Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective. Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children. Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively. Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.

Comparison of Clinical Results Between a 4-point Scleral Fixation of Intraocular Lenses Using Gore-tex Suture and a 2-point Fixation Using Prolene Suture

Purpose: To compare clinical outcomes between a 4-point scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture or a 2-point scleral fixation using Prolene sutureMethods: In this multicenter, retrospective cohort study, patients were enrolled who had undergone a pars plana vitrectomy and either a 4-point scleral fixation using Gore-Tex suture or a 2-point scleral fixation using Prolene suture. Preoperative biometrics, postoperative refractive outcomes, and postoperative surgical complication rates were evaluated.Results: Thirty-seven eyes underwent scleral fixation with Gore-Tex suture, while 44 eyes underwent scleral fixation with Prolene suture. Postoperative best corrected visual acuity was 0.20 (± 0.34) in the Gore-Tex group and 0.21 (± 0.28) in the Prolene group (logMAR, 20/32 on the Snellen scale) (p = 0.691). No significant difference was found in the average prediction error between the Gore-Tex (-0.13 ± 0.68 D) and Prolene (-0.21 ± 1.27 D) groups (p = 0.077). The postoperative complication rate was lower in the Gore-Tex group (17%) than in the Prolene group (41%) (p = 0.023).Conclusion: A 4-point scleral fixation using Gore-Tex suture may be a good alternative to a conventional scleral fixation using Prolene suture for IOL implantations in eyes without capsular support, with a lower risk of postoperative complications.

The Exoscope in Neurosurgery: An Overview of the Current Literature of Intraoperative Use in Brain and Spine Surgery

Background: Exoscopes are a safe and effective alternative or adjunct to the existing binocular surgical microscope for brain tumor, skull base surgery, aneurysm clipping and both cervical and lumbar complex spine surgery that probably will open a new era in the field of new tools and techniques in neurosurgery. Methods: A Pubmed and Ovid EMBASE search was performed to identify papers that include surgical experiences with the exoscope in neurosurgery. PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) were followed. Results: A total of 86 articles and 1711 cases were included and analyzed in this review. Among 86 papers included in this review 74 (86%) were published in the last 5 years. Out of 1711 surgical procedures, 1534 (89.6%) were performed in the operative room, whereas 177 (10.9%) were performed in the laboratory on cadavers. In more detail, 1251 (72.7%) were reported as brain surgeries, whereas 274 (16%) and 9 (0.5%) were reported as spine and peripheral nerve surgeries, respectively. Considering only the clinical series (40 studies and 1328 patients), the overall surgical complication rate was 2.6% during the use of the exoscope. These patients experienced complication profiles similar to those that underwent the same treatments with the OM. The overall switch incidence rate from exoscope to OM during surgery was 5.8%. Conclusions: The exoscope seems to be a safe alternative compared to an operative microscope for the most common brain and spinal procedures, with several advantages that have been reached, such as an easier simplicity of use and a better 3D vision and magnification of the surgical field. Moreover, it offers the opportunity of better interaction with other members of the surgical staff. All these points set the first step for subsequent and short-term changes in the field of neurosurgery and offer new educational possibilities for young neurosurgery and medical students.

Outcomes Associated With Osteochondral Allograft Transplantation in Dogs

The purpose of this study was to retrospectively characterize outcomes and complications associated with osteochondral allograft transplantation for treating chondral and osteochondral lesions in a group of client-owned dogs with naturally-occurring disease. Records were reviewed for information on signalment, treated joint, underlying pathology (e.g., osteochondritis dissecans; OCD), and type, size, and number of grafts used. Complications were classified as “trivial” if no treatment was provided, “non-surgical” if non-surgical treatment were needed, “minor surgical” if a minor surgical procedure such as pin removal were needed but the graft survived and function was acceptable, or “major” if the graft failed and revision surgery were needed. Outcomes were classified as unacceptable, acceptable, or full function. Thirty-five joints in 33 dogs were treated including nine stifles with lateral femoral condyle (LFC) OCD and 10 stifles with medial femoral condyle (MFC) OCD treated with osteochondral cylinders or “plugs.” There were 16 “complex” procedures of the shoulder, elbow, hip, stifle, and tarsus using custom-cut grafts. In total there were eight trivial complications, one non-surgical complication, two minor surgical complications, and five major complications for a total of 16/35 cases with complications. Accordingly, there were five cases with unacceptable outcomes, all of whom had major complications while the other 30 cases had successful outcomes. Of the 30 cases with successful outcomes, 15 had full function and 15 had acceptable function. Based on these subjective outcome assessments, it appears osteochondral allograft transplantation is a viable treatment option in dogs with focal or complex cartilage defects. However, no conclusions can be made regarding the inferiority or superiority of allograft transplantation in comparison to other treatment options based upon these data.

Diagnosis and Management of Surgical Site Infections: Narrative Review

Infection of the wound after surgery is a regular occurrence. Wound infection is a complicated process that involves a molecular interplay between numerous biological processes. Wound infections are associated with a high rate of morbidity and mortality. Surgical site infections are a common surgical complication that affects approximately 3%-6% of all surgical procedures according to different studies. Surgical site infections (SSIs) cause negative consequences in patients, such as prolonged hospitalization and mortality. Each incision causes wound contamination, however there are established techniques to reduce the incidence of SSI. Improved adherence to evidence-based preventative strategies such as adequate antibiotic prophylaxis, in particular, can help to reduce the rate of SSI. The sort of procedure used determines the correct diagnosis of SSI. Early detection, on the other hand, is critical for good management of all surgical operations. Consistent antibiotic therapy, wound drainage, and, if necessary, vigorous wound debridement are all part of the treatment for SSI. Following that, wound management is determined by the location and nature of the infection. This study aims to: Diagnosis and Management of Surgical Site Infections. In this review we will be looking at surgical site infections epidemiology, etiology, diagnosis and management.

Vertebrobasilar dissecting aneurysms: microsurgical management in 42 patients

OBJECTIVE Vertebrobasilar dissecting (VBD) aneurysms are rare, and patients with these aneurysms often present with thromboembolic infarcts or subarachnoid hemorrhage (SAH). The morphological nature of VBD aneurysms often precludes conventional clip reconstruction or coil placement and encourages parent artery exclusion or endovascular stenting. Treatment considerations include aneurysm location along the vertebral artery (VA), the involvement of the posterior inferior cerebellar artery (PICA), and collateral blood flow. Outcomes after endovascular treatment have been well described in the neurosurgical literature, but microsurgical outcomes have not been detailed. Patient outcomes from a large, single-surgeon, consecutive series of microsurgically managed VBD aneurysms are presented, and 3 illustrative case examples are provided. METHODS The medical records of patients with dissecting aneurysms affecting the intracranial VA (V4), basilar artery, and PICA that were treated microsurgically over a 19-year period were reviewed. Patient demographics, aneurysm characteristics, surgical procedures, and clinical outcomes (according to modified Rankin Scale [mRS] scores at last follow-up) were analyzed. RESULTS Forty-two patients with 42 VBD aneurysms were identified. Twenty-six aneurysms (62%) involved the PICA, 14 (33%) were distinct from the PICA origin on the V4 segment of the VA, and 2 (5%) were located at the vertebrobasilar junction. Thirty-four patients (81%) presented with SAH with a mean Hunt and Hess grade of 3.2 at presentation. Six (14%) of the 42 patients had been previously treated using endovascular techniques. Nineteen aneurysms (45%) underwent clip wrapping, 17 (40%) were treated with bypass trapping, and 6 (14%) underwent parent artery sacrifice. The complete aneurysm obliteration rate was 95% (n = 40), and the surgical complication rate was 7% (n = 3). The 8 patients with unruptured VBD aneurysms were significantly more likely to be discharged home (n = 6, 75%) compared with 34 patients with ruptured aneurysms (n = 9, 27%; p = 0.01). Good outcomes (mRS score ≤ 2) were observed in 20 patients (48%). Eight patients (19%) died. CONCLUSIONS These data demonstrate that patients with VBD aneurysms often present after a rupture in poor neurological condition, but favorable results can be achieved with open microsurgical repair in almost half of such cases. Microsurgery remains a viable treatment option, with the choice between bypass trapping and clip wrapping largely dictated by the specific location of the aneurysm and its relationship to the PICA.

Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

Jejuno-colonic anastomosis to restore intestinal continuity in a case of intestinal failure due to type I short bowel syndrome

Short bowel syndrome is a rare surgical complication associated with high morbidity and mortality, significant decrease in quality of life and increasing costs to the healthcare system. In some cases, this condition can be mitigated and even reversed if the intestinal transit is restored with a minimum of 75-100 centimeters of small intestine and a segment of the colon. Some of the surgical techniques available within autologous gastrointestinal reconstruction are Serial transverse enteroplasty (STEP), Longitudinal intestinal lengthening (LILT), and as a last resort, intestinal transplantation. We presented a case of intestinal failure due to type I short bowel syndrome who improved in clinical stage from D4 to D2 after intestinal continuity restitution was performed with a jejuno-colonic anastomosis.