surgical experience
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2022 ◽  
Vol 10 (3) ◽  
pp. 811-819
Wen-Xiang Li ◽  
Han-Xing Tong ◽  
Chen-Tao Lv ◽  
Hua Yang ◽  
Gang Zhao ◽  

2022 ◽  
Vol 25 (1) ◽  
pp. E008-E019
Alfredo Rego ◽  
W. Douglas Boyd ◽  
Enrique Gongora ◽  
William E. Johnson, III ◽  
Nabil A. Munfakh ◽  

Background: As of 2019, pericardial closure was performed in only a small portion of the over 320,000 cardiac surgeries performed annually. However, evidence regarding the benefits of pericardial closure or reconstruction has been accruing, particularly with the publication of the RECON study in 2019.  Methods: This group of authors convened to try to arrive at consensus expert opinion regarding pericardial reconstruction. Structured topic questions initially were used to stimulate discussion. Subsequently, a survey of proposed expert opinion statements was conducted among the authors. Based on that survey, consensus expert opinion statements and recommendations were compiled. Results: The expert opinions encompass various topics relating to pericardial reconstruction, including definitions, benefits/risks, and technique. Observed benefits include reductions in: (1) adhesions; (2) postoperative pericardial effusion, atrial fibrillation, and bleeding; and (3) readmissions and length of hospital stay. Expert opinion recommendations regarding surgical technique are compiled into a single chart. Complete pericardial reconstruction should be performed, using native pericardial tissue if available and viable; if not feasible, a patch may be used. Patches that stimulate the formation of site-specific tissue in situ (such as natural extracellular matrix) may have additional benefits (including bioregenerative properties and lack of inflammatory response). Closure should be taut, but tension-free. Adequate drainage of the closed pericardium must be ensured. Conclusions: Based on available data and collective surgical experience, we endorse pericardial reconstruction as standard approach in appropriately selected patients. We also endorse adoption of standardized pericardial reconstruction techniques to optimize patient outcomes and improve evidence quality in future studies.

2022 ◽  
Vol 22 (1) ◽  
Hyo-jeong Kim ◽  
Se-Hoon Kim ◽  
Hoi-seon Jeong ◽  
Bum-Joon Kim

Abstract Background Intramedullary parasitic infection is extremely uncommon, and clinical presentation of Brown-Sequard syndrome is even rarer. Case presentation The authors report a case involving a 57-year-old woman with Brown-Sequard syndrome, in whom magnetic resonance imaging and clinical and epidemiological features were similar to those of acute transverse myelitis. Myelotomy suggested inflammation caused by latent parasite eggs in the spinal cord. Antiparasitic and steroid therapies were administered postoperatively. To the author’s knowledge, this is the first report to describe a surgical experience for Taenia solium eggs in the spinal cord. Conclusion Intramedullary parasitic infection is a diagnostic challenge that requires careful discrimination from other diseases. If parasite infection is suspected in a progressively deteriorating patient, myelotomy should be considered for rapid and accurate treatment.

2021 ◽  
Vol 30 (04) ◽  
pp. 275-278
Humayun Kaleem Siddiqui ◽  
Jawad Safdar ◽  
Kanza Ghauri

The novel-coronavirus (2019-nCOV) emerged in Wuhan City in December 2019, this resulted in a quick and catastrophic health problem all over the world but our country is slightly less affected by the pandemic. There could be a number of reasons for less numbers of Covid positive cases and lack of awareness and reduced Covid testing capacity and hence less mortality in Pakistan. In order to provide assistance to an ever increasing number of infected patients and, at the same time taking care of urgent maxillofacial conditions. This manuscript gives the reader in a nutshell the overall surgical experience of oral and maxillofacial practice at Aga Khan University Hospital, Karachi, Pakistan in the COVID-19 pandemic and would like to provide a number of recommendations that would assist the scheduling process of surgical management during the COVID-19 pandemic and reduce the risk of infection among healthcare workers and others involved with the service. KEYWORDS: Maxillofacial surgery; Coronavirus; COVID-19; Pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Ffion Dewi ◽  
Darren Scroggie ◽  
Samir Pathak ◽  
Natalie Blencowe ◽  
Andrew Hollowood ◽  

Abstract Background A new outcomes-based curriculum is soon to be implemented for UK surgical trainees. Performance will be evaluated against the standard expected of a new consultant. Accurate recording of operative experience and performance will therefore be crucial to demonstrate achievement of this standard. The current eLogbook system for recording surgical experience has many benefits including simplicity and accessibility, but may misrepresent actual experience because most operations are considered as a whole; unlike some colorectal operations, involvement in steps within many upper gastrointestinal (UGI) operations cannot be recorded. Methods Impact on training by the COVID-19 pandemic led to discussion and identification of cultural and logistical barriers to accurate recording of experience. To address these, a modification to enhance the current eLogbook system was developed by trainees and trainers at a university teaching hospital. An existing typology was used to deconstruct common UGI operations into their component steps, which can be recorded at this more detailed level.  Results The modified deconstructed logbook concept is described using a worked example, which can be applied to any operation. We also describe the integration of a component-based training discussion into the surgical team brief and debrief; this complements the deconstructed logbook by promoting a training culture. Conclusions Using the described techniques, trainees of all levels can comprehensively and accurately describe their surgical experience. Senior trainees will benefit from recording complex operations which they are not expected to complete in their entirety, whilst less experienced trainees will benefit from the ability to record their involvement in more basic parts of operations. The suggested approach will reduce misrepresentation of experience, encourage proactive planning of training opportunities, and reduce the impact of crises such as pandemics on surgical training.

2021 ◽  
Vol 23 (Supplement_G) ◽  
Luca Restivo ◽  
Antonio De Luca ◽  
Matteo Castrichini ◽  
Alessandro Pierri ◽  
Elisabetta Rauber ◽  

Abstract Aims Cardiac tumors are rare and heterogeneous entities which still remain a diagnostic and therapeutic challenge. The treatment for most cardiac tumors is prompt surgical resection. We sought to provide an overview of surgical results from a series of consecutive patients treated at our tertiary centre during almost a 20-year experience. Methods and results In this single centre study, 55 consecutive patients with cardiac tumor underwent surgical treatment from January 2002 to April 2021. Of these, 42% of patients were male and the mean age was 62 ± 12 years. Almost 27% of patients were symptomatic at the time of the diagnosis, mostly for dyspnoea and palpitations. The most frequent benign cardiac tumor was myxoma (58% of cases), occurring mainly in the left atrium (97%). Pleomorphic sarcoma was the most frequent primary malignant cardiac tumour (7.2% of cases), mainly located in the ventricles (25% left ventricle; 50% right ventricle). In all cases of benign tumors surgery was successful with no relapses. In 50% of cases of pleomorphic sarcoma relapses were observed during follow-up. After a median follow-up of 44 months, 15 (27%) patients died. While malignant tumors presented a limited survival, benign tumours showed a very good prognosis. Conclusions Cardiac tumours require a multidisciplinary work-up to guarantee a prompt diagnosis and appropriate treatment. In our surgical experience, the prognosis of benign tumours was excellent, while malignant tumours had poor outcomes despite radical surgery.

2021 ◽  
pp. 000313482110385
John O. Hwabejire ◽  
Haytham M. A. Kaafarani ◽  
Hassan Mashbari ◽  
Joseph Misdraji ◽  
Peter J. Fagenholz ◽  

Background COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution’s surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period. Methods All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed. Results Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation. Conclusion Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.

2021 ◽  
pp. 000313482110488
Preston W. Leader ◽  
Douglas R Oyler ◽  
Tonya M Carter ◽  
Donna S. Damron ◽  
Cortney Y. Lee ◽  

Background The aim of this study was to evaluate pain control and patient satisfaction using an opioid-free analgesic regimen following thyroid and parathyroid operations. Methods Surveys were distributed to all postoperative patients following total thyroidectomy, thyroid lobectomy, and parathyroidectomy between January and April 2020. After surgery, patients were discharged without opioids except in rare cases based on patient needs and surgeon judgment. We measured patient-reported Numeric Rating Scale (NRS) pain scores and satisfaction categorically as either satisfied or dissatisfied. Results We received 90 of 198 surveys distributed, for a 45.5% response rate. After excluding neck dissections (n = 6) and preoperative opioid use (n = 4), the final cohort included 80 patients after total thyroidectomy (26.3%), thyroid lobectomy (41.3%), and parathyroidectomy (32.5%).The majority reported satisfaction with pain control (87.5%) and the entire surgical experience (95%). A similar proportion of patients reported satisfaction with pain control after total thyroidectomy (90.9%), thyroid lobectomy (90.5%), and parathyroidectomy (80.8%), indicating the procedure did not significantly impact satisfaction with pain control ( P = .47). Patients who reported dissatisfaction with pain control were more likely to receive opioid prescriptions (30% vs 2.9%, P < .01), but the majority still reported satisfaction with their entire operative experience (70%). Discussion Even with an opioid-free postoperative pain regimen, most patients report satisfaction with pain control after thyroid and parathyroid operations, and those who were dissatisfied with their pain control generally reported satisfaction with their overall surgical experience. Therefore, an opioid-free postoperative pain control regimen is well tolerated and unlikely to decrease overall patient satisfaction.

2021 ◽  
Vol 233 (5) ◽  
pp. S211
Nicholas J. Iglesias ◽  
Taylor P. Williams ◽  
Claire B. Cummins ◽  
Shana S. Kalaria ◽  
Alexander Perez ◽  

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