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Cureus Apr 2024The azygos artery is an uncommon vascular variant of the anterior cerebral artery (ACA). This anomaly is associated in a high percentage with aneurysms. Management of...
The azygos artery is an uncommon vascular variant of the anterior cerebral artery (ACA). This anomaly is associated in a high percentage with aneurysms. Management of azygos ACA aneurysms represents a surgical challenge. We present five patients who underwent microsurgical treatment for distal azygos ACA aneurysms with complex morphology. Four patients showed subarachnoid hemorrhage (SAH) and one complained of sentinel headache. Early preoperative digital subtraction angiography (DSA) or computerized tomography angiography (CTA) was performed. All patients were treated by surgical clipping via an anterior interhemispheric approach. During follow-up, all patients had a satisfactory outcome, with postoperative angiograms showing complete resolution of aneurysms.
PubMed: 38784372
DOI: 10.7759/cureus.58808 -
BMC Pediatrics May 2024To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in...
PURPOSE
To compare the clinical characteristics, surgical management and prognosis of mesenteric lymphatic malformations (ML) and omental lymphatic malformations (OL) in children.
METHODS
This retrospective study included 148 ML patients and 53 OL patients who underwent surgical treatment at two centers between January 2016 and December 2022. Details about the patients' clinical characteristics, cyst characteristics, preoperative complications, surgical methods, and prognosis were retrieved and compared.
RESULTS
No significant differences in sex ratio, prenatal diagnosis, or age of diagnosis were noted between ML and OL patients. Vomiting was more common in ML patients than in OL patients (46.6% vs. 22.6%, P = 0.002), but OL patients were more likely to be misdiagnosed (35.8% vs. 18.9%, P = 0.012). The size of the cysts in OL patients was significantly larger than that in ML patients (14.0 [4.0-30.0] vs. 10.0 [2.0-50.0] cm, P<0.001), and cysts with turbid fluid were more common in OL patients (38.0% vs. 20.6%, P<0.001). More OL patients than ML patients had preoperative hemorrhage or infection of cysts (41.5% vs. 31.8%, P<0.016). Cyst excision was performed in 137 (92.6%) ML patients and 51 (96.2%) OL patients, and the incidence of postoperative complications was lower (12.6% vs. 4.2%, P = 0.165) among OL patients. The main postoperative complications included adhesive ileus and recurrence of cysts. Additionally, more OL patients than ML patients were treated with laparoscopic surgery (69.8% vs. 39.2%, P<0.001).
CONCLUSIONS
There were differences in clinical characteristics, cyst characteristics and preoperative complications between ML and OL patients. Cyst excision was the most common surgical method that was used to treat both ML and OL patients, and laparoscopic surgery could be a feasible surgical approach for treating OL patients with a good prognosis.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Humans; Retrospective Studies; Male; Female; Omentum; Infant; China; Child, Preschool; Lymphatic Abnormalities; Mesentery; Child; Postoperative Complications; Prognosis; Infant, Newborn
PubMed: 38783260
DOI: 10.1186/s12887-024-04808-w -
Acta Ortopedica Mexicana 2024the use of blood transfusions leads to increased hospital costs and an increased risk of medical complications and death. Therefore, it is necessary to study the... (Observational Study)
Observational Study
INTRODUCTION
the use of blood transfusions leads to increased hospital costs and an increased risk of medical complications and death. Therefore, it is necessary to study the incidence of major bleeding events and the factors associated with these outcomes in patients undergoing primary total hip arthroplasty (THA).
MATERIAL AND METHODS
observational, longitudinal and prospective study, carried out at the High Specialty Medical Unit of Traumatology and Orthopedics of Lomas Verdes of the Mexican Institute of Social Security, in the Joint Replacement Service, in the period from March 1, 2020 to July 1, 2020.
RESULTS
the incidence of major bleeding in patients undergoing primary THA was 84.8%, when considering two criteria: a decrease in hemoglobin 2 g/dl and the need for transfusion 2 units of red blood cells. This figure increased to 87.1% when also including trans-surgical bleeding at its 75th percentile, equivalent to 500 ml. Transfusion of at least one unit of red blood cells during surgery was performed in 68% of patients. Trans-surgical bleeding reached a maximum of 1,900 ml, with a 75th percentile of 500 ml. Unlike other studies, in our institution, female gender did not prove to be a significant risk factor for major bleeding.
CONCLUSION
it is advisable to analyze the procedures and particularities of THA surgery that may be associated with a lower risk of bleeding in older patients.
Topics: Humans; Arthroplasty, Replacement, Hip; Female; Male; Prospective Studies; Aged; Middle Aged; Risk Factors; Longitudinal Studies; Postoperative Hemorrhage; Incidence; Blood Loss, Surgical; Blood Transfusion; Adult; Aged, 80 and over; Mexico; Sex Factors
PubMed: 38782473
DOI: No ID Found -
Langenbeck's Archives of Surgery May 2024Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk... (Meta-Analysis)
Meta-Analysis
PURPOSE
Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB).
METHODS
We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses.
RESULTS
23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB.
CONCLUSION
Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.
Topics: Humans; Gastric Bypass; Risk Factors; Postoperative Hemorrhage; Obesity, Morbid; Risk Assessment
PubMed: 38775865
DOI: 10.1007/s00423-024-03346-4 -
Frontiers in Medicine 2024This study was aimed to summarize the complications and their management associated with XEN gel stent implantation. (Review)
Review
AIM
This study was aimed to summarize the complications and their management associated with XEN gel stent implantation.
METHODS
A systematic review of literature was conducted using Medline (via PubMed), EMBASE, the Cochrane Library databases, and China National Knowledge Infrastructure, from their inception to February 1, 2024.
RESULTS
A total of 48 studies published between 2017 and 2024 were identified and included in the systematic review, including 16 original studies (retrospective or prospective clinical studies), 28 case reports, and 4 case series, which followed patients for up to 5 years. Early postoperative complications of XEN gel stent implantation include hypotony maculopathy (1.9-4.6%), occlusion (3.9-8.8%), suprachoroidal hemorrhage (SCH), choroidal detachment (0-15%), conjunctival erosion, and exposure of the XEN gel stent (1.1-2.3%), wound and bleb leaks (2.1%) and malignant glaucoma (MG) (2.2%). Mid-postoperative complications of XEN gel stent implantation included migration of XEN (1.5%), ptosis (1.2%), endophthalmitis (0.4-3%), macular edema (1.5-4.3%), hypertrophic bleb (8.8%) and subconjunctival XEN gel stent fragmentation (reported in 2 cases). Late postoperative complications reported in cases included spontaneous dislocation and intraocular degradation.
CONCLUSION
XEN gel stent implantation is a minimally invasive glaucoma surgery (MIGS) procedure for glaucoma, known for its potential to minimize tissue damage and reduce surgical duration. However, it is crucial to note that despite these advantages, there remains a risk of severe complications, including endophthalmitis, SCH, and MG. Therefore, postoperative follow-up and early recognition of severe complications are essential for surgical management.
PubMed: 38770050
DOI: 10.3389/fmed.2024.1360051 -
Asian Journal of Surgery May 2024Conventional hemorrhoidectomy is the mainstay of treatment for symptomatic haemorrhoids, but reported postoperative complications remains the main concern. On the... (Review)
Review
Conventional hemorrhoidectomy is the mainstay of treatment for symptomatic haemorrhoids, but reported postoperative complications remains the main concern. On the contrary, with its minimally invasive nature, laser hemorrhoidoplasty showed the potential to reduce postoperative complications and discomfort. Therefore, we performed a systemic review and meta-analysis to evaluate the postoperative outcome of laser hemorrhoidoplasty compared to conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques. Of all studies from PubMed, EMBASE, Cochrane database, and Google Scholar, we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy. The primary outcomes were operative blood loss and postoperative haemorrhage, and the secondary outcomes were the operative time, postoperative pain score, complications, and haemorrhoid recurrence. In this study, we found that laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy. However, incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups. Consistent results were found in 5 subgroup analyses, including studies with low risk of bias, studies using 1470 nm laser, and studies using 980 nm laser, studies conducted in Asia, and studies conducted in Europe and America.
PubMed: 38762410
DOI: 10.1016/j.asjsur.2024.04.156 -
Trials May 2024The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial...
Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial.
BACKGROUND
The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.
METHODS
We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.
DISCUSSION
This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.
TRIAL REGISTRATION
UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
Topics: Humans; Prospective Studies; Abdominal Wound Closure Techniques; Abdominal Wall; Suture Techniques; Surgical Wound Infection; Digestive System Surgical Procedures; Incisional Hernia; Elective Surgical Procedures; Treatment Outcome; Incidence; Wound Healing; Equivalence Trials as Topic; Randomized Controlled Trials as Topic; Time Factors
PubMed: 38760769
DOI: 10.1186/s13063-024-08167-w -
Surgery May 2024Clinically relevant postpancreatectomy hemorrhage occurs in 10% to 15% of patients after pancreaticoduodenectomy, mainly in association with clinically relevant...
BACKGROUND
Clinically relevant postpancreatectomy hemorrhage occurs in 10% to 15% of patients after pancreaticoduodenectomy, mainly in association with clinically relevant postoperative pancreatic fistula. Prevention of postpancreatectomy hemorrhage by arterial coverage with a round ligament plasty or an omental flap is controversial. This study assessed the impact of arterial coverage with an original retromesenteric omental flap on postpancreatectomy hemorrhage after pancreaticoduodenectomy.
METHODS
This single-center retrospective study included 812 open pancreaticoduodenectomies (2012-2021) and compared 146 procedures with arterial coverage using retromesenteric omental flap to 666 pancreaticoduodenectomies without arterial coverage. The Fistula Risk Score was calculated. The primary endpoint was a 90-day clinically relevant postpancreatectomy hemorrhage rate according to the International Study Group of Pancreatic Surgery classification.
RESULTS
There were more patients with a Fistula Risk Score ≥7 in the arterial coverage-retromesenteric omental flap group: 18 (12%) versus 48 (7%) (P < .01). Clinically relevant postpancreatectomy hemorrhage was less frequent in the arterial coverage- retromesenteric omental flap group than in the no arterial coverage group: 5 (3%) versus 66 (10%), respectively (P = .01). Clinically relevant postoperative pancreatic fistula occurred in 28 (19%) patients in the arterial coverage- retromesenteric omental flap group compared with 165 (25%) in the no arterial coverage group (P = .001). There were fewer reoperations for postpancreatectomy hemorrhage or postoperative pancreatic fistula in the arterial coverage- retromesenteric omental flap group: 1 (0.7%) versus 32 (5%) in the no arterial coverage group (P = .023). In multivariate analysis, arterial coverage with retromesenteric omental flap was an independent protective factor of clinically relevant postpancreatectomy hemorrhage (odds ratio 0.33; 95% confidence interval [0.12-0.92], P = .034) whereas postoperative pancreatic fistula of any grade (odds ratio = 10.1; 95% confidence interval: 5.1-20.3, P < .001) was predictive of this complication.
CONCLUSION
Arterial coverage with retromesenteric omental flap can reduce rates of clinically relevant postpancreatectomy hemorrhage after pancreaticoduodenectomy. This easy and costless technique should be prospectively evaluated to confirm these results.
PubMed: 38760227
DOI: 10.1016/j.surg.2024.03.039 -
Technology and Health Care : Official... 2024Spleen Epstein-Barr Virus (EBV)-positive inflammatory follicular dendritic cell sarcoma (FDCS) is rare, and the imaging signs are unclear. The COVID-19 has been...
BACKGROUND
Spleen Epstein-Barr Virus (EBV)-positive inflammatory follicular dendritic cell sarcoma (FDCS) is rare, and the imaging signs are unclear. The COVID-19 has been confirmed to be the cause of pneumonia and can cause a variety of diseases including myocarditis. However, it has not been reported to be the cause of the exacerbation or activation of EBV-positive inflammatory FDCS.
OBJECTIVE
The objective is to extract the imaging features of EBV-positive inflammatory FDCS in the spleen and analyze the reasons for the special features of this case.
METHODS
By analyzing the patient's treatment process and imaging examinations (A 77-year-old female was admitted to the hospital due to generalized discomfort and pain symptoms. When she was admitted to the hospital a year earlier with COVID-19 pneumonia, a chest CT scan showed that she had a splenic tumor. During this admission, CT scans showed two irregularly shaped and unevenly dense soft tissue density masses within the spleen, with uneven enhancement on contrast-enhanced im-aging within the solid components and along the edges. PET/CT scans revealed elevated glucose metabolism in the masses. Postoperative pathological diagnosis confirmed splenic EBV-positive inflammatory FDCS.), reading the literature, sorting out the disease cognitive process, epidemiology, and pathological data of EBV-positive inflammatory FDCS, we discussed the imaging manifestations and possible differential diagnosis of the disease.
RESULTS
The patient was finally diagnosed with splenic EBV-positive inflammatory FDCS.
CONCLUSIONS
Imaging features of EBV-positive inflammatory FDCS in the spleen include a high incidence of hemorrhage and necrosis, persistent moderate enhancement of the solid portion, a "capsular-like enhancement" structure at the tumor edge, and possibly active glucose metabolism with high Standardized Uptake Values (SUVs). COVID-19 infection and long-term COVID-19 sequelae may exacerbate and activate EBV-positive inflammatory FDCS in the spleen, and the mechanism remains to be further studied.
Topics: Humans; Female; Aged; Dendritic Cell Sarcoma, Follicular; Epstein-Barr Virus Infections; Positron Emission Tomography Computed Tomography; COVID-19; Splenic Neoplasms; Spleen; Herpesvirus 4, Human; Tomography, X-Ray Computed; SARS-CoV-2
PubMed: 38759066
DOI: 10.3233/THC-248038 -
Alternative Therapies in Health and... May 2024Cirrhotic portal hypertension and associated opening of collateral circulation, improper feeding or sudden increase of abdominal pressure are the causes of esophageal...
BACKGROUND
Cirrhotic portal hypertension and associated opening of collateral circulation, improper feeding or sudden increase of abdominal pressure are the causes of esophageal and gastric variceal bleeding. Esophageal and gastric variceal bleeding is one of the most common and serious complications during decompensation of cirrhosis. Endoscopic surgery is an effective method for treating esophageal and gastric variceal hemorrhage. Still, postoperative health management is required to reduce the occurrence of rebleeding and improve the quality of life of patients with esophageal and gastric variceal hemorrhage.
OBJECTIVE
Our study aims to assess the impact of a health management program on the clinical efficacy, rebleeding rate, varicose vein disappearance, self-management ability, and quality of life of patients who have undergone endoscopic surgery for esophageal and gastric variceal hemorrhage.
DESIGN
This was a retrospective study.
SETTING
This study was performed in the Department of Gastroenterology, Taihe County People's Hospital, due that all the author came to take up positions in the hospital.
PARTICIPANTS
A total of 80 esophageal and gastric variceal hemorrhage patients who received endoscopic surgery in our hospital from January 2020 to January 2022 were selected as the research subjects and were divided into a study group and control group based on the random number table method, with 40 patients in each group. There were 59 males and 11 females, aged from 29 to 81 years old. For Child-Pugh classification of liver function, there were 27 cases in grade A, 34 cases in grade B and 19 cases in grade C.
INTERVENTIONS
Patients in both groups received endoscopic treatment. Postoperative health management procedures were implemented in the observation group, including establishing a health management team, health management including self-psychological counseling, daily diet management, rest management, medication management, and complications prevention and management and procedure implementation including pre-discharge guidance and follow up after discharge. Routine health management was implemented in the control group, including understanding the lifestyle and disease control status of patients after treatment, giving health education and guidance, including diet, daily exercise, intervention drugs, psychological state, and other aspects, and reminding patients to return to the hospital outpatient clinic once a time after discharge.
PRIMARY OUTCOME MEASURES
(1) clinical efficacy (2) rebleeding rate (3) varicose vein disappearance (4) self-management ability, and (5) quality of life.
RESULTS
The total clinical effective rate was 92.5% in the observation group and 82.5% in the control group (P < .05). The rebleeding rate and varicose vein disappearance rate were 2.5% and 70.0% in the observation group, presented better relative to those of 12.5% and 55% in the control group, respectively (P < .05). After intervention, the scores of self-management ability [(18.27±3.11) points, (17.84±3.64) points, (17.17±3.10) points and (18.34±3.32) points vs (16.08±2.86) points, (15.10±2.86) points, (15.48±2.54) points and (16.18±2.84) points] and quality of life [(78.23±8.10) points, (79.06±6.62) points, (78.12±3.10) points and (80.15±7.12) points vs (64.11±6.46) points, (65.15±2.36) points, (65.48±2.57) points and (72.16±2.97) points] in the observation group were higher than the control group (P < .05).
CONCLUSION
The implementation of a health management program in esophageal and gastric variceal hemorrhage patients after endoscopic treatment is helpful to improve the clinical effect of endoscopic treatment, reduce the rebleeding rate and varicose veins, and improve the self-management ability and quality of life of patients, which has important clinical significance.
PubMed: 38758139
DOI: No ID Found