Spontaneous rupture of liver abscess with biliary communication presenting as a lumbar mass

Pyogenic liver abscess was first reported in the writings of Hippocrates, which was based on the type of fluid recovered from the abscess related to a high mortality rate ranging between 15% and 19% at that time. However in 1938, Ochsner and De Bakey described the recommended surgical treatment as the primary treatment modality. Surgery remained the therapy of choice until the mid-1980s, when percutaneous drainage was shown to be a safer alternative in many cases. Spontaneous rupture of liver abscess may occur free in the peritoneal cavity or in neighbouring organs, an event which is generally considered as a surgical emergency, while localized rupture can be managed with drainage, either percutaneous or surgical/minimal invasive techniques and addition of appropriate antibiotic treatment. In cases where there is uneventful rupture of abscess and localized to the neighbouring organs and tissues can be successfully treated by a combination of broad-spectrum antibiotics and percutaneous drainage and endoscopic management.

Intramedullary Nailing of Intertrochanteric Fractures - Minimal Invasive Techniques for Reduction

Background: An intramedullary nail has become the implant of choice for intertrochanteric fractures. This paper introduced some minimal invasive techniques were used to improve quality of intertrochanteric fracture reduction. Methods: Of 119 intertrochanteric fractures treated from January 2014 to October 2019. All patients who received internal fixation on traction bed, and who could not achieve satisfactory closed reduction through the process of "external rotation, abduction, traction, adduction and internal rotation". Reductions were classified as good, acceptable, or poor. We had acceptable reduction in 83 cases and poor reduction in 37 cases though closed reduction. The displacement was reduced using some minimal invasive techniques. Results: After performing the relative techniques in these cases, no case had a poor result. 112(94.9%) cases were in a good reduction. Anatomical reduction should always be achieved in intertrochanteric fractures. Conclusion: The minimal invasive techniques could help the surgeon achieve satisfactory reduction in intertrochanteric fractures. This work had the potential to improve the cognition of reduction of intertrochanteric fractures for surgeons, especially beginners and juniors.

Predicting the Risk of Postoperative Complications in Patients Undergoing Minimally Invasive Resection of Primary Liver Tumors

Minimal-invasive techniques are increasingly applied in clinical practice and have contributed towards improving postoperative outcomes. While comparing favorably with open surgery in terms of safety, the occurrence of severe complications remains a grave concern. To date, no objective predictive system has been established to guide clinicians in estimating complication risks as the relative contribution of general patient health, liver function and surgical parameters remain unclear. Here, we perform a single-center analysis of all consecutive patients undergoing laparoscopic liver resection for primary hepatic malignancies since 2010. Among the 210 patients identified, 32 developed major complications. Several independent predictors were identified through a multivariate analysis, defining a preoperative model: diabetes, history of previous hepatectomy, surgical approach, alanine aminotransferase levels and lesion entity. The addition of operative time and whether conversion was required significantly improved predictions and were thus incorporated into the postoperative model. Both models were able to identify patients with major complications with acceptable performance (area under the receiver-operating characteristic curve (AUC) for a preoperative model = 0.77 vs. postoperative model = 0.80). Internal validation was performed and confirmed the discriminatory ability of the models. An easily accessible online tool was deployed in order to estimate probabilities of severe complication without the need for manual calculation.

ASSESMENT OF PATIENT SATISACTION FOR CERVICAL SCAR POST THYROIDECTOMY

Background:- Thyroidectomy is a common procedure performed for thyroid disease these days. Plan of surgery depends on histology, location and size of lesion.Thyroidectomy is preceded by conventional midcervical skin crease incision, performed by Theoder kocher in late 1870, to advanced mininmal invasive technique. Minimal invasive techniques have certain upright from conventional surgery.This study aims to study patient satisfaction for cervical scar with thyroidectomy conventional kocher's incision.Material & Method:- Sixty five 65 patient underwent thyroidectomy from September 2017 to February 2020 at American international institute of medical sciences Udaipur, Rajasthan. Patient clinical data retrospectively reviewed and patient scar satisfaction acquired telephonically by using validated patient scar assessment questionnaire and data analyzed statistically. Result:- Around 95% patients show high level of satisfaction in the study having scores consistent with scar satisfaction after conventional thyroidectomy. Majority of patients were satisfied with the appearance of their scars,around 5% of patients (n=3) reported significant levels of self consciousness. Conclusion:- .Majority of patients were satisfied with their scars post thyroidectomy.Despite high level of satisfaction there are people shows significant levels of consciousness.There is need of further study to decide certain factor whether encouraging minimal invasive technique over conventional thyroid surgery.

Successful Management of Renal Fusion Anomaly of Kidney with Nephrolithiasis and Urinary Incontinence

The presence of an ectopic ureter may be indicated by continuous wetting, seen especially in girls. In majority of such cases, an ectopic ureter is associated with a duplex collecting system and complete ureteral duplication. A 32-year-old female presented with urinary incontinence with normal voiding episodes and right flank pain. On investigation, she was found to have duplex moiety on the right-side with partially duplicated ureter and quadruple moiety on the left-side with partially duplicated quadruple ureter with ectopic opening of ureters. The patient also had right upper calyceal stone. It was successfully managed with totally minimal invasive technique with retrograde intrarenal surgery for right nephrolithiasis and left laparoscopic ureteric reimplantation for ectopic ureter. Patient was continent during the follow-up period of nine months with no significant complications. Developmental anomalies of kidney and ureter though rare, can be managed with total minimal invasive techniques, requires proper planning, instruments and its implementation.

Treatment of Varicose Veins with minimal invasive strategies

The mode of treatment of varicose veins has changed substantially over the last 20 years. Minimal invasive techniques have been established and seek the most gentle and safest way of treatment. Ultrasound is the basic instrument to guide these techniques. Endothermal ablation with laser or radiofrequency has become the standard technique for treatment of axial reflux. It requires local tumescence anaesthesia. Other, tumescencless techniques have been developed and established. Today there are many minimal invasive ways to treat varicosity. The treatment strategy can be tailored to the individual patient.

Splenic Rupture After Minimal Invasive Lateral Retropleural Corpectomy

Retropleural minimal invasive approach to the thoracolumbar junction has become more popular in the last decade both for degenerative and traumatic spine surgery as it marries the advantages of direct vision typical of open surgery and the philosophy of tissue sparing which characterizes the thoracoscopic approach. Nevertheless, as with the just mentioned techniques, this approach also requires the caudal displacement of the diaphragm with the organs below including the spleen. The authors report one case of postoperative spleen disruption following a retropleural minimal invasive approach in a patient with an underlying grade II spleen lesion occurred 8 days before and considered safe by the general surgeon. We conclude that even negligible spleen injuries must be considered an absolute contraindication to thoracolumbar junction lateral approach even with minimal invasive techniques.

Treatment of Adolescent Hallux Valgus With Percutaneous Distal Metatarsal Osteotomy

Background. Hallux valgus is a complex deformity of the first ray of the foot, and a significant number of adolescents develop this deformity. More than 130 surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal invasive techniques have been proposed and reported to be successful and cost-effective. The objective of this study was to describe the clinical course of adolescent patients treated with percutaneous distal metatarsal osteotomy. Methods. A retrospective study included patients who had a percutaneous hallux valgus correction during the years 2008 to 2015. The following measurements were compared before surgery up to last follow-up: AOFAS Hallux-Metatarsophalangeal-Interphalangeal questionnaire and radiological measurements (HVA, IMA, DMAA). Any postoperative complications were extracted from the medical records. Results. The procedure was performed on 32 feet (27 patients). All patients were <18 years of age. There were 10 male patients (12 feet) and 17 female patients (20 feet). Average age at surgery was 15.8 years (range = 13-18 years). Average follow-up time was 43 months (range= 24-94 months). The average AOFAS score before surgery was 66, and after surgery, at last follow-up was 96. This difference was significant (P value <.0001). Most patients were pain free after the procedure and returned to appropriate age functioning. Significant improvement was noted in all radiological criteria. Conclusions. Percutaneous distal metatarsal osteotomy is safe, reliable, and effective for the correction of mild to moderate symptomatic hallux valgus in adolescents. Levels of Evidence: Level IV

OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS USING MINIINVASIVE TECHNIQUES

Summary. The aim of the study. To improve the results of surgical treatment of patients with acute pancreatitis using minimal invasive techniques. Matherials and Methods of the study. The results of surgical treatment of 75 patients with different forms of acute pancreatitis were analyzed. All patients were examined and operated on. Results of the study. Minimally invasive interventions were performed in 92 % of the analyzed patients. Intraoperatively acute pancreatic edema was observed in 43 % of patients, hemorrhagic pancreatic necrosis – in 24 %, infected pancreatic necrosis – in 33 %. The postoperative period was complicated by 13.3 %, the mortality rate was 9.3 %. Conclusions. The use of minimally invasive techniques for treating acute pancreatitis can significantly improve the results of surgical treatment of patients with this pathology. The frequency of complications and lethality decreases. Also, it is possible to significantly reduce operational trauma, and hence the number of bed-days of stay in hospital treatment. This contributes to reducing the financial cost of treatment in patients with acute pancreatitis, as well as improving the quality of life of this category of patients.