative time to initiating chemotherapy. Future efforts should be focused on identifying postoperative recovery criteria and optimum multidisciplinary communication methods that allow recovered patients to start chemotherapy sooner.

scholarly journals Optimizing Respiratory-Swallowing Coordination in Patients With Oropharyngeal Head and Neck Cancer

2017 ◽  
Vol 2 (13) ◽  
pp. 103-110 ◽  
Author(s):  
Bonnie Martin-Harris ◽  
Kendrea L. (Focht) Garand ◽  
David McFarland
Keyword(s):  
Head And Neck ◽  
Survival Rates ◽  
Oral Intake ◽  
Well Being ◽  
Surgical Approaches ◽  
Future Work ◽  
Functional Morbidity ◽  
The Impact ◽  
Cross System

Swallowing impairment (dysphagia) represents the highest functional morbidity in oropharyngeal (OP) head and neck (HNC) treated either with surgical approaches followed by radiation or with more recent organ preservation protocols, including combined chemotherapy and radiation. Despite the promising overall increasing survival rates, swallowing impairments remain chronic, are often resistant to traditional swallowing therapy, and have devastating consequences on health and well-being. The respiratory-swallow cross-system approach presented here extends beyond traditional swallowing interventions that commonly targets muscles and structures alone, and is instead, directed toward the re-establishment of optimal respiratory-swallowing coordination. Results from our work investigating a respiratory-swallow treatment (RST) paradigm is presented, including results from an RST clinical trial in HNC patients, primarily with OP cancers, with chronic and with intractable dysphagia post-cancer and post-traditional swallowing treatment. Future work will investigate the impact of RST on the degree and durability of clinical outcomes, including oral intake and quality of life, while also examining the potential added benefits of a home practice program that uses a commercially available and easy to use recording and analysis hardware and software.

scholarly journals Population perception of surgical approach in minimally invasive surgery

2015 ◽  
Vol 9 (1-2) ◽  
pp. 1 ◽  
Author(s):  
Shogo Inoue ◽  
Mitsuru Kajiwara ◽  
Jun Teishima ◽  
Akio Matsubara
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Approach ◽  
Young Female ◽  
Surgical Approaches ◽  
Paramedical Staff ◽  
The Impact

Introduction: The aim of this study was to better understand the impact that public opinion might have on surgical approaches in urologic minimally invasive surgery (MIS).Methods: We collected surveys from 400 participants, including the general population (n = 220) and paramedical staff (n = 180). Participants were anonymous. The survey included 16 questions on the characteristics and preference for the surgical approach if a urologic MIS were performed on them.Results: The responders preferred the transumbilical approach (57.0%) to the subcostal approach (43.0%). In particular, the preference for a transumbilical approach was significantly higher in females (65.1% vs. 49.3%, p = 0.0014). Similarly, when participants were divided into two groups (<50 years and >50 years), the preference for the transumbilical approach was significantly higher in the younger group (60.8% vs. 48.0%, p = 0.0187). Logistic regression analysis revealed that preference for this approach was about 2 times more likely to rise in the females (p = 0.032).Conclusions: Preference for the transumbilical approach was significantly higher young female respondents. This patient subset most values the cosmetic benefits of transumbilical approach in urologic MIS.

scholarly journals The Utility of Anatomical Liver Resection in Hepatocellular Carcinoma: Associated with Improved Outcomes or Lack of Supportive Evidence?

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1441 ◽  
Author(s):  
Michelle Ju ◽  
Adam C. Yopp
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Venous Blood ◽  
Current Data ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Venous Blood Flow ◽  
Anatomical Resection ◽  
Recurrence Rates ◽  
The Impact

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. Surgical resection of HCC remains one of the mainstays of curative therapies and is associated with five-year overall survival rates approaching 60%. Despite improved perioperative outcomes, locoregional recurrence within the first two years following hepatic resection is of significant concern with recurrence rates of up to 50%. The use of anatomical resection surgical approaches, whereby the portal venous blood flow is ligated proximal to the tumor bed, is postulated to reduce recurrence rates due to reduction of micrometastatic disease. The aim of this review is to characterize the definition of an anatomical resection (AR) during partial hepatectomy, discuss the theoretical advantages of AR during hepatic resection for HCC, and to present evidence of the impact of AR on outcome measures in patients with HCC. Based on current data, there is a lack of conclusive evidence to support the universal use of AR in cirrhotic patients with HCC. A randomized clinical trial is warranted to further clarify the debate between AR versus non-anatomical resection (NAR) for HCC.

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