There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

Titanium Cage in Comparison with Nano-Hydroxyapatite Bone Graft Substitutes in Cervical Reconstruction

Cervical spondylosis is a disease that occurs with age and affects the discs and joints in the cervical spine located in the neck. The hydroxyapatite (HA) bone graft substitutes can used as a potential bone-forming agent, however, the efficacy of using HA is challenging in cervical reconstruction. In this regard, nano-based HA was used in this study to explore its sagittal parameters and clinical potency in relative to titanium (TiO2) cage in patient with cervical spondylosis. 50 patients suffering from cervical spondylosis were divided in two groups and were grafted with either TiO2 cage or nano-HA. The sagittal parameters, including cervical spine lateral radiographs (C0−2Coob and C2−7Coob) were taken pre- and post-operation (3-month, one-year and two-year). The clinical potency was also done based on the JOA scores. Angle analysis indicated that the C0−2Cobb and C2−7Cobb angles were significantly changed after the operation in both TiO2 cage and nano-HA groups, whereas no significant changes was determined in nano-HA relative to TiO2 cage condition. Also, it was shown that JOA scores were significantly higher after the operation than pre-operation, indicating a potential cervical reconstruction after surgery in both groups which slightly were higher for nano-HA groups.

The differential effect of cervical kyphosis correction surgery on global sagittal alignment and health-related quality of life according to head- and trunk-balanced subtype

OBJECTIVE No reports have investigated how cervical reconstructive surgery affects global sagittal alignment (GSA), including the lower extremities, and health-related quality of life (HRQOL). The study was aimed at elucidating the effects of cervical reconstruction on GSA and HRQOL. METHODS Twenty-three patients who underwent reconstructive surgery for cervical kyphosis were divided into a head-balanced group (n = 13) and a trunk-balanced group (n = 10) according to the values of the C7 plumb line, T1 slope (T1S), and pelvic incidence minus lumbar lordosis (PI-LL). Head-balanced patients are those with a negative C7 sagittal vertical axis (SVA), a larger LL than PI, and a low T1S. Trunk-balanced patients are those with a positive SVAC7, a normal PI-LL, and a normal to high T1S. Various sagittal Cobb angles, SVA, and lower-extremity alignment parameters were measured before and after surgery using whole-body stereoradiography. RESULTS Cervical malalignment was corrected to achieve cervical sagittal balance and occiput-trunk (OT) concordance (center of gravity [COG]–C7 SVA < 30 mm). Significant changes in the upper cervical spine and thoracolumbar spine were observed in the head-balanced group, but no significant change in lumbopelvic alignment was observed in the trunk-balanced group. Lower-extremity alignment did not change substantially in either group. HRQOL scores improved significantly after surgery in both groups. SVACOG–C7 and SVAC2–7 were negatively and positively correlated with the 36-Item Short-Form Health Survey physical component score and Neck Disability Index, respectively. The visual analog scale for back pain, Oswestry Disability Index, and PI-LL mismatch improved significantly in the head-balanced group after cervical reconstruction surgery. CONCLUSIONS Patients with cervical kyphosis exhibited compensatory changes in the upper cervical spine and thoracolumbar spine, instead of in the lower extremities. These compensatory mechanisms resolved reciprocally in a different fashion in the head- and trunk-balanced groups. HRQOL scores improved significantly with GSA restoration and OT concordance following cervical reconstruction.

The importance of preoperative T1 slope for determining proper postoperative C2–7 Cobb’s angle in patients undergoing cervical reconstruction

Background This study aimed to explore the relationship among different cervical sagittal parameters in asymptomatic volunteers and the correlation between surgical efficacy and difference of presumed and actual postoperative C2–7 Cobbs’s angle (C2–7COBB), which was calculated based on preoperative T1 slope (T1S) in patients undergoing cervical reconstruction. Methods In total, 158 inpatients with cervical spondylosis and 274 asymptomatic volunteers were retrospectively reviewed. Cervical sagittal parameters, such as C2–7COBB, T1S, thoracic inlet angle (TIA), and neck tilt (NT), were compared. Then, the correlation among these parameters was analyzed in asymptomatic volunteers, and a regression equation between T1S and C2–7COBB was established and used to analyze the correlation among the Japanese Orthopaedic Association (JOA) score improvement, the sagittal parameters, and the difference between presumed and actual postoperative C2–7COBB in patients after cervical reconstruction. Results The mean T1S, C2–7COBB, and TIA were significantly decreased in patients (P < 0.01). T1S and NT had a strong correlation with TIA (P < 0.01). T1S demonstrated a moderate correlation with C2–7COBB in asymptomatic volunteers (r = 0.569, P < 0.01). A regression equation had been established as C2–7COBB = 0.742 × T1S − 0.866. The mean C2–7COBB and JOA score improved significantly (P < 0.05) postoperatively. Moreover, the JOA improvement rate showed a significant negative correlation with the difference in the presumed and actual postoperative C2–7COBB (r = − 0.696, P < 0.01). Conclusion Our study successfully established a regression equation for calculating postsurgical C2–7COBB based on the correlation between T1S and C2–7COBB in asymptomatic volunteers. The regression equation could be used for guiding surgeons to accomplish an ideal postsurgical C2–7COBB for patients with cervical spondylosis.

Kehamilan Pasca Tindakan Manchester Fothergill

Pregnancy after a manchester fothergill action is rare, occurring 1-10,000 post-action. post- manchester fothergill pregnancy can cause premature labor, spontaneous abortion, fetal death, maternal urinary complaints, and sepsis. Case of a 34-year-old female patient, G3P1A1L1 37-38 weeks of term parturient latent phase of first stage + once previous cesarean section + history of manchester fothergill. Previous history of childbirth the patient gave birth through cesarean section and term, the birth weight of children 3200 gr. The second pregnancy the patient suffered a miscarriage at 13-14 weeks gestation and found cervical elongation, then the patient was performed cervical reconstruction with the manchester fothergill procedure after the patient received his normal menstrual cycle. after 2 years later the patient came pregnant with a gestational age of 9 months with complaints of low back pain in the placenta. The conclusion of this case of pregnancy after the manchester fothergill action is a rare condition. pelvic organ prolapse and cervical elongation in pregnancy are conditions to be aware of, therefore early diagnosis is very important for smooth pregnancy. individual approach depends on gestational age, the severity of the prolapse is a matter that must be considered for the choice of delivery. prevention of complications can determine the success of a pregnancy. it must also be concluded that prolapse is not a disease of the elderly. Keywords: cervical elongation, Manchester Fothergill