Comparison of Tubeless Mini Percutaneous Nephrolithotomy with Conventional Technique in a Tertiary Care Center

Introduction: Mini Percutaneous Nephrolithotomy (mPCNL) is a safe and efficient method for management of nephrolithiasis. Post procedure nephrostomy tube drainage is considered as the standard practice. In recent years, tubeless mPCNL with the use of double J (DJ) stent alone has replaced the placement of the nephrostomy tube. Aims: This study intends to evaluate the safety and efficacy of tubeless Mini Percutaneous Nephrolithotomy. Methods: A total of 80 patients with Nephrolithiasis, admitted to Urology Unit of Nepalgunj Medical College, between September 2018 and September 2019 were enrolled in the study and divided into two groups: Tubeless group where tube was omitted and Standard Group where it was placed. The two groups were compared with respect to hemoglobin drop and blood transfusion requirement, hospital stay and analgesic requirement in the post-operative period. Results: Mean age of the patients was 34.30 ± 13.19 years. Mean stone size was 19.03 mm. The mean change in hemoglobin after standard mPCNL was 1.68 gm/dl and that in the tubeless group was 1.11 (p=0.018). The tubeless group had a significantly (p=0.001) shorter hospital stay (3.05 ± 1.23 days) compared to standard group (3.85 ± 0.86). The postoperative pain as assessed by visual analogue scale, was more in the standard group necessitating additional analgesia. It was significantly higher in the standard group at 12, 24, 48 hours, as compared to the tubeless group. Conclusion: Placement of nephrostomy tube can be omitted as a routine practice as Tubeless mini PCNL has an added advantage of significantly reduced postoperative pain, less analgesic requirement, shorter hospital stay, less postoperative blood loss.

Conventional Dissection and Bipolar Electrocauterization Methods of Tonsillectomy: A Comparative Study

Introduction: Tonsillectomy is frequently performed surgical procedure. There are several different methods with varied advantages and disadvantages. In spite of the different techniques available there is no consensus and definite evidence for best method. The most commonly performed are conventional dissection and bipolar electrocauterization methods. Aims: The aim of the study was to compare time required for the completion of surgery, intraoperative and postoperative blood loss along with post operative pain between conventional dissection and bipolar electrocauterization methods. Methods: This comparative study was conducted from August 2019 to March 2021 in total of 30 patients planned for tonsillectomy in department of Otorhinolaryngology, Nepalgunj Medical College Teaching Hospital.In every patient right side tonsillectomy was done with conventional dissection method and left side tonsillectomy was done with bipolar electrocauterization method. Results: The mean age was 27.2±13.08 years. The mean duration of surgery was 16.53 ± 2.43 min and 11.10 ± 1.93 min in conventional dissection method and bipolar electrocauterization method respectively. The difference was statistically significant. Intraoperative blood loss was significantly lower in bipolar electrocauterization method with mean intraoperative blood loss of 19 ±4.62 ml in bipolar electrocauterization group and 81.83 ±36.54 ml in conventional dissection method. The pain intensity was statistically similar in both methods at all-time intervals post operatively. Conclusion: In tonsillectomy, bipolar electrocauterization method has advantage over conventional dissection method in regards to reduced surgical time and intra operative blood loss, without any significant difference in post-operative pain intensity and post-operative hemorrhage.

Tranexaminezuur in de gynaecologische en senologische heelkunde: een literatuuroverzicht

Tranexamic acid in gynecological and breast surgery: a literature review In gynecological and breast surgery, intra- or postoperative blood loss can cause many complications. A large number of interventions have already been described in literature to limit intraoperative blood loss. Tranexamic acid significantly reduces the amount of vaginal blood loss in women with menorrhagia and is also recommended as a treatment for postpartum hemorrhage. Tranexamic acid has been shown to be safe and efficient in limiting blood loss in many other surgical disciplines. In this literature review, the different applications of the use of tranexamic acid in gynecological and breast surgery are explained. The conclusion is that tranexamic acid can be a safe additional treatment that can reduce the total blood loss and the risk of postoperative complications and blood transfusion in various types of gynecological and breast surgery.

The Use of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review

Background: There are several papers that investigate the use of tranexamic acid (TXA) in anterior cruciate ligament reconstructions (ACLR) or other arthroscopic procedures that show favorable results and little to no complications. We aimed to perform a systematic review of all published randomized controlled trials (RCTs) that wanted to determine the effectiveness of intravenous use of TXA in ACLR. Methods: Data collection was performed independently by two authors via a previously created spreadsheet. They extracted information such as: first author name, publication year, lot size, TXA protocol, surgical protocol, outcome measures and follow-up duration. Results: After applying the screening process and the inclusion criteria, we were left with a total six RCTs. The selected studies included a total of 699 randomized patients. Statistical significance regarding a lower pain score (VAS) in the intervention groups was mostly reported for the early postoperative period (2 weeks). A statistically significant decrease in hemarthrosis grade was reported for the first 2–3 weeks. Conclusions: in our study, we show that TXA use in arthroscopic ACLR decreases postoperative blood loss and pain. Some evidence of improvement in functional scores was observed, but we believe that this needs to be addressed in specific long-term result studies.

The role of suction drainage in the management of peri-operative bleeding in Total and Unicomcompartmental knee arthroplasty: a retrospective comparative study

Background Suction drainage is commonly applied after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) to reduce hematoma, swelling and to favor surgical wound healing. However, its efficacy remains controversial; thus, the purpose of this study is to evaluate drainage efficiency in the management of postoperative bleeding in TKA and UKA. Methods The cohort comprised 134 clinical records of patients affected by knee osteoarthritis (OA) who underwent either TKA or UKA. All the patients were subdivided into 2 groups: the first one with drainage and the second one without drainage (respectively 61 and 73 patients). For each group, hemoglobin levels in the preoperative, first, second and third postoperative day were collected. Postoperative complications such as swelling, bleeding from the surgical wound or the need for blood transfusion, were also recorded. Results Our results did not show any significant difference of hemoglobin levels in the first (p = 0.715), second (p = 0.203) and third post-operative day (p = 0.467) between the two groups. Moreover, no significant correlation between knee swelling or transfusion rate and the drainage was observed (p = 0.703 and p = 0.662 respectively). Besides, a significant correlation was found between bleeding from the surgical wound and the absence of drainage (p = 0.006). Conclusions The study demonstrates how the routine use of suction drainage does not provide substantial benefits in the postoperative blood loss management after TKA or UKA. Trial registration ClinicalTrials.gov NCT04508101, 09/08/2020, Retrospectively registered Level of evidence III

Comprehensive treatment of pathology of the ascending, arch and descending thoracic aorta by performing operations of the hybrid "elephant trunk"

The purpose of the study – study and demonstration of the possibilities of the technique of complete replacement of the ascending, arch, vessels of the arch and descending thoracic aorta "elephant trunk" surgery in patients with aortic arch aneurysms.Material and methods. The paper describes the technique and demonstrates the results of the first 29 operations of prosthetics of the ascending, arch, vessels of the arch and descending thoracic aorta, which were performed by the staff of the Department of Surgical Treatment of Aortic Pathology National M.Amosov ICVS of the NAMS of Ukraine" in 2016-2020. Results. Hospital mortality was 10.3%, three patients died. The causes of death were: the following acute cardiovascular failure, uncontrolled bleeding, and multiple organ failure in each case. In none of the operated patients the level of postoperative blood loss did not require rethoracotomies.Conclusions. The optimal way to correct aneurysms of the aortic arch is the operation of prosthetics of the ascending, arch and descending thoracic aorta - "elephant trunk". Improvement of preoperative diagnostics, surgical equipment, optimization of methods of protection of the brain, spinal cord and visceral organs, the possibility of using hybrid / endovascular techniques to treat patients with complex lesions of the aortic arch pool with hospital mortality within 10.3%.

The Efficacy and Safety of Postoperative Tranexamic Acid, Hemocoagulase Agkistrodon, and their Combination in Patients Undergoing Heart Valve Replacement With Cardiopulmonary Bypass

Background Excessive bleeding is a major complication in patients undergoing cardiac surgery. We aimed to compare the efficacy and safety of postoperative tranexamic acid (TXA), hemocoagulase agkistrodon and their combination in patients undergoing heart valve replacement surgery with cardiopulmonary bypass (CPB). Methods This was a retrospective study. The enrolled patients were intravenously injected with TXA at a dose of 1.0 g during the intraoperative period. After surgery, the patients were assigned to four groups: the control group (Group C), the TXA group (Group T), the hemocoagulase agkistrodon group (Group H) and the combination group (Group TH). The primary efficacy outcomes were the total blood loss (TBL) from the time of the operation to postoperative Day 2, postoperative blood loss within 2 days, and transfusion of red blood cells and plasma from the operation to postoperative Day 3. The primary safety endpoint was the incidence of thromboembolic events. Results A total of 252 patients were recruited. There were no statistically significant differences in terms of the TBL, postoperative blood loss, volumes of red blood cells or plasma transfusion among the four groups. However, an increased total pericardial drainage volume and longer length of stay in the ICU were found in Group H compared with in Group T. In addition, increased volumes of total pericardial drainage were found in Group TH compared with Groups C and T. A similar result was also found in the number of days of pericardial drainage. Regarding safety outcomes, fibrinogen levels on postoperative Days 1 and 2 in Groups H and TH were significantly lower than those in Groups C and T, while the frequencies of human fibrinogen transfusion in Groups H and TH were higher, with the highest frequency in Group H. The transfusions of human fibrinogen among Groups C, T, H and TH were 1.45%, 2.78%, 64.71%, and 28.72%, respectively. No significant differences were found in the postoperative incidences of thromboembolic events and acute kidney injuries among all groups. Conclusions Bleeding events after cardiac valve replacement surgery with CPB were not improved by postoperative administration of TXA, hemocoagulase agkistrodon or their combination. Hemocoagulase agkistrodon is related to hypofibrinogenemia and increased transfusions of human fibrinogen.

The Efficiency of Simultaneous Systemic and Topical Use of Tranexamic Acid in Spinal Fusion Surgery

Background and Aim Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery. Patients and Methods This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group). Results Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant). Conclusion Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.

Accuracy of reporting estimated blood loss in open repair of pelvic and acetabular fractures

Background: Pelvic injuries after blunt trauma are often repaired with open reduction-internal fixation (ORIF), often resulting in high blood loss. We compare calculations of estimated perioperative blood loss (EPBL) against reported intraoperative blood loss (RIBL) by visual estimation to evaluate their accuracy during ORIF for pelvic fractures. Materials and Methods: A retrospective observational study was conducted at a Level 1 trauma center. 142 patients requiring ORIF of acetabular and/or pelvic ring fracture between ages 18 to 89 years from 3/1/2017 to 2/28/2019 were included. EPBL was calculated by Gross Method. Statistical analyses were conducted using R statistical software. Medians and inter-quartile ranges were used to summarize variables. A two-sample Wilcoxon signed rank test was performed. The agreement and reproducibility of RIBL and EPBL were examined with concordance correlation coefficients (CCC) and Bland-Altman plots. Results: Median RIBL was 450 mL [250, 800], while median EPBL was 2142 mL [1213, 3607]. The median difference was -1692 mL (p<0.001). The Bland-Altman plot showed consistent under-reporting in RIBL versus EPBL. A proportional bias (p<0.001), indicated that the level of bias was not constant between levels of blood loss. The CCC between RIBL and EPBL was 0.076 [-0.016, 0.167]. Pearson’s Correlation Coefficient was 0.213 (p=0.011). RIBL and EPBL had a weak positive correlation. Discussion: Blood loss during ORIF calculated by EPBL was significantly higher than RIBL. Our results suggest that blood loss reporting may be inaccurate in ORIF of pelvic fractures. These findings necessitate formulation of an accurate method permitting proper blood loss reporting. Keywords: postoperative blood loss; surgical blood loss; orthopedic surgery; estimation techniques