Comparative study of modified Stoppa approach and ilioinguinal approach for pelviacetabular fractures

Background: The present study was done to study advantages and disadvantages of modified Stoppa approach (MSA) and ilioinguinal approach (IIA) for surgery of pelviacetabular fractures involving anterior column, anterior wall, quadrilateral plate with protrusion and complex fractures, pelvic ring fractures with pubic diastasis or sacroiliac joint disruptions which needs to be stabilized anteriorly.Methods: Study was conducted in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad on patients with pelviacetabular fractures during June 2018 to March 2020. In our study of 25 patients, they were divided into group A containing 13 patients operated using MSA and group B containing 12 patients operated using IIA. Follow up period was 12-18 months (mean=15) and 12-16 months (mean=14) for group A and B, respectively. Patients assessed using modified Merle d’Aubigné score and Matta’s score.Results: Mean modified Merle d’Aubigné score was 16 and 14 for group A and B, respectively (p value=0.89). Mean blood loss and operative time were less in MSA. Superficial infection was found in one patient each of group A and B whereas one patient developed deep infection in group B. One patient each of both group had hip pain suggestive of early arthrosis. In group B, two patients developed meralgia paresthetica. One patient developed external iliac artery thrombosis and inguinal hernia in group B. one patient from group A developed incisional hernia.Conclusions: MSA was better and simpler than IIA with due adequate training and practice to achieve direct access for pelviacetabular fracture reduction and also it requires less operative time, less blood loss and better postoperative outcome.

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Supra-ilioinguinal versus modified Stoppa approach in the treatment of acetabular fractures: reduction quality and early clinical results of a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1428-y ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Sheng Yao ◽

Kaifang Chen ◽

Yanhui Ji ◽

Fengzhao Zhu ◽

Lian Zeng ◽

...

Keyword(s):

Operative Time ◽

Clinical Results ◽

Acetabular Fractures ◽

Ilioinguinal Approach ◽

Quadrilateral Plate ◽

Stoppa Approach ◽

Group A ◽

The Mean ◽

Group B ◽

Approach Group

Abstract Background To compare the efficacy of the operative techniques, complications, reduction quality and hip functional recovery by using the supra-ilioinguinal approach and the modified Stoppa approach for the management of acetabular fractures. Methods A consecutive cohort of 60 patients from September 2014 to October 2017 with displaced acetabular fractures involving the quadrilateral plate were treated operatively with supra-ilioinguinal approach (group A) and modified Stoppa approach (group B), respectively. There were 36 patients in group A and 24 patients in group B. The surgical details, complications, radiographic and clinical results were recorded. The quality of reduction was assessed by measuring the residual step and gap displacement of postoperative CT with a standardized digital method. Results The complications, reduction quality (gaps and steps) and hip function recovery had no significant statistical difference in approaches. The mean operative time was shorter and the mean intraoperative haemorrhage was less in group A. There were statistical differences in the operative time (P = 0.025) and intraoperative haemorrhage (P = 0.003) between the supra-ilioinguinal approach and the modified Stoppa approach. Conclusion Compared to the modified Stoppa approach, the supra-ilioinguinal approach provides a closer visualization to the quadrilateral plate, the operative time was shorter and the intraoperative haemorrhage was clearly less. It is at least equal to or could be a better choice to deal with complicated acetabular fractures especially involving the quadrilateral plate and the anterior one third of the iliac bone.

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TONSILLECTOMY IN PAEDIATRIC POPULATION

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.04.1540 ◽

2016 ◽

Vol 23 (04) ◽

pp. 499-503

Author(s):

Raheel Ahmad ◽

Farhan Salam ◽

Abdul Saeed Khan ◽

Faisal Bashir ◽

Atif Rafique

Keyword(s):

Standard Deviation ◽

Blood Loss ◽

Operative Time ◽

Controlled Trial ◽

Operation Time ◽

Group A ◽

Group B ◽

Cold Steel Dissection ◽

Cold Dissection ◽

Dissection Method

Objectives: To compare mean operative time and Intra operative blood lossbetween bipolar electro dissection and cold dissection tonsillectomy in paediatric population.Study Design: Randomized controlled trial. Place and Duration: Department of ENT and Headand Neck Surgery, Continental Medical College, Hospital Lahore, from 1 January 2015 to 30September 2015. Materials and Methods: This study included 164 patients of age group 4 to12 years of either gender undergoing tonsillectomy. The patients were divided into two equalgroups designated as A and B each having 82 patients using simple random sampling. Patientsin group A were operated for tonsillectomy by bipolar electrocautry while group B underwenttonsillectomy by cold steel dissection method. All patients in both groups were assessed foroperating time and intra-operative blood loss. Results: Out of 82 cases of Bipolar DissectionGroup 49(60%) patients were male and 33(40%) patients were female. Whereas in 82 casesof Cold Dissection Group 51(62%) patients were male and 31(38%) patients were female.Mean age of patients was 7.2(SD ± 1.97) years. Mean operation time was 15 minutes withstandard deviation ± 1.21 in group A as compared to group B where mean operation time was20 minutes with standard deviation ± 1.87. Mean blood loss was 7 ml with standard deviation± 2.53 in patients of group A as compared to Patients in group B who mean blood loss of 30ml with standard deviation ± 3.46. Group A had statistically significant lower operative time andblood loss than group B. Conclusion: Tonsillectomy with bipolar electro dissection method ismuch better than cold steel dissection method. It has an advantage of less blood loss duringsurgery. It significantly reduces intra operative time.

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Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System

Advances in Medicine ◽

10.1155/2016/7639727 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ebrahim Ghayem Hassankhani ◽

Farzad Omidi-Kashani ◽

Shahram Moradkhani ◽

Golnaz Ghayem Hassankhani ◽

Mohammad Taghi Shakeri

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Operative Time ◽

Intraoperative Blood Loss ◽

Curve Correction ◽

Universal Clamp ◽

Outcome Scores ◽

Group A ◽

Group B

Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was 58°±7° (42°–74°) in group A and 60°±9° (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (P=0.001). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores.

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Laparoscopic versus open hysterectomies in obese patients

International Surgery Journal ◽

10.18203/2349-2902.isj20185014 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3893

Author(s):

Soliman A. El Shakhs ◽

Moharam A. Mohamed ◽

Mahmoud A. Shahin ◽

Ahmed M. Eid

Keyword(s):

Blood Loss ◽

Surgical Procedure ◽

Operative Time ◽

Laparoscopic Hysterectomy ◽

Obese Patients ◽

Optimal Route ◽

Significant Difference ◽

Group A ◽

Prospective Comparative Study ◽

Group B

Background: Hysterectomy is one of the most frequently performed surgical procedure. Though there are three approaches in hysterectomy (open, vaginal and laparoscopic), still there are controversies regarding the optimal route for performing it.Methods: This prospective comparative study included 42 obese patients subjected for pan-hysterectomy as a treatment. The forty-two patients were allocated into two groups: group (A) subjected to laparoscopic pan-hysterectomy, group (B) subjected to open pan-hysterectomy.Results: There was significant difference between the two groups regarding mean operative time, blood loss, analgesic requirements and hospital stay, while no significant difference regarding intra-operative complications.Conclusions: Laparoscopic hysterectomy in obese patients has emerged as a viable, safe and better alternative to open hysterectomy amongst appropriately trained surgeons.

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Comparison of microdebrider assisted adenoidectomy and adenoid curette adenoidectomy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181669 ◽

2018 ◽

Vol 4 (3) ◽

pp. 819

Author(s):

Shaweta . ◽

Ramesh K. Azad ◽

R. S. Minhas ◽

Shobha Mohindroo

Keyword(s):

Blood Loss ◽

Operative Time ◽

Symptomatic Relief ◽

Complete Removal ◽

Operative Blood Loss ◽

Left Behind ◽

Adenoid Tissue ◽

Group A ◽

Residual Tissue ◽

Group B

Background: Adenoidectomy is the surgical procedure to remove the adenoids. It is conventionally performed using the curettage method. The aim is to compare between adenoid curette adenoidectomy and microdebrider assisted adenoidectomy.Methods: From April 2016 to March 2017, 50 patients (34 males and 16 females), requiring adenoidectomy were randomized into two groups each of twenty five. Group A underwent microdebrider assisted adenoidectomy. Group B underwent conventional adenoidectomy using the curettage method. The parameters studied were intra-operative time, blood loss, residual tissue, associated trauma, and post-operative symptomatic relief and complications. Results: Microdebrider assisted adenoidectomy was significantly better in terms of residual tissue left behind as compared to adenoid curette adenoidectomy (p<0.001), similar operative blood loss and operative time with no difference in complications.Conclusions: Microdebrider-assisted adenoidectomy is a safe and effective alternative to curettage method as it allows complete removal of adenoid tissue under direct vision.

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Assessment of Shoulder Function after Internal Fixation of Humeral Diaphyseal Fractures in Young Adults: A Prospective Comparative Study

Advances in Orthopedics ◽

10.1155/2021/9471009 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Hossam Fathi Mahmoud ◽

Ahmed Hatem Farhan ◽

Fahmy Samir Fahmy

Keyword(s):

Young Adults ◽

Blood Loss ◽

Internal Fixation ◽

Operative Time ◽

Shoulder Function ◽

Humeral Shaft ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Group A ◽

Group B

Background. Humeral shaft fractures are commonly encountered in casualties. There are different methods of operative internal fixation with no consensus on the best technique. The objective of this study was to assess shoulder function and rate of complications among two different options of fixation, intramedullary nailing, and minimal invasive plate osteosynthesis (MIPO) in young adults. Methods. Forty-two patients with humeral shaft fractures were included in the study and divided into two equal groups: group A treated with antegrade intramedullary locked nails (IMN) and group B with MIPO. Fracture union was evaluated with serial X-rays, and shoulder function was assessed in both groups using the scale of the American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles Shoulder Scale (UCLA), and visual analog score (VAS). The mean differences between groups were recorded and considered significant if the P value was ˂0.05. Results. The results were reported prospectively with no significant differences in mean age, sex, side of injury, type of fracture, mechanism of injury, and the follow-up period between the groups studied. Group A had shorter operative time and minimal blood loss than group B. Regarding shoulder function scores (ASES, UCLA, and VAS), the results in the MIPO group were better than the IMN group with shorter time of union and fewer complications. Conclusion. Despite a shorter operative time and lower blood loss during locked intramedullary nail fixation in the management of humeral shaft fractures, MIPO enables more superior shoulder function with better fracture healing and lower morbidities.

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Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2014.11.spine14710 ◽

2015 ◽

Vol 23 (1) ◽

pp. 42-48 ◽

Cited By ~ 7

Author(s):

Xinyu Liu ◽

Suomao Yuan ◽

Yonghao Tian ◽

Lianlei Wang ◽

Yanping Zheng ◽

...

Keyword(s):

Blood Loss ◽

Vertebral Column ◽

Operative Time ◽

Kyphotic Angle ◽

Vertebral Column Resection ◽

Average Blood Loss ◽

Group A ◽

Angular Kyphosis ◽

Group B

OBJECT The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. METHODS A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3–5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°–75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). RESULTS In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°–24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200–8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°–34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). CONCLUSIONS An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.

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Totally laparoscopic pancreaticoduodenectomy: Learning curve.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14717 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14717-e14717

Author(s):

Igor Khatkov ◽

Viktor Tsvirkun ◽

Roman Izrailov ◽

Pavel Tiutiunnik

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Postoperative Morbidity ◽

Operative Time ◽

Postoperative Mortality ◽

Safe Procedure ◽

Laparoscopic Pancreaticoduodenectomy ◽

Group A ◽

Group B ◽

Totally Laparoscopic

e14717 Background: Laparoscopic pancreaticoduodenectomy (LPDE) has become increasingly popular in the world and now is considered to be a technically feasible and safe procedure for patients with tumors of the head of the pancreas and the periampullare area. At the same time, according to the literature data, a lot of surgeons stop performing totally laparoscopic pancreaticoduodenectomy (TLPDE) after 5 – 15 procedures because of the difficulties of learning curve. Aim of thew study: to evaluate the learning curve of totally laparoscopic pancreaticoduodenectomy. Methods: The data of 43 patients who were planed for LPDE during 5 year were analyzed. All the procedures were performed by one surgical team. 35 patients underwent totally laparoscopic pancreaticoduodenectomy (TLPDE). For 8 patients the procedures were palliative or converted. Patients were divided in three groups. Group A, B and C – 12;12;11 patients respectively. Operative time, intraoperative blood loss and the level of postoperative morbidity were examined. Results: Among the 43 patients, 35 patients underwent TLPDE. The conversion rate was in the group A - 33% (4 patients), group B – 33%(4 patients) and group C – no conversions. Mean operative time of TLPDE for the group A was - 542min; group B – 542min and group C less than 360min, minimally - 280). Mean blood loss was for group A - 683ml, group B – 612ml and group C 250ml. Total level of all kinds of postoperative morbidity was: group A - 66,5%, group B – 65,5% and group C – 36,0%. Postoperative mortality was: group A - 8,3%(one of the patients died from insufficiency of the pancreatojejenostomy, another – because of acute heart failure without any surgical complications); group B – 0% and group C - 0%. Conclusions: The results of TLPDE become significantly better after 25 procedures. The most difficult and potentially dangerous for intra and postoperative complications were: dissection along superior mesenteric and portal vein and suturing of pancreaticojejuno anastomosis. Performing TLPDE by the same team, including nurses, is a very important factor for quick learning curve and safety.

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Laparoscopic Radical Prostatectomy: The Learning Curve of a Low Volume Surgeon

The Scientific World JOURNAL ◽

10.1155/2013/974276 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Anuar I. Mitre ◽

Mario F. Chammas ◽

José Eugênio A. Rocha ◽

Ricardo Jordão Duarte ◽

Gustavo Xavier Ebaid ◽

...

Keyword(s):

Radical Prostatectomy ◽

Blood Loss ◽

Learning Curve ◽

Operative Time ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Estimated Blood Loss ◽

Group A ◽

Low Volume ◽

Group B

Objective. Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program.Materials and Methods. A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon’s experience.Results. Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence.Conclusion. Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

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Mid-term results of an anterior ilioischial plating for complex acetabular fractures with a combined anterior approach: a retrospective cohort study

10.21203/rs.2.10376/v1 ◽

2019 ◽

Author(s):

Weikun Meng ◽

Yi Ou ◽

Zhaoxiang Wu ◽

Hongchang Yang ◽

Ge Chen ◽

...

Keyword(s):

Blood Loss ◽

Anterior Approach ◽

Operative Time ◽

Fracture Reduction ◽

Acetabular Fractures ◽

Time Interval ◽

Intraoperative Blood Loss ◽

Ilioinguinal Approach ◽

Stoppa Approach ◽

Hip Function

Abstract Background: Bi-columnar plating via combined anterior and posterior approaches is routinely applied treatment for complex acetabular fractures with noteworthy shortcomings. The goal of this study was to evaluate the effectiveness of the anterior plating with an ilioischial plate through the combined anterior approach for complex acetabular fracture treatment. Methods: Patients with complex acetabular fractures treated at our trauma centre between January 2015 and December 2016 were retrospectively reviewed. Fractures were stabilized with an ilioischial plate via a modified Stoppa approach combined with the 1st window of the ilioinguinal approach. Interval between injury and surgery, operative time and intraoperative blood loss were recorded. Fracture reduction was evaluated radiographically with the modified Matta's criteria at 3 days postoperatively. Postoperative hip function was assessed using the modified Merle d'Aubigne and Postel clinical grading system over at least 1 year postoperatively. Results: Twenty patients were included with an average follow-up of 17 months (range, 13-28). The mean time interval between injury and surgery was 7.0 days (range, 3-13 days), operative time was 2.0 hours (range, 1.4-3.2 hours), and intraoperative blood loss was 320 mL (range, 220-450 mL). Fracture reduction was excellent in 15 cases (75%), good in 3 cases (15%), fair in 1 case (5%), and poor in 1 case (5%). Final hip function was excellent in 13 cases (68%), good in 3 cases (16%), fair in 2 cases (11%), and poor in 1 case (5%). Bony healing was achieved in all cases and few complications were reported including recoverable obturator nerve injuries in 2 patients (10%) and traumatic arthritis in 1 patient (5%). Conclusions: Anterior fixation of complex acetabular fractures with an ilioischial plate via the combined anterior approach yielded clinically satisfactory mid-term outcomes, providing a potentially effective alternative to the conventional treatment algorithm.

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