Single- and multistage surgical treatment of patients with degenerative sagittal imbalance

Objective. To analyze the nearest clinical and radiological results of simultaneous and staged surgical treatment of patients with degenerative sagittal imbalance.Material and Methods. Retrospective monocentric cohort study included analysis of data from 54 patients who underwent simultaneous combination of surgical methods with obligatory corrective anterior fusion at the L4–L5 or at L4–L5 and L5–S1 levels (Group I, n = 27) or similar surgical intervention though divided into stages with an interval of 5 days or more (Group II, n = 27). A comparison of clinical, radiological, and operational data during inpatient treatment was carried out.Results. The duration of surgery was 410.93 ± 76.34 minutes in Group I and 594.63 ± 102.61 minutes in Group II (p = 0.000001); the blood loss was 926.67 ± 378.63 ml versus 1345.19 ± 522.97 ml, respectively (p = 0.001575). Postoperative clinical and radiological parameters did not differ between groups: VAS back (p = 0.248647), VAS leg (p = 0.196140), PT (p = 0.115965), SVA (p = 0.208449), LL (p = 0.023654), LDI (p = 0.931646), PI-LL (p = 0.693045), GAP (p = 0.823504), and restoration of the ideal Russoly type (p = 0.111476). The incidence of perioperative complications in groups was comparable: 17 (62.96 %) in Group I and 15 (55.56 %) in Group II (p = 0.583171). Patients with a high Charlson comorbidity index had a significantly higher incidence of complications (p = 0.023471). The index of surgical invasiveness in Group I had a significant correlation with the total number of complications (r = 0.421332).Conclusion. Clinical and radiological results and the incidence of complications are comparable between single- and multistage approaches to correct sagittal balance disorders. In staged treatment, the total duration of surgery and the volume of blood loss are significantly higher. With a high Charlson comorbidity index and Mirza surgical invasiveness index, a multistage approach to the treatment of patients with sagittal imbalance is preferred.

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Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027316-26 ◽

2020 ◽

Vol 27 (3) ◽

pp. 16-26

Author(s):

Evgenii S. Baykov ◽

Alexey V. Peleganchuk ◽

Abdugafur J. Sanginov ◽

Olga N. Leonova ◽

Aleksandr V. Krutko

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Perioperative Complications ◽

Sagittal Imbalance ◽

Radiological Parameters ◽

Results Of Treatment ◽

Group I ◽

Surgical Methods ◽

Group Ii ◽

Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

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Relationship between Charlson comorbidity index, early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures: a retrospective analysis

Scientific Reports ◽

10.1038/s41598-021-96765-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xu Jianda ◽

Yasuhiro Homma ◽

Yuta Jinnai ◽

Tomonori Baba ◽

Xu Zhuang ◽

...

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Elderly Patients ◽

Charlson Comorbidity Index ◽

Trochanteric Fractures ◽

Early Recovery ◽

Time Out ◽

Significant Difference ◽

Comorbidity Index ◽

First Time

AbstractThe aim of this study was to evaluate how the Charlson Comorbidity Index (CCI) scores contribute to early recovery and 2-year mortality in elderly patients undergoing surgical treatment of inter-trochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1–4) or high-CCI groups (CCI: 5–6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2% respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P = 0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P < 0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P = 0.029, 0.010). Charlson comorbidity index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

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A comparative study between laparoscopic and open cholecystectomy in cases of cholecystitis with cholelithiasis: one year experience in tertiary care center

International Surgery Journal ◽

10.18203/2349-2902.isj20170446 ◽

2017 ◽

Vol 4 (3) ◽

pp. 903 ◽

Cited By ~ 3

Author(s):

Ashutosh Shukla ◽

Sharad Seth ◽

Alok Ranjan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Blood Loss ◽

Open Cholecystectomy ◽

Care Center ◽

Tertiary Care ◽

Gall Stone ◽

Treatment Strategies ◽

Group I ◽

Duration Of Surgery ◽

Group Ii

Background: Gall stones are a major cause of morbidity all over the world. Until the end of 1980’s, open cholecystectomy was the gold standard for treatment of stones in the gall bladder. Laparoscopy has revolutionized surgery causing a re-evaluation of treatment strategies including cholecystectomy, however, it is not completely devoid of pitfalls. This study was undertaken to determine whether laparoscopic cholecystectomy can be recommended over open cholecystectomy as the procedure of choice for the treatment of cholecystitis with cholelithiasis.Methods: This study included a total of 100 patients in the age group 20-70 years diagnosed as calculous cholecystitis on ultrasonography and admitted to the surgical wards of Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India between November 2014 to October 2015. They were divided into two groups. Group I (n = 50) who underwent laparoscopic cholecystectomy and Group II (n = 50) who underwent open cholecystectomy.Results: A comparison of the two groups showed that the duration of surgery was significantly more in Group I (mean 52.32 minutes) as compared to Group II (mean 37.66 minutes) (p <0.001). There was <100 ml blood loss in the majority of Group I cases (94%), however, in Group II, majority had blood loss ≥100 ml (96%) (p <0.001). Mean duration of post-operative pain was 14.68 hours in group I and 27.92 hours in group II (p <0.001). Time taken to restoration of oral feeds, was less in group I (mean 11.68 hours) as compared to group II (mean 17.24 hours). Post-operative hospital stay was a mean of 1.18±0.52 days in Group I and a mean of 4.78±1.42 days in Group II (p<0.001). The time taken for resumption of normal activity was two days and three days (p <0.001) in group I and II respectively. In Group I, average cost of treatment was rupees 10870, but in Group II it was significantly more at rupees 12152 (p = 0.007).Conclusions: Laparoscopic cholecystectomy as a surgical procedure can be recommended over open cholecystectomy in carefully selected patients of gall stone disease.

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Laparoscopy versus laparotomy in the treatment of benign ovarian cyst

Annals of King Edward Medical University ◽

10.21649/akemu.v11i4.1085 ◽

2016 ◽

Vol 11 (4) ◽

Author(s):

Humaira Akram ◽

Sohail Khurshid Lodhi ◽

Tabinda Rana

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Ovarian Cyst ◽

Preoperative Evaluation ◽

Normal Activity ◽

Group I ◽

Significant Difference ◽

Duration Of Surgery ◽

Laparoscopic Fenestration ◽

Group Ii

Objective: To compare laparoscopy with laparotomy in the treatment of benign ovarian cyst in women under 40 years of age. Design: Experimental. Place and duration of study: The study was conducted over a period of one and half year from June 2003 to Nov 2004 in Obstetrics & Gynaecology Department, Unit-III, Lady Willingdon Hospital, Lahore. Subjects & Methods: The sixty consecutive patients of benign ovarian cysts who required surgical treatment underwent either Laparoscopy(group I). or laparotomy (group II). The laparoscopic fenestration, aspiration and cystectomies were performed in group I (30 patients). However, ovarian cystectomies, salpingo-oophorectomy and oophorectomy were performed by laparotomy in group II (30 patients). Results: The comparison was done with respect to duration of surgery intra-operative blood loss, time of mobilization, duration of hospital stay and amount of analgesia used, time to return to normal activity. The amount of analgesics used, time of mobilization, duration of hosp ital stay and time to return to normal activity was less (P<0.05) in Laparoscopy as compared to Laparotomy. There was statistically no significant difference in the duration of surgery, blood loss and post operative morbidity (P>0.05). Conclusion: With appropriate preoperative evaluation, laparoscopic surgery is safe and effective in treating benign ovarian cyst in women under 40 years of age where the risk of malignancy is low. It is associated with early mobilization, less use of analgesia, shorter hospital stay.

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Comparison of single-layer continues or two-layer interrupted pancreatojejunal suture in Frey procedure for treatment of chronic pancreatitis: a prospective randomized study

Polish Journal of Surgery ◽

10.5604/01.3001.0013.5381 ◽

2019 ◽

Vol 91 (5) ◽

pp. 1-5

Author(s):

Audrius Šileikis ◽

Saulius Jurevičius ◽

Mykolas Butvila ◽

Kęstutis Strupas

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Randomized Study ◽

Single Layer ◽

Prospective Randomized Study ◽

Complex Method ◽

Frey Procedure ◽

Group I ◽

Duration Of Surgery ◽

Group Ii

Background Many patients with chronic pancreatitis are elected for surgery when endoscopic interventions are ineffective. Duodenum preserving pancreatic head resection introduced by Charles F. Frey is the most common procedure used for surgical treatment of chronic pancreatitis. However, technical aspects of this procedure have not been studied extensively. Goal Our prospective randomized study is aimed to compare usage of single-layer continuous (I group) and two-layer interrupted sutures (II group) in constructing pancreatojejunostomy after Frey procedure. Methods and materials In a period between 2009 and 2016, a total of 103 patients, diagnosed with chronic pancreatitis and determined medical indications for surgical treatment were included into the study and randomized into group I (52 patients) and group II (51 patients). Preoperative, intraoperative patient characteristics and postoperative results were compared between both groups. Results Mean duration of surgery was statistically shorter in group I - 210 min., while in group II - 240 min (p =0,004). Pancreatojejunoanastomosis construction time was shorter in group I - 19 (±6) min versus 51 (±18) min in group II, p <0,001. No statistically relevant differences were observed in postoperative morbidity: group I - 51,9 % and group II - 45,1 % (p = 0,177) and mortality: group I - 3,8 % and group II - 2 % (p = 0,636). Conclusions Frey procedure using single-layer continuous pancreatojejunostomy is safe, fast and less complex method in surgical treatment of chronic pancreatitis.

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Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison

Journal of Neurosurgery Spine ◽

10.3171/2014.3.spine13714 ◽

2014 ◽

Vol 20 (6) ◽

pp. 636-643 ◽

Cited By ~ 77

Author(s):

Bawarjan Schatlo ◽

Granit Molliqaj ◽

Victor Cuvinciuc ◽

Marc Kotowski ◽

Karl Schaller ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Cohort Group ◽

Group I ◽

Duration Of Surgery ◽

Group Ii

Object Recent years have been marked by efforts to improve the quality and safety of pedicle screw placement in spinal instrumentation. The aim of the present study is to compare the accuracy of the SpineAssist robot system with conventional fluoroscopy-guided pedicle screw placement. Methods Ninety-five patients suffering from degenerative disease and requiring elective lumbar instrumentation were included in the study. The robot cohort (Group I; 55 patients, 244 screws) consisted of an initial open robot-assisted subgroup (Subgroup IA; 17 patients, 83 screws) and a percutaneous cohort (Subgroup IB, 38 patients, 161 screws). In these groups, pedicle screws were placed under robotic guidance and lateral fluoroscopic control. In the fluoroscopy-guided cohort (Group II; 40 patients, 163 screws) screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. The primary outcome measure was accuracy of screw placement on the Gertzbein-Robbins scale (Grade A to E and R [revised]). Secondary parameters were duration of surgery, blood loss, cumulative morphine, and length of stay. Results In the robot group (Group I), a perfect trajectory (A) was observed in 204 screws (83.6%). The remaining screws were graded B (n = 19 [7.8%]), C (n = 9 [3.7%]), D (n = 4 [1.6%]), E (n = 2 [0.8%]), and R (n = 6 [2.5%]). In the fluoroscopy-guided group (Group II), a completely intrapedicular course graded A was found in 79.8% (n = 130). The remaining screws were graded B (n = 12 [7.4%]), C (n = 10 [6.1%]), D (n = 6 [3.7%]), and E (n = 5 [3.1%]). The comparison of “clinically acceptable” (that is, A and B screws) was neither different between groups (I vs II [p = 0.19]) nor subgroups (Subgroup IA vs IB [p = 0.81]; Subgroup IA vs Group II [p = 0.53]; Subgroup IB vs Group II [p = 0.20]). Blood loss was lower in the robot-assisted group than in the fluoroscopy-guided group, while duration of surgery, length of stay, and cumulative morphine dose were not statistically different. Conclusions Robot-guided pedicle screw placement is a safe and useful tool for assisting spine surgeons in degenerative spine cases. Nonetheless, technical difficulties remain and fluoroscopy backup is advocated.

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Rib deformity correction in children with pectus excavatum

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto20202716-10 ◽

2020 ◽

Vol 27 (1) ◽

pp. 6-10

Author(s):

Sergey V. Kolesov ◽

Dmitriy V. Khaspekov ◽

Alexander A. Snetkov ◽

Artur S. Sar ◽

Arkadiy I. Kazmin

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Children And Adolescents ◽

Pectus Excavatum ◽

Randomized Study ◽

Deformity Correction ◽

Treatment Results ◽

Group I ◽

Duration Of Surgery ◽

Group Ii

The article is devoted to a comparative analysis of the surgical treatment of pectus excavatum. A prospective, single-center, non-randomized study of the immediate results of the correction of pectus excavatum in children and adolescents is presented. Material and methods. The treatment results of 40 patients (27 men and 13 women) aged 3 to 18 years, operated between March 2005 and March 2016 were analyzed. All patients were examined according to the standard algorithm: chest MSCT, spirometry. All patients were divided into 2 groups. Group I patients operated on by the open resection method with plastic surgery of the costal arches (n=27). Group II patients operated with the use of minimally invasive technology according to NUSS, which does not provide for correction of deformation of costal arches (n=13). Results. In group II, significantly less blood loss was noted (35.7 ml versus 137 ml in group I, p0.05), shorter duration of surgery (230 min versus 27.5 min in group I, p0.05). It is worth noting the earlier discharge from the hospital in patients with minimally invasive correction of deformity. Conclusion. Minimally invasive thoracoplasty is an effective way to correct pectus excavatum in children and adolescents, which can significantly reduce the duration of surgery and intraoperative blood loss, is comparable in basic terms with reconstructive surgery, but inferior due to the lack of correction of deformation of the rib arches.

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Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459318806442 ◽

2018 ◽

Vol 9 ◽

pp. 215145931880644 ◽

Cited By ~ 5

Author(s):

Lei Jiang ◽

Andrew Chia Chen Chou ◽

Nivedita Nadkarni ◽

Caris En Qi Ng ◽

Yun San Chong ◽

...

Keyword(s):

Surgical Treatment ◽

Hip Fracture ◽

Charlson Comorbidity Index ◽

Demographic Data ◽

Survival Rates ◽

Predictive Ability ◽

Fracture Pattern ◽

Mortality Data ◽

Comorbidity Index

Introduction: This study aims to assess the correlation of the age-adjusted Charlson comorbidity index (ACCI) with 5-year mortality in a surgically treated hip fracture population. Materials and Methods: A retrospective analysis was performed on 1057 patients aged 60 years and above who underwent surgery for hip fracture with a minimum of 5-year follow-up (92.2% 5-year follow-up rate) in a tertiary hospital. Manual review of patients’ electronic hospital records was performed to record demographic data, comorbidities, and length of stay. Mortality data were extracted from the hospital’s electronic medical records and corroborated with the National Electronic Health Record. Results: Of the 1057 patients, 283 (26.8%) were male. The majority of patients were 80 years of age and above (42.5%), with the oldest patient operated on age 102 with a mean age of 77.8 (8.6) years. Four hundred eighteen (39.5%) patients sustained extracapsular intertrochanteric fractures. The mean follow-up duration was 8 years and 3 days with an overall survivorship of 37.2%. A multiple regression model constructed with ACCI, age, gender, and fracture pattern demonstrated satisfactory predictive ability with a concordance statistic of 0.68. Patients with a higher ACCI category (≥6) had an increased 5-year mortality rate (41.8%) with an odds ratio of 13.6 (6.7-31.8, P < .001) compared to those with an ACCI category of 3 and below (89.3%). Discussion: The study demonstrates that ACCI correlated with 5-year mortality after surgical treatment of hip fracture. This information is pertinent in the counseling of patients with regard to their midterm survival following hip fracture surgery and may inform policy makers of the varied midterm survival rates in patients with differing ACCI scores and educate the allocation of health-care resources. Conclusion: The ACCI correlates with 5-year mortality after surgical treatment of hip fracture.

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Results of modern tuboperitoneal infertility treatment

Vojnosanitetski pregled ◽

10.2298/vsp0901057t ◽

2009 ◽

Vol 66 (1) ◽

pp. 57-62 ◽

Cited By ~ 1

Author(s):

Drenka Turjacanin-Pantelic ◽

Dragana Bojovic-Jovic ◽

Biljana Arsic ◽

Eliana Garalejic

Keyword(s):

Statistical Analysis ◽

Surgical Treatment ◽

Infertility Treatment ◽

P Value ◽

Modern Approach ◽

Vitro Fertilization ◽

Group I ◽

Significant Difference ◽

Group Ii

Background/Aim. A modern approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy. Methods. A retrospectiveprospective study on 66 women treated operatively form tuboperitoneal infertility was performed. Data from patient's anamnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant. Results. Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.4%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups. Conclusion. Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.

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Outcomes of ophtalmologic surgical procedures of esotropia in children and adolescents

Vojnosanitetski pregled ◽

10.2298/vsp0808627k ◽

2008 ◽

Vol 65 (8) ◽

pp. 627-631

Author(s):

Tamara Kljakovic-Avramovic ◽

Miroslav Vukosavljevic ◽

Sinisa Avramovic

Keyword(s):

Surgical Treatment ◽

Prospective Study ◽

Children And Adolescents ◽

Deviation Angle ◽

Group Iii ◽

Military Medical Academy ◽

Group I ◽

Medical Academy ◽

Group Ii ◽

Common Manifestation

Background/Aim. Esotropia is the most common manifestation form of strabism accompanied by refraction deviations and amblyopia. The aim of this prospective study was to present the outcomes of surgical treatment of esotropia in children and adolescents. Methods. Within the period from January 1st 2006 to February 1st 2007 at the Clinic for Ophtalmology, Military Medical Academy, Belgrade a total of 25 patients with esotropia (34 eyes) and previously corrected refraction anomaly and treated amblyopia were operated on. The patients were 4-19-year of age. All of the patients were submitted to a complete ophtalmologic and orthoptic examination prior to the surgery, and a month, three months and six months after the surgery. The surgery was performed under general anesthesia. Out of the total number of the patients nine were operated on both eyes, while 16 patients on one eye with amblyopia or frequent esodeviation. Nine patients were submitted to retroposition of the inner straight muscle, two to myectomy of the outer straight muscle, while in 14 of the patients a combination of retroposition and myectomy was performed. The patients were divided into three groups according to the preoperative angle at the distance and followed-up accordingly after the surgery. Deviation angle at the distance in the group I was 18-25 DP, in the group II 26-35 PD, while in the group III it was 36-60 PD. Results. The most numerous, group I (12 patients; 48%), a month following the surgery showed angle reduction by 55.58%, after three months 63.25%, and after six months 63.92%. The group II consisted of 8 patients (32%) showed angle reduction by 70.75% a month following the surgery, by 76% after three months, and by 79.12% after six months. The group III (5 patients; 20%) showed angle reduction by 72.20% a month following the surgery, 79.20 after three months, and 80.12% after six months following the surgery. Conclusion. The best postoperative outcomes after a month, three and six months were obtained in the group of patients with the highest esodeviation angle at the distance solved by the surgery on both eyes. Timely surgical treatment befell into major precondition for developing and maintaining the elements of binocular vision in the operated on patients. .

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