Naples Prognostic Score to Predict Postoperative Complications After Colectomy for Diverticulitis

Background The Naples Prognostic Score (NPS) has proven efficacy as a prognostic tool for postoperative outcomes in patients undergoing surgery for neoplastic diseases. However, the role of the NPS score in inflammatory surgical diseases has not yet been studied. We aimed to evaluate NPS predictive value in patients undergoing colectomy due to diverticulitis. Methods A single-center retrospective study including all patients who underwent colectomy for diverticulitis between July 2008 and March 2020 was established. Patients' demographics, clinical and surgical data were recorded and analyzed. Patients were scored on a scale of 0-4 and received one point for preoperation albumin <4 g/dL, cholesterol ≤180 mg/dL, Neutrophil to Lymphocyte Ratio >2.96, and Lymphocyte to Monocyte ≤4.44. Results Out of 3292 patients admitted because of diverticulitis during the study period, 159 patients (4.83%) underwent colectomy. Of those patients, fifty patients were eligible for NPS analysis. 35 patients (70%) were females with a mean age of 62.81 ± 14.51. Thirty-two (64%) patients underwent an elective operation. The postoperative complications rate was 36% (N = 18). The mortality rate was 6% (N = 3). ROC showed a strong association between the NPS and mortality (area = .88, P = .03) and wound infection (area = .78, P = .01). In patients who underwent urgent surgery, there was an association between NPS and re-operation ( P = .04). There was a correlation between NPS and Clavien-Dindo score (Spearman’s coefficient = .284, P = .045). Conclusions/Discussion The Naples prognostic score is an effective tool for predicting postoperative complications in patients undergoing colectomy for diverticulitis. It may assist the surgeon in deciding on extent of the operation for diverticulitis and in elective cases also on timing.

Comparative analysis of an innovative app versus conventional techniques to improve patient compliance after minor oral surgical procedures (Preprint)

BACKGROUND Certain factors such as compliance, comprehension, retention of instructions, and other unaccounted elements impact the objectives of post-operative care. It is imperative that patients follow the instructions and prescribed regimen diligently for a smooth and placid healing. Keeping the same principles in view, ExoDont was designed by our team, an android-based mHealth app which ensures a smooth post-operative period for the patients after a dental extraction. Besides providing post-operative instructions at defined intervals, the app also sends out drug reminders as an added advantage over other available conventional modes. OBJECTIVE To compare the compliance rate of individuals with respect to the prescribed regimen, postoperative instructions, and additionally, assess any significant changes in post-operative complications rate under the three categories namely Verbal, Verbal plus Written, and ExoDont group. METHODS The patients after tooth extraction were randomly assigned to the aforementioned groups and a one week follow-up through a phone call was planned to obtain the responses from study participants. The result obtained from the three groups was then statistically analyzed. RESULTS The compliance rate in patients for post-operative instructions and prescribed drug adherence was statistically significant in the group using ExoDont app than in Verbal or Verbal plus Written group. However, the difference in the incidence of postoperative complication rate was not significant among the three groups. CONCLUSIONS As evident from the result, it is anticipated that the ExoDont app will be revolutionary in not only circumventing the unaccounted possibilities of missing the prescribed dose and post-operative instructions but also ensure a smooth post-operative phase and easy recovery for the patients.

Laparoscopic right colectomy with intracorporeal ileotransverse anastomosis (results of the pilot study)

AIM: to evaluate the safety of intra- and extracorporeal ileotransverse anastomosis in laparoscopic right hemicolectomy.PATIENTS AND METHODS: a pilot «case-control» study included two groups of patients, who underwent laparoscopic right colectomy according to a standardized technique. An intracorporeal anastomosis (IA) was formed in the main group (n = 20), in the control group — extracorporeal anastomosis (EA) (n = 18).RESULTS: in main group the postoperative complications rate was 20%, in the control group — 28% (p = 0.71). The postoperative hospital stay in the main group was significantly less than in control (5.0 vs 7.3 days) (p < 0.001).CONCLUSION: the postoperative complications rate in both groups was not significant, but postoperative hospital stay was shorter in IA group. A randomized controlled trial is required.

En-Bloc Transplantation of Dual Adult Kidneys with Multiple Vessels

Background. To provide optimal nephron mass, two adult kidneys with suboptimal function can be transplanted into one single recipient. All techniques described to date are based on the lengthy sequential transplantation of one allograft after the other, in each iliac fossa, or through one long incision in the right iliac quadrant. Material and Methods. We report on a novel shorter and simpler operative technique allowing the en-bloc transplantation of seven dual adult kidneys with multiple vessels into a single iliac fossa, with revascularization through the donor aorta and vena cava. A proposal for the identification, allocation, procurement, and placement of the dual adult kidneys is presented. Results. There was no primary non-function, no thrombosis, and no urinary leakage. No urosepsis and hydronephrosis were noted during the follow-up. The operative time was 180 min. At 36 months, serum creatinine levels averaged 1.8 mg/dL (range 1.4–1.9 mg/dL). Conclusions. The procedure described permits converting two complex vascular kidneys into one en-bloc graft, which then can be transplanted into a single iliac incision, using only one arterial and one venous anastomoses. It avoids extensive dissection, shortens the operative time, and reduces the complications rate for the elderly recipients. It is applicable to the transplantation of dual kidneys with single or multiple arteries.

The effect of chemotherapy on the complication rates of implant and free flap breast reconstruction: A Systematic Review

Purpose This study investigated the impact of chemotherapy on complication rates of implant and free flap breast reconstruction. The effect of timing and dosage of chemotherapy in minimizing the breast reconstruction surgery (BRS) complications were also investigated. Methods PRISMA guidelines were used to search relevant studies published from January 2009 to September 2021. Quality of selected studies were assessed using GRADE assessment and risk of bias was performed using Cochrane Collaboration’s tool and ROBINS-I. Rates of major and minor complications of neoadjuvant systemic therapy (NST) and adjuvant systemic therapy (AST) were compared by t-test using GraphPad Prism v.9.3.0 and P value <0.05 was considered statistically significant. Results A total of 19 studies comprising 49,217 patients were included. The GRADE assessment showed low risk of bias and good quality across studies. Three-hundred and twenty patients had implant reconstruction, 3,172 had flap reconstruction and 46,062 had both flap and implant reconstruction surgery. There was no significant difference in complication rates of patients between flap reconstruction surgery and implants. (P=0.4) In all studies, total complication rates for post-chemotherapy BRS patients was 46.03% compared to 32.49% without chemotherapy (P=0.09). Overall major complications rate was 14.5% (P=0.61) with NST and 21.1% (P=0.69) with AST. Minor complications rate was 28.8% (P=0.97) with NST and 39.5% (P=0.59) with AST. Complication rate of NST was lower than AST, but not statistically significant (P=0.64). No significant correlation was found between timing/duration of chemotherapy and rates of BRS complications (P=0.76). Conclusion No significant difference in BRS complications with and without chemotherapy was established. Despite these results suggesting little difference between NST and AST or chemotherapy in BRS complications, prospective control studies are currently limited, and more are necessary to better inform surgeons and their patients.

Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis

Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

Safety and effectiveness of an iris hook assisted phacoemulsification in vitrectomized eyes

AIM: To introduce a simple iris hook assisted phacoemulsification (PE) procedure and evaluate the safety and efficacy of it in completely vitrectomized eyes. METHODS: A single centre study which included 65 previously completely vitrectomized eyes of 62 patients who underwent cataract surgery. Patients were randomly divided into 3 groups. Patients received PE, and intraocular lens (IOL) implantation with the assistance of iris hook (SynergetiesTM) as group A (25 eyes); patients who received PE assisted with a 25G pars plana irrigation as group B (20 eyes), and patients who received PE performed without the help of any instrument as group C (20 eyes). Main outcome measures were surgery duration, Ultrasound (U/S) total time, endothelial cell density (ECD), cumulative dissipated energy (CDE) and complications of the procedures. RESULTS: With the help of iris hook, the patients in group A had the lowest ECD loss rate (0.07±0.03, 0.09±0.03, and 0.10±0.03, P<0.05), shortest CDE (12.2±4.1, 15.8±6.0, and 16.0±6.0, P<0.05) and U/S total time (36.6±13.0s, 46.3±16.4s, and 47.6±16.1s, P<0.05), and minimal incidence of complications. The longest surgery duration was in group B (19.4±1.6min) and maximum complications rate in group C (20% miosis, 10% posterior capsular tears, 5% zonular dialysis, 5% cystoid macular edema). While best-corrected visual acuity (BCVA), intraocular pressure (IOP) and ECD did not show a significant difference among the three groups. CONCLUSION: Without prolonged surgery duration, the iris hook assistant method can minimize heat generation during surgery and incidence of complications, which transfer the challenged PE in vitrectomized eyes into a regular surgery. It does not need any change in the hydrodynamic parameters and in the bag PE technique, easy to operate even for junior surgeons.

The Comparison of a C-Shaped Partial Stapled Hemorrhoidopexy (C-PSH) Versus Circular Stapled Hemorrhoidopexy (CSH) in Patients with IV Grade Hemorrhoid: A Retrospective Study

Aims The aims of this study were to present a C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of IV grade hemorrhoid and to assess the clinical outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). Methods Conventional CSH kit matched with an intestinal spatula was used for performing C-PSH. One hundred and fifty eight patients who suffered IV grade hemorrhoid and underwent C-PSH or CSH at Hangzhou Third hospital between December 2017 and July 2019 were retrospected. Intraoperative and postoperative outcomes in both groups were collected and analyzed. Results Operative time, estimated blood loss and hospital stay were similar in both two groups (p values were 0.238, 0.563 and 0.101 respectively). Pain scores on the first defecation, 1st, 2nd, 3rd and 7th postoperative days in the C-PSH group were respectively lower than those in the CSH group, and the numeric rating scale (NRS) scores were 3.29±1.52 vs. 4.23±1.99 (p=0.001), 3.82±1.49 vs. 4.63±1.17 (p<0.001), 3.12±1.51 vs. 3.71±1.85 (p=0.030), 2.67±1.52 vs. 3.37±1.54 (p=0.005) and 1.34±0.92 vs.1.84±1.14 (p=0.003). Fecal urgency incidences in the C-PSH group were lower than those in the CSH group on the 1st, 2nd, 3rd and 7th postoperative days, and the incidences occurred in the C-PSH group vs. CSH group were 44.7% vs. 61.0% (p=0.041), 30.3% vs. 46.3% (p=0.038), 25.0% vs. 43.9% (p=0.013) and 13.2% vs. 35.4% (p=0.001) respectively. Overall postoperative complications rate occurred in the CSH group was higher than that in the C-PSH group, (16/82 vs. 6/76, p=0.035). Six patients suffered from anal stenosis in the CSH group and no patient suffered from stenosis in the C-PSH group (p=0.047). One year recurrence rate in the C-PSH group and CSH group was 8.0% (6/75) vs. 6.3% (5/79), (p=0.687). Conclusions The C-PSH seems to be an efficacy and safety technique in treating IV grade hemorrhoid. It has advantages in alleviating postoperative pain, fecal urgency and anal stenosis compared with CSH. It could be an alternative technique in the treatment of IV grade hemorrhoid.

Transvenous lead extraction – summary of the experience of a single Bulgarian center – a retrospective study

There has been increased rate of cardiac implantable electronic devices (CIED) implanted worldwide. Respectively the numbers of patients with absolute indications for lead extraction (pacemaker and ICD) grow up exponentially. The aim of our study is to present the initial experience and long-term results of pacemaker and ICD lead extraction in patients treated in Cardiology department of University hospital “Sveta Anna” Sofi a. Material and Methods: Retrospective study was performed of patients with CIED implanted greater than 1 year and indications for lead extraction. Clinical and procedural characteristics, success rate, complications rate, and reinfection rate data were collected and analyzed. Results: In the period August 2016 to May 2021, a total of 54 patients were admitted to our department with an absolute indication for lead extraction. A total of 114 pacemakers and ICD electrodes were extracted during 54 procedures. In 47 patients (87%) was shown complete technical success with removal of all hardware and in 53 patients (98.1%) clinical success of the procedure was found. The incidence of major periprocedural complications requiring urgent cardiac surgery in our series was 2 (3.7%). Follow-up revealed a very low recurrence infection rate – only 1 patient (1.9%). Conclusion: Lead extraction is a safe and effective procedure. The establishment of a specialized center with an organized system for lead extraction is key in achieving excellent short- and long-term results.