Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report

A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter. In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst. Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.

The Predictive Factor for Favorable Outcome after Surgical Treatment of Benign Prostate Hyperplasia Performed by Young Urologist: Is Surgical Modality Important in Beginner Urologists?

Objective: To identify predictive factors for favorable outcomes after surgical treatments that were performed by beginner urologists in patients with benign prostate hyperplasia (BPH), we retrospectively evaluated outcomes after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of prostate (TURP) that were performed by two young urologists.Methods: Of 80 patients who were treated with HoLEP or TURP, 31 (HoLEP) and 36 (TURP) patients who were followed up for 3 months were enrolled in this study. Preoperative and perioperative variables were evaluated to identify predictive factors for favorable outcome after surgical treatment for BPH.Results: At 3 months postoperative after HoLEP or TURP, the median decrease in International Prostate Symptom Score (IPSS) was 13.0. Patients whose IPSS decreased by over 13 points were categorized into a favorable response group after HoLEP or TURP. Univariate and multivariate logistic regression analyses were performed to identify predictors of favorable outcomes at 3 months after HoLEP or TURP, and the preoperative IPSS was identified as an independent predictor for favorable outcomes.Conclusion: When young urologists plan to perform surgical treatment for BPH, they should consider that the severity of symptoms is the most important factor for favorable outcomes. The type of surgical modality for managing BPH is less important.

Fluorescent sentinel lymph node mapping with icg in endometrial cancer. An initial experience in Argentina

Background: Near-infrared fluorescence-based sentinel lymph node (SLN) mapping technique with indocyanine green (ICG) has been found a useful surgical modality for sentinel node detection and disease staging in endometrial cancer (EC) worldwide. Objective: We aimed to introduce the SNL mapping technology using ICG and Near Infrared (NIR) fluorescence in Argentina. We aimed to assess the overall and bilateral detection rate of ICG based SNL mapping along with verifying its feasibility and effectiveness in surgical staging. We also aimed to discover the perceptions of surgeons regarding the use of ICG as a tracer and NIR as light-medium in SNL mapping. Method: ICG SLNs identification was evaluated retrospectively. This study was performed at the Hospital Aleman de Buenos Aires in September, 2017The detection rates were calculated along with the analysis of the number of SNL observed and operative time, and time taken by overall surgery. Subsequently, the surgeons were interviewed to ascertain their opinion of using ICG SNL mapping in endometrial cancer staging. Results: Four patients with endometrial cancer were included for analysis. The overall and bilateral detection rates have been 100% and 75%, respectively. While, under white light, no SLNs were identified. The average operative time of nodes resection was estimated 2.15 minutes. The fluorescence has been used for 2.2 minutes and overall time taken by surgery was estimated 71.5 minutes. The estimated blood loss (EBL) has been lower than 50 ml. The responses of surgeons’ from the interview have been 100% positive. The cost of the procedure based on the amount of dye used was 25 dollars per patient. Conclusion: Laparoscopic ICG SLN resulted to be feasible, practical and no expensive surgical modality for uterine cancer triage.

An overview on the art of piezosurgery in the maxillofacial practice

Introduction: Piezosurgery is an emerging boom in the field of maxillofacial surgery for precise, safe and effective osteotomies sparing the adjacent vital structures compared to conventional surgery. Corpus: It works on the principle of piezoelectric effect in which crystals in the piezoelectric substances get deformed on the application of an electric field. Various studies gave the evidence of improved wound healing and bone formation compared to conventional approaches. The soft tissue sparing capability with improved patient comfort and decreased blood loss gave the utmost importance for this surgical technique in the present as well as future world of surgery. Conclusion: Piezosurgery has emerging as a promising surgical modality with a wide range of clinical applications throughout the whole field of surgery.

Clinical evaluation and management of scrotal swelling

Background: The present study was conducted with the main purpose to identify the mode of presentation, various treatment modalities and outcome of these with their complications.Methods: This prospective study was carried out on a total of 100 subjects presented with scrotal swellings. Exhibiting symptoms were noted including discomfort, painless swelling, urine symptoms and fever. Questionnaires were used to analyse all the predisposing factors of patients, which were then categorized as idiopathic, urinary problems, trauma or previous history. Ultrasound as well as colour Doppler was carried out on all subjects. The options for treatment were either surgical or conservative. The cases treated were recorded accordingly and follow up was done.Results: The majority of study patients, that is, 56%, suffered with scrotal swelling on the right side, followed by left (40%) and bilateral side (4%). 63% of the subjects were presented with symptoms of painless swelling. Whereas 27% of the study subjects were presented with symptoms of pain and fever and 10% of them showed only the symptoms of pain. The majority of study subjects, that is, 71% were treated with surgical modality. Whereas 29% with conservation modality. The most common USG finding found among the study subjects was hydrocoele (37%). 37 (37.0%) subjects having hydrocoele suffered postoperative complications.Conclusions: Younger age group and manual labourers were more prone to scrotal swellings. Few of the operated cases developed postoperative complications like epididymoorchitis. There is a resurgence of thorough clinical examination to establish a diagnosis in patients with scrotal swelling.

Large bowel obstruction in palliative care: overview, management and monitoring

Patients with pelvic and abdominal cancers usually present with bowel obstruction, especially peritoneal, colorectal, and pancreatic carcinomatosis. A poor prognosis has been reported for patients that suffer from gastrointestinal bowel obstruction secondary to later stage carcinomatosis, although maximal treatment approaches might have been administered. In this context, these patients are suggested to survive for only a few weeks to months, and parenteral nutrition did not enhance the outcomes in these situations. Medical treatment includes the administration of corticosteroids, opioids, anticholinergics, octreotide, and anti-emetics, while surgical outcomes might be more efficacious with more favorable clinical outcomes. However, these operations have been reported with multiple complications that might worsen the prognosis. Stent application is another non-surgical modality with fewer adverse events. Nevertheless, evidence regarding its superiority over the surgical approaches is conflicting among the different studies in the literature. Accordingly, further investigations are still needed for adequate validation.

Posterior Quadrant Disconnection for Childhood Onset Sub-Hemispheric Posterior Head Region Epilepsy: Indications in an Indian Cohort and Outcome

<b><i>Background:</i></b> Posterior quadrant disconnection (PQD) is an under-utilized surgical technique in the management of refractory epilepsy. There is a dearth of data pertinent to post-PQD seizure outcomes. <b><i>Methods:</i></b> This retrospective study analyzed patients with drug-resistant childhood-onset epilepsy who underwent PQD at our center from 2009 to 2018. The clinical, imaging, and electrophysiological data were reviewed. The seizure outcome was noted from the latest follow-up in all patients. <b><i>Results:</i></b> Fifteen patients underwent PQD, with a mean age at onset of epilepsy of 3.3 ± 4.6 years. All patients had seizure onset in childhood with focal onset of seizures, and in addition, 5 had multiple seizure types. All cases underwent presurgical workup with MRI, video-EEG, psychometry, while PET/MEG was done if required. Engel Ia and ILAE I outcomes were considered to be favorable. The histology of the specimen showed 9 patients (60%) had gliosis, 4 (26.7%) had focal cortical dysplasia (FCD), while 1 patient had nodular heterotopia and another had polymicrogyria-pachygyria complex. Postoperative follow-up was available in 14 cases. One patient was lost to follow-up. Mean follow-up duration for the cohort was 45 + 24 months. At last, follow-up (<i>n</i> = 14), 66.7% (10 cases) had favorable outcome (Engel Ia). At the end of 1-year follow-up, up to 73% (<i>n</i> = 11) of the patients were seizure-free. Four patients developed transient hemiparesis after surgery which improved completely by 3–6 months. <b><i>Conclusions:</i></b> Gliosis was more common etiology requiring PQD in our series than Western series, where FCD was more common. PQD is a safe and effective surgical modality in childhood-onset epilepsy with posterior head region epileptogenic focus.

A 10-min novel technique for involutional entropion: Mini-incisional continuous ligation everting sutures

Purpose To introduce a novel technique of mini-incisional continuous ligation everting sutures for correction of involutional entropion and report the surgical outcome. Methods A retrospective case series. Eighty-five eyelids of 77 patients who underwent correction of involutional lower lid entropion using mini-incisional continuous ligation everting sutures were included in this study. The medical records of patients with at least 24 months of follow-up after surgery were reviewed. We collected information on demographic and clinical characteristics, including sex, age at surgery, duration of follow-up, horizontal lid laxity, surgical outcomes, and complications. Main outcome measures were success of surgery, recurrence rate, time to recurrence, and risk factors for recurrence. Results The median (interquartile range) age at the time of surgery was 72.0 (65.5–78.0) years and the median (interquartile range) follow-up duration was 24.0 (24.0–42.5) months. Thirty-seven eyelids (43.5%) showed horizontal eyelid laxity on a lid distraction test The surgical outcome was successful in the majority of patients (94.1%) with a recurrence rate of 5.9% in the 2 years after surgery. Only female sex was significantly correlated with recurrence of entropion (odds ratio 9.466, 95% confidence interval 1.022 to 87.670, P = 0.048). Conclusion This novel technique is a promising surgical modality for correction of lower lid involutional entropion because of its ease of application, simplicity, compatibility with anticoagulants, and low recurrence rate.

Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

ObjectivesThe benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are well established although the financial impact of robotic-assisted hysterectomy (RH) compared with laparoscopic hysterectomy (LH) is disputed.DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Participants35 304 women having a hysterectomy for EC identified from Hospital Episode Statistics.Primary and secondary outcome measuresThe primary outcome was the association between route of surgery on cost at intervention, 30, 90 and 365 days for women undergoing an open hysterectomy (OH) or MIS (LH/RH) for EC in England. The average marginal effect was calculated to compare RH versus OH and RH versus LH which adjusted for any differences in the characteristics of the surgical approaches. Secondary outcomes were to analyse costing data for each surgical approach by age, Charlson Comorbidity Index (CCI) and hospital MIS rate classification.ResultsA total of 35 304 procedures were performed, 20 405 (57.8%) were MIS (LH: 18 604 and RH: 1801), 14 291 (40.5%) OH. Mean cost for LH was significantly less than RH, whereas RH was significantly less than OH at intervention, 30, 90 and 365 days (p<0.001). Over time, patients who underwent RH had increasing CCI scores and by the 2015/2016 year had a higher average CCI than LH. Comparing the cost of LH and RH against CCI score identified that the costs closely reflected the patients’ CCI. Increasing disparity was also seen between the MIS and OH costs with rising age. When exploring the association between provider volume, MIS rate and surgical costs, there was an association with the higher the MIS rate the lower the average cost.ConclusionsFurther research is needed to investigate costs in matched patient cohorts to determine the optimum surgical modality in different populations.