Dorsal Capsular Defect and Synovial Fistula to the Fourth Extensor Compartment: A Late Complication after Arthroscopic Dorsal Wrist Ganglionectomy

2018 ◽  
Vol 23 (03) ◽  
pp. 404-407
Author(s):  
Ines C. Lin ◽  
Alexander Y. Shin ◽  
Allen T. Bishop
Keyword(s):  
Open Surgery ◽  
Ligament Reconstruction ◽  
Late Complication ◽  
Wrist Pain ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Arthroscopic Findings ◽  
Extensor Compartment ◽  
Capsular Defect

Arthroscopic dorsal wrist ganglionectomy is demonstrably a safe procedure with recurrence rates comparable to open surgery. We present a patient with wrist pain following arthroscopic ganglion excision. MRI and arthroscopic findings showed a large dorsal capsular defect, synovial fistula to the fourth extensor compartment, and dorsal radiocarpal ligament resection. Ligament reconstruction and capsular imbrication resolved her symptoms. We postulate that this complication resulted from a large capsular resection. Because we feel that it can be difficult to judge the size of the debridement through an arthroscope, the need for adequate capsular resection in dorsal wrist ganglionectomy needs to be balanced by consideration of potential complications from more aggressive capsular debridement, and thus we feel that capsular resection should be limited to no more than 1 cm2.

scholarly journals Laparoscopic Appendectomy Versus Open Appendectomy in Children: Evolution over Time

2021 ◽  
Vol 26 (1) ◽  
pp. 44-46
Author(s):  
Laura Dumitrică ◽  
Luminiţa Dobrotă ◽  
Bogdan Neamţu
Keyword(s):  
Laparoscopic Appendectomy ◽  
Comparative Evaluation ◽  
Open Surgery ◽  
Postoperative Ileus ◽  
Open Appendectomy ◽  
Safe Procedure ◽  
The World ◽  
Clinical Benefits ◽  
Meta Analyses ◽  
Reduced Risk

Abstract Laparoscopic appendicitis surgery is accepted in more and more centers around the world. Studies and meta-analyses of studies have shown that laparoscopic appendicitis is a feasible and safe procedure with numerous clinical benefits, such as shorter postoperative ileus, lower incidence of wound infection, lower postoperative pain and duration, recurrence faster to activities. Because laparoscopic appendectomy has been associated with a reduced risk of surgical complications, it may provide a better alternative versus open surgery. A review of data relevant to the evaluation of laparoscopic appendectomy versus open appendectomy as reflected in the literature of the last 2 decades would be relevant for the growing progressive interest of laparoscopic surgery for acute appendicitis and for its comparative evaluation with classical open appendicitis intervention.

scholarly journals Treating the patient with acute rupture of penetrating atherosclerotic ulcer of the thoracic aorta

2015 ◽  
Vol 96 (3) ◽  
pp. 377-380
Author(s):  
I R Yagafarov ◽  
R R Sayfullin ◽  
M M Iskhakov ◽  
N V Gazizov ◽  
M G Khatypov ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Spontaneous Rupture ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Long Term Results ◽  
Safe Procedure ◽  
Descending Thoracic Aorta ◽  
Prosthetic Repair ◽  
Penetrating Atherosclerotic Ulcer

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

scholarly journals A closed system irrigation & drainage technique for surgical evacuation of chronic subdural haematomas

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 619 ◽  
Author(s):  
Haider Kareem ◽  
Hadie Adams
Keyword(s):  
Length Of Stay ◽  
Closed System ◽  
Chronic Subdural Haematoma ◽  
Burr Hole ◽  
Ageing Population ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
The One ◽  
Irrigation Drainage ◽  
Drainage Technique

Background: Chronic subdural haematoma (CSDH), is a common neurosurgical disorder that is associated with morbidity and mortality affecting the ageing population. The aim is to present the treatment experience of CSDH patients treated with a technique that combines the classical single burr-hole irrigation and the continuous closed system drainage: The closed system irrigation & drainage (CSID) technique. Methods: The cases undergoing CSDH evacuation with the CSID method were captured over a 4-year period at a tertiary neurosurgical centre. The authors describe the performance of this methods with respect to post-operative clinical and radiological features, including recurrence rates, complications, and length of stay. Results: A total of 36 cases undergoing 42 CSID procedures (30 unilateral and 6 bilateral CSDHs) were performed, in cases ranging between 55-95 years old (median age 79 years). The rate of recurrence or significant ruminant blood in the subdural space on post-operative imaging was 11% (n=4). No cases of pneumocephalus were observed in this series (n=0). The mean (SD) skin-to-skin time for this procedure was 13.4 (4.4) minutes, with a mean (SD) length of stay of 4 (1.9) days. Conclusion: We conclude that the one burr-hole closed system irrigation and drainage technique with a sub-periosteal drain seems to be a simple, effective and safe procedure for treatment of CSDH. It’s well tolerated under local anaesthesia for patients with high co-morbidities and these preliminary results indicated it may potentially be a better option for treatment of CSDH with a lower rate of post-operative complications.

Laparoscopic retroperitoneal lymph node dissection (L-RPLND) as therapeutic in stage I nonseminomatous germ cell testicular tumors: Findings from a referral center.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 411-411
Author(s):  
Nicola Nicolai ◽  
Francesca Gasperoni ◽  
Davide Biasoni ◽  
Nicholas Tarabelloni ◽  
Mario Catanzaro ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Vascular Invasion ◽  
Open Surgery ◽  
Continuous Variable ◽  
Stage I ◽  
Retroperitoneal Lymph Node Dissection ◽  
Safe Procedure ◽  
Full Data ◽  
Referral Center

411 Background: Active surveillance or one course of BEP are the usual policies in stage I NSGTT. RPLND has been progressively abandoned due to morbidity and, mostly, to its low reproducibility. L-RPLND was introduced aiming at reducing morbidity, but few systematic data are available concerning its therapeutic efficacy. A long-term accrual in a referral center is presented. Methods: Analysis includes patients undergoing primary L-RPLND between 2000 and 2014, performed by 4 different surgeons. Patients underwent unilateral dissection according to a template in use since 1980. Adjuvant chemotherapy was provided in cases with a positive nodal ratio ≥ 25%. Regular follow-up was provided. Performance, safety and effectiveness measures have been analyzed. Results: Out of 225 patients, full data including clinico-pathologic variables and follow-up are available in 188 cases. Mean age is 31 yrs, vascular invasion is present in 37.2%. Left dissections are 52%. Fifteen (8%) cases have been converted to open RPLND. Median duration of RPLND is 200 min. Median number of removed nodes is 15 (IQR: 11-20). Complications of Clavien Dindo grade ≥ 3 are 9. Twenty-six patients have metastatic nodes (pN+) and 6 received adjuvant chemotherapy. After a median follow-up of 40 months (range: 24, 71), 11 relapses occurred: 6 (3.7%) of 162 pN0 and 5 of 20 pN+ not undergoing adjuvant chemotherapy. Infield recurrences are not reported. All relapsed patients have been rescued by first line chemotherapy. Presence of vascular invasion (p .073) and node ratio as continuous variable (p .097) are not associated with recurrence considering all cases, while conversion to open RPLND is significant (p .019), considering patients operated by the two surgeons with homogeneous variables. Conclusions: L-RPLND in a referral centre is a safe procedure and is apparently effective as open surgery, as there is no an excess of relapses in pN0 cases (3.6%), and the proportion of relapses in pN1 (25%) compares with the traditional figures of open surgery. Conversion to open surgery may be a marker predicting recurrence in a mature phase of experience.

scholarly journals Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under anaesthesia

2020 ◽  
Vol 37 (1) ◽  
pp. 167-175
Author(s):  
Ciaran Scott Hill ◽  
Anouk Borg ◽  
Muhammad Zubair Tahir ◽  
Dominic Nolan Paul Thompson
Keyword(s):  
Open Surgery ◽  
Primary Outcome Measure ◽  
Safe Procedure ◽  
Delayed Presentation ◽  
Initial Management ◽  
Manipulation Under Anaesthesia ◽  
Atlantoaxial Rotatory Fixation ◽  
Group 2 ◽  
Rotatory Fixation ◽  
Group 1

Abstract Aims The aims were to evaluate the safety of manipulation under anaesthesia (MUA) for atlantoaxial rotatory fixation (AARF) and the relative efficacy of rigid collar vs halo-body orthosis (HBO) in avoiding relapse and the need for open surgery. Methods Cases of CT-verified AARF treated by MUA were identified from a neurosurgical operative database. Demographic details, time to presentation and aetiology of AARF were ascertained through case note review. Cases were divided according to method of immobilisation after successful reduction, either rigid collar (group 1) or HBO (group 2). The primary outcome measure was relapse requiring open surgical arthrodesis. Results Thirty-three patients (2.2–12.7 years) satisfied inclusion criteria. Time to presentation varied from 1 day to 18 months. There were 19 patients in group 1 and 14 in group 2. There were no adverse events associated with MUA. 9/19 (47%) patients in group 1 resolved without need for further treatment compared with 10/14 (71%) in group 2 (p = 0.15). Of the 10 patients who failed group 1 treatment, four resolved after HBO. A total of ten patients (30%) failed treatment and required open surgery. Conclusions MUA is a safe procedure for AARF where initial conservative measures have failed. MUA followed by immobilisation avoids the need for open surgery in over two thirds of cases. Immobilisation by cervical collar appears equally effective to HBO as an initial management, and so a step-wise approach may be reasonable. Delayed presentation may be a risk factor for relapse and need for open surgery.

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