Colectomy Followed by J-Pouch Reconstruction to Correct Total Colonic Aganglionosis

Background: Patients suffering from complete colonic aganglionosis (TCA) require the best surgical care possible. Only a few studies reported J-Pouch repair as the primary reconstructive surgery in TCA patients. This study adds to the current literature a thorough clinical and functional outcomes group. Methods: Between 2011 and 2021, medical records of Hirschsprung disease (HD) patients who underwent J-Pouch reconstruction during infancy (n = 12) were reviewed. In close follow-up, bowel function and satisfaction with operation results were evaluated. The median age at the time of J-Pouch reconstruction was 16 months, and covering ileostomies were closed four months later. There were no postoperative problems. After the final repair, Pouch-related problems (PRP) occurred in 27% of the children and were treated conservatively. There was no histological evidence of pouchitis in any of the individuals. The median 24-h stooling frequency was 4–5 at the latest follow-up 51 months following enterostomy closure. Conclusions: The current study’s findings support the existing literature and advocate for J-pouch repair in TCA patients. However, more research will be needed to determine the best time to undergo pouch surgery and ileostomy closure in TCA patients.

An Overview on Etiology, Diagnosis and Management of Ovarian Dermoied Cyst: Simple Review Article

The most common neoplastic ovarian lesions in teens are mature cystic teratomas (MCTs) or dermoid cysts. Little is known about the cause of dermoid cysts. Elevated levels of estrogen and progesterone have been suggested to stimulate the sebum components of these tumors, which may explain why MCTs grow after puberty and stop growing after menopause. MCTs are often asymptomatic and are randomly identified during examination or diagnostic imaging. MCTs show a special appearance during ultrasonography. Most studies suggest that most ovarian dermoid cysts can be successfully treated surgically using laparoscopic surgery. Reduced adhesion formation is one of the benefits of laparoscopic treatment for dermoid cysts. Studies also suggest that laparoscopy causes less blood loss. Less hospitalization and less postoperative pain. And there are fewer postoperative problems than the laparotomy approach. In this article, we will look at the etiology, diagnosis, and treatment of dermoid cysts in the ovary.

Breast conserving surgery using oxidized regenerated cellulose as filling biomaterial: recommendations to improve clinical outcomes

Oxidized regenerated cellulose is considered an optimal local hemostatic agent thanks to its favorable biocompatibility, absorption characteristics and ease-of-use. Recently, oxidized regenerated cellulose has also been used as a filler in breast conserving surgery with a reconstructive purpose in order to repair partial breast defects and improve aesthetic outcomes. However, some postoperative problems due to its use, such as allergic reactions, seroma, foreign-body reaction and misdiagnosis during the follow-up of breast cancer patients, have been shown. These possible surgical complications can undermine clinical outcomes and lead to delay the beginning of oncological treatments with a negative impact on patient quality of life and survival. An adequate surgical expertise and the compliance with some specific recommendations are crucial in order to minimize postoperative issues and optimise aesthetic outcomes.

Muscle Atrophy and Artery Shrinkage of Residual Limb After Trans-Femoral Amputation: A Morphological Study

Aim: After limb amputation, patients will face many complex postoperative problems. The pathogeny of these problems usually involves blood circulation disorders, vascular lesions and other angioneurotic issues. The correlation between blood flow/vessels and those residual limb problems like the most prevalent muscle atrophy is very importent. Method: Through the case study of eight unilateral trans-femoral amputees, this research performed the morphological index analysis of residual limb muscle atrophy, arterial shrinkage and their potential correlations. Results: The atrophy level of muscles and the shrinkage level of arteries were different. Overall, Different muscles have different atrophy. Compared with the prosthesis users, those cases without using prosthesis exhibited more severe muscle atrophy and arterial shrinkage in their residual limbs. For the correlation between muscle atrophy and arterial shrinkage on the basis of blood supply relationship, there was a positive correlation expressed only in the cases using prosthesis. Conclusion: Using a prosthesis could not only effectively achieve the functional compensation for residual limb, but also promote a joint adaptation of the muscular and arterial physiological state of both the sound and amputated limbs to the new gait pattern and body balance, as well as rehabilitation process.

Myasthenia is a poor prognosticator for perioperative outcomes after robotic thymectomy for thymoma

OBJECTIVES The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy. METHODS This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7 years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma. RESULTS Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P = 0.02, P = 0.04). Postoperative complications were significantly higher in the myasthenic group (P = 0.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22–3.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10–2.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2 years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09–2.71; P = 0.43). CONCLUSIONS The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.

Undesirable Postoperative Anesthesia Outcomes at Two National Referral Hospitals: A Cross-Sectional Study in Eritrea

Background. Postoperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the postoperative period. Method. A cross-sectional study design was applied on 470 patients who underwent different types of surgeries within a three-month period. Patients were interviewed 24 hours after operation (POD 1) using the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension “Discomfort and needs” of the LPPSq was considered, and the measurements of that dimension are presented in this report. Items of the dimension were standardized and measured using a five-point Likert scale from “Not at all” to “Extremely.” Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22). Results. The prevalence were computed in two manners, prevalence of those with ‘at least a little bit’ outcomes, which was computed to see the total occurrence of these outcomes, and prevalence of those having ‘more than moderate’ outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, postoperative pain, for ‘at least a little bit’ and ‘more than moderate’ were 82.6% and 43.6%, respectively. The rest of the postoperative undesirable outcomes were less frequently reported. Conclusion. Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed.

Incidence and predictive factors of problems after fixation of trochanteric hip fractures with sliding hip screw or intramedullary devices

Introduction: Hip fractures are common and disabling injuries, usually managed surgically. The most common type outside the joint capsule are trochanteric fractures, usually fixed with either sliding hip screw or intramedullary nail. Data are available in the National Hip Fracture Database (NHFD) on early failure and other major complications, but late or subtler complications may escape recording. This study sought to quantify such problems after fixation performed at 3different sites and identify their predictors. Methods: Patients with a trochanteric fracture treated at 1 of 3 sites were identified from the NHFD over a 3-year period. Any with further, related episodes of care were identified, and reasons recorded, then age- and sex-matched with those with no such episodes. Data was collected on Arbeitsgemeinschaft für Osteosynthesefragen classification, tip-apex distance, American Society of Anesthesiologists (ASA) grade, Abbreviated Mental Test Score and pre-injury mobility. The cohorts were compared, and a binomial logistic regression model used to identify predictors of problems. Results: A total of 4010 patients were entered in the NHFD across 3 sites between January 2013 and December 2015. Of these, 1260 sustained trochanteric fractures and 57 (4.5%) subsequently experienced problems leading to re-presentation. The most common was failure of fixation, occurring in 22 patients (1.7%). The binomial logistic regression model explained 47.6% of the variance in incidence of postoperative problems with ASA grade and tip-apex distance being predictive. Discussion: The incidence of re-presentation with problems was around of 5%. A failure rate of less than 2% was seen, in keeping with existing data. This study has quantified the incidence of subtler postoperative problems and identified their predictors. The type of implant used was not amongst them and patients with both implants experienced problems. Fixation continues to yield imperfect results, but patient health and robust surgical technique remain important factors in a good outcome.

Advanced T stage and thick rectus abdominis muscle triggers outlet obstruction and high-output stoma following ileostomy in patients with rectal cancer

Background Ileostomy creation is an excellent approach to prevent leakage in patients undergoing low anterior resection for the treatment of rectal cancer. However, the two major complications of ileostomy are outlet obstruction and high-output stoma, and these complications remain unavoidable postoperative problems of ileostomy. Methods Risk factors associated with outlet obstruction and high-output stoma were retrospectively analyzed. The study included 83 patients with rectal cancer who underwent surgery. Of these patients, 34 underwent ileostomy creation. Results We found that outlet obstruction and high-output stoma were highly related (p = 0.03). Additionally, a thick rectus abdominis muscle and advanced T stage were the common risk factors of outlet obstruction (p = 0.0005 and p = 0.01, respectively) and high-output stoma (p = 0.04 and p = 0.03, respectively). Conclusions Our findings suggest that rectus abdominis muscle thickness and advanced T stage are predictive markers of outlet obstruction and high-output stoma.

Postoperative care

After surgery, and before being transferred to the ward, patients will be recovered in a specially designated area: the recovery area or post-anaesthetic care unit (PACU). In recovery, there are some postoperative problems that we need to be familiar with managing: postoperative nausea and vomiting (PONV), emergence delirium (it is important to recognize it, and be able to differentiate it from agitation) and pain. Those patients who need postoperative critical care will be admitted to a high-dependency unit (HDU) or paediatric intensive care unit (PICU), depending on their required level of care. Each time the patient is transferred to a different area, a thorough handover between the giving and receiving team is paramount. This chapter provides the reader with the means to manage common recovery problems, and an understanding of patient postoperative dependency levels.