scholarly journals Primary Anastomosis versus Colostomy in Patients with Penetrating Colonic Injuries; A Comparative Study

2021 ◽  
Vol 15 (7) ◽  
pp. 1840-1842
Author(s):  
Khalid Mahmood ◽  
Allah Nawaz ◽  
Ahmad Hassan Khan ◽  
Asad Rizwan Rana ◽  
Rażą Farrukh ◽  
...  
Keyword(s):  
Sample Size ◽  
Primary Repair ◽  
Primary Anastomosis ◽  
Complication Rates ◽  
Abdominal Abscess ◽  
Significant Difference ◽  
Lower Complication ◽  
Ethical Approval ◽  
Blotting Technique ◽  
Colon Injuries

Background: Penetrating colon injuries treatment has been a controversial topic of discussion in medical literature. The literature shows that randomized trials comparing primary repair versus bypass showed no significant difference in complication rates between the two groups. While other trials comparing complication rates between the two groups showed that the primary repair has lower complication rates as compared to the colostomy. Methodology: Randomized control trail was conducted in six months of duration from 1stJanuary 2020 to 31stDecember 2020in surgical unit of DHQ Teaching Hospital / SMC (UOS), Sargodha. After taking Ethical approval from the hospital, the study was conducted on 300 patients sample size calculated through open Epi sample size calculator with margin of error 5% and confidence interval 95%. Randomized blotting technique was used for randomization to overcome biasness. Results: Group 01 of primary anastomosis had 97 (64.67%) males and 53 (35.33%) females while group 02 of colostomy had 92 (66.34%) males and 58 (33.66%) females. complications intra-abdominal abscess was analyzed between both groups. In group 01 primary anastomosis, only 4 (2.66%) patients develop intra-abdominal abscess while in rest of patients i.e. 146(97.34%) showed efficacy to primary anastomosis. In group 02 of colostomy, 27 (18%) patients develop intra-abdominal abscess while rest of patients i.e. 123(82%) patients showed efficacy towards colostomy. Conclusion: In penetrating colon injuries, anastomosis showed more efficacy, safe to use and excellent results on the basis of post-operative complications as compared to colostomy. Keywords: Primary anastomosis, defunctioning in colostomy, penetrating colonic injuries, effectiveness

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

Complications of neuroendoscopic septostomy

2021 ◽  
pp. 1-7
Author(s):  
Travis J. Atchley ◽  
Blake Sowers ◽  
Anastasia A. Arynchyna ◽  
Curtis J. Rozzelle ◽  
Brandon G. Rocque
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Ventricular Size ◽  
Current Procedural Terminology ◽  
Operative Techniques ◽  
Chi Square ◽  
Intraoperative Complication ◽  
Significant Difference ◽  
Lower Complication

OBJECTIVE The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications. METHODS The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded. RESULTS Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications. CONCLUSIONS Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.

Native Arterio-Venous Fistula for Hemodialysis: What to Expect Early after Creation?

2003 ◽  
Vol 4 (2) ◽  
pp. 39-44 ◽  
Author(s):  
M. Leblanc ◽  
E. Saint-Sauveur ◽  
V. Pichette
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Complication Rates ◽  
Ultrasound Dilution ◽  
Flow Monitoring ◽  
Significant Difference ◽  
Lower Complication ◽  
Vascular Mapping ◽  
Venous Fistula

Native arterio-venous fistulas (AVFs) are preferred for hemodialysis vascular access over synthetic grafts and long-term catheters. However, prevalence rates of native AVFs are variable around the world and have increased only slightly in United States since the DOQI guidelines. To increase rates of native AVFs, pre-operative vascular mapping by ultrasound has been found of major help for appropriate selection of the vessels. The minimal desirable lumen diameter of the artery should be > 2 mm and > 2.5 to 3 mm for the vein at the anatomosis. Early failure can be reduced to less than 10% when the feeding artery is > 2 mm, even in diabetics. If sizes of the vessels are smaller than those targets at the wrist, moving to the upper arm should be considered. The interval between creation and first cannulation varies from 2 weeks to 4 months. There might not be much advantage to wait for more than 4 weeks; however, in large dialysis units, observing a delay of 4 to 6 weeks may be worthwhile to avoid initial problems such as infiltrations and lacerations. Access flow monitoring is essential since it is a reliable predictor of vascular access dysfunction, reducing associated morbidity and costs. Early monitoring of recently created native AVFs has shown that the increase in intra-access blood flow occurs very soon after construction and becomes maximal after a few weeks. A recent prospective study involving all new native AVFs monitored by ultrasound-dilution between weeks 6 and 10 after creation, and every 3 to 6 weeks over 4 months, showed no statistically significant difference in access blood flow between the initial and final measurements (respective values of 1132 ± 681 and 1097 ± 644 ml/min). Access flow was higher in males, and in brachio-cephalic compared to radio-cephalic AVFs. Over the long-term, AVFs are associated with longer patency and lower complication rates, and efforts should be directed at further increasing their prevalence.

scholarly journals Outcomes of Primary Repair and Anastomosis for Traumatic Colonic Injuries in a Tertiary Trauma Center

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 440
Author(s):  
Marie Shella De Robles ◽  
Christopher J. Young
Keyword(s):  
Surgical Management ◽  
Trauma Center ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
Injury Mechanism ◽  
Complication Rates ◽  
Colonic Injury ◽  
Significant Difference ◽  
Injured Part ◽  
Resection And Anastomosis

Background: Surgical management for traumatic colonic injuries has undergone major changes in the past decades. Despite the increasing confidence in primary repair for both penetrating colonic injury (PCI) and blunt colonic injury (BCI), there are authors still advocating for a colostomy particularly for BCI. This study aims to describe the surgical management of colonic injuries in a level 1 metropolitan trauma center and compare patient outcomes between PCI and BCI. Methods: Twenty-one patients who underwent trauma laparotomy for traumatic colonic injuries between January 2011 and December 2018 were retrospectively reviewed. Results: BCI accounted for 67% and PCI for 33% of traumatic colonic injuries. The transverse colon was the most commonly injured part of the colon (43%), followed by the sigmoid colon (33%). Primary repair (52%) followed by resection-anastomosis (38%) remain the most common procedures performed regardless of the injury mechanism. Only two (10%) patients required a colostomy. There was no significant difference comparing patients who underwent primary repair, resection-anastomosis and colostomy formation in terms of complication rates (55% vs. 50% vs. 50%, p = 0.979) and length of hospital stay (21 vs. 21 vs. 19 days, p = 0.991). Conclusions: Regardless of the injury mechanism, either primary repair or resection and anastomosis is a safe method in the management of the majority of traumatic colonic injuries.

Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries

2009 ◽  
Vol 66 (5) ◽  
pp. 1286-1293 ◽  
Author(s):  
Amy Vertrees ◽  
Matthew Wakefield ◽  
Chris Pickett ◽  
Lauren Greer ◽  
Abralena Wilson ◽  
...  
Keyword(s):  
Primary Repair ◽  
Primary Anastomosis ◽  
Colon Injuries

Bone grafting in foot and ankle surgery. A review of 300 cases

1998 ◽  
Vol 88 (3) ◽  
pp. 109-118 ◽  
Author(s):  
KT Mahan ◽  
HJ Hillstrom
Keyword(s):  
Complication Rates ◽  
Allogeneic Bone ◽  
Graft Material ◽  
Foot And Ankle ◽  
First Metatarsal ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Bone Complications

Three hundred foot and ankle bone grafts were reviewed in three separate series of 100 consecutive grafts from two institutions. The series represent a period from 1977 to 1990 and demonstrate treatment patterns that varied over time and between institutions in indications, graft material, and perioperative management. Over 42% of the 300 grafts were for calcaneal osteotomies; most were Evans calcaneal osteotomies. Over 72% of the grafts were allogeneic bone-bank bone, which performed well in calcaneal osteotomies and for packing of defects. Upon review of the incidence of bone complications, no significant differences were observed between surgical procedures that used autogenous versus allogeneic grafts. However, four out of six failures of first metatarsal repair were with allogeneic bone. There was a significant difference in complication rates for the major indications for bone-graft surgery. Nonunions and arthrodeses resulted in higher complication rates than expected, whereas calcaneal osteotomies resulted in a lower complication rate than expected.

scholarly journals DrillCutTM vs. VersaCutTM prostate tissue morcellation devices after holmium laser enucleation: A prospective, randomized controlled trial

2018 ◽  
Vol 13 (8) ◽  
Author(s):  
Ahmed Ibrahim ◽  
Mostafa M. Elhilali ◽  
Mohammed A. Elkoushy ◽  
Sero Andonian ◽  
Serge Carrier
Keyword(s):  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Holmium Laser ◽  
Complication Rates ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Significant Difference ◽  
Ethical Approval ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Introduction: We aimed to compare efficacy, safety, and cost of disposables of the DrillCutTM morcellator with the VersaCutTM morcellator after holmium laser enucleation of the prostate (HoLEP).Methods: After obtaining ethical approval, consecutive patients undergoing HoLEP for symptomatic benign prostatic hyperplasia were randomized to have their enucleated prostates morcellated by either Karl Storz® DrillCutTM or Lumenis® VersaCutTM morcellators. All procedures were performed by two experienced urologists. Patients’ demographics and perioperative data were recorded. Both morcellators were compared for their safety, efficacy, and cost-effectiveness.Results: Eighty-two patients were included in the study (41 per each arm). Both groups were comparable in terms of age, preoperative prostate size (114 vs. 112 mL; p>0.05), enucleation time (95.3 vs. 91.7 minutes; p>0.05), and morcellation time (22.6 vs. 17.3 minutes; p>0.05). The DrillCutTM was associated with significantly lower morcellation rate when compared with the VersaCutTM(3.6 vs. 4.9 g/min; p= 0.03). In terms of safety, there was no significant difference between both morcellators in complication rates (2.4% vs. 7.3 %; p=0.1). However, there was one case of bladder perforation requiring exploration with the VersaCutTM. The DrillCutTM was associated with significantly higher cost of disposables when compared with the VersaCutTM ($247.5 vs. $160.9; p<0.01).Conclusions: Despite the small sample size, the DrillCutTM was associated with lower morcellation rate when compared with the VersaCutTM. However, this difference may not be clinically significant. Although both morcellators were comparable in their safety, the DrillCutTM was associated with higher cost of disposables when compared with the VersaCutTM.

scholarly journals Comparison of penile prosthesis types' complications: A retrospective analysis of single center

2020 ◽  
Vol 92 (4) ◽  
Author(s):  
Erdem Kisa ◽  
Mehmet Zeynel Keskin ◽  
Cem Yucel ◽  
Murat Ucar ◽  
Okan Yalbuzdag ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Penile Prosthesis ◽  
Diabetes Type 2 ◽  
Pelvic Surgery ◽  
Complication Rates ◽  
Initial Surgery ◽  
Significant Difference ◽  
Lower Complication ◽  
Group 2 ◽  
Group 1

Objectives: The aim of this study was to compare clinical outcomes and complication rates associated with semirigid (malleable) and inflatable penile prostheses (PPs) and investigate the factors that influence these complications. Material and methods: The records of 131 patients who had undergone penile prosthesis implantation (PPI) in our clinic due to erectile dysfunction (ED) between January 2010 and March 2019 were retrospectively reviewed. The initial surgery included 116 primary implants and 15 men had two revision operations. Patients were assigned to two groups as semirigid (malleable) PPI (group 1) and inflatable PPI (group 2) patients, and obtained data were compared across these two groups. Results: Group 1 included 93 patients, while Group 2 included 38 patients. Postoperative complication rates of Group 1 were 8.6% (n = 8), and Group 2 were 21% (n = 8), and the comparison of postoperative complication rates revealed a statistically significant difference between the two groups (p = 0.025). The majority of these complications (50%) was constituted by mechanical failure associated with inflatable PPs. When patients were further segregated as those with and without diabetes type 2 (DM) and those who had and had not undergone radical pelvic surgery (RPS), the comparison of complication rates across these subgroups did not yield any significant difference. Conclusions: We determined in this study that semirigid (malleable) PPs were associated with lower complication rates compared to the inflatable group, particularly with regard to mechanic failure, and that DM and history of RPS did not make a difference in complication rates in patients planned to undergo PPI.

scholarly journals Favourable outcomes of coccygectomy for refractory coccygodynia

2014 ◽  
Vol 96 (2) ◽  
pp. 136-139 ◽  
Author(s):  
B Haddad ◽  
V Prasad ◽  
W Khan ◽  
M Alam ◽  
S Tucker
Keyword(s):  
Pain Relief ◽  
Wound Complication ◽  
Daily Activities ◽  
Rank Test ◽  
Complication Rates ◽  
Significant Difference ◽  
Lower Complication ◽  
Signed Rank Test ◽  
Poor Outcomes

Introduction Coccygodynia is a condition associated with severe discomfort in the region of the coccyx. While traditional procedures had poor outcomes and high complication rates, recent literature suggests better outcomes and lower complication rates with coccygectomy. Methods Data were collected retrospectively from clinical notes. A questionnaire was used to evaluate the outcomes. The outcome measures included pain analogue score (PAS) in sitting and during daily activities as well as patients’ overall pain relief. Overall improvement in pain and complications were documented. Results Between 2000 and 2010, 14 patients underwent total coccygectomy for refractory coccygodynia. All patients were available for follow-up appointments and the follow-up duration ranged from 24 to 132 months (mean: 80 months). The aetiology was traumatic in eight patients and non-traumatic in six. The PAS improved from a median of 9 to 4 for sitting and from 7.5 to 2.5 for daily activities. One patient had mild discharge for more than two weeks. No patients required further surgery. Twelve patients (85.7%) had excellent or good pain relief. Only one patient was unsatisfied. A Wilcoxon signed-rank test revealed significant improvement in pain when sitting (p<0.05) and during activities of daily living (p<0.05) at the final follow-up visit. A Mann–Whitney U test did not show a significant difference in improvement in PAS between the traumatic and non-traumatic groups (p=0.282 and 0.755). Conclusions In our series, total coccygectomy offered satisfactory relief of pain in the majority of patients with a low wound complication rate.

Article Commentary: Evolving Colon Injury Management: A Review

2013 ◽  
Vol 79 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Cpt Lauren T. Greer ◽  
Maj Suzanne M. Gillern ◽  
Maj Amy E. Vertrees
Keyword(s):  
Wide Spectrum ◽  
Primary Repair ◽  
Damage Control ◽  
Primary Anastomosis ◽  
Penetrating Trauma ◽  
Management Options ◽  
The Past ◽  
Non Destructive ◽  
Historical Management ◽  
Colon Injuries

The colon is the second most commonly injured intra-abdominal organ in penetrating trauma. Management of traumatic colon injuries has evolved significantly over the past 200 years. Traumatic colon injuries can have a wide spectrum of severity, presentation, and management options. There is strong evidence that most non-destructive colon injuries can be successfully managed with primary repair or primary anastomosis. The management of destructive colon injuries remains controversial with most favoring resection with primary anastomosis and others favor colonic diversion in specific circumstances. The historical management of traumatic colon injuries, common mechanisms of injury, demographics, presentation, assessment, diagnosis, management, and complications of traumatic colon injuries both in civilian and military practice are reviewed. The damage control revolution has added another layer of complexity to management with continued controversy.

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