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BMC Surgery Jun 2024Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially...
Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study.
BACKGROUND
Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE STUDY: This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP.
METHODS
The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM).
RESULTS
Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%).
CONCLUSIONS
The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study's retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials.
TRIAL REGISTRATION
Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.
Topics: Humans; Female; Retrospective Studies; Pelvic Organ Prolapse; Laparoscopy; Middle Aged; Aged; Surgical Mesh; Treatment Outcome; Vagina; Rectum; Defecation; Postoperative Complications; Gynecologic Surgical Procedures; Syndrome; Constipation
PubMed: 38877450
DOI: 10.1186/s12893-024-02474-4 -
Journal of Cranio-maxillo-facial... Jun 2024The orbital cavity is a subject of interest for various specialists, and achieving optimal outcomes requires comprehensive, multidisciplinary management. This study aims...
The orbital cavity is a subject of interest for various specialists, and achieving optimal outcomes requires comprehensive, multidisciplinary management. This study aims to report 10 years of experience in the preoperative, surgical, and postoperative care of patients with orbital lesions, examining their clinical, radiological, and anatomopathological features and outcomes. A retrospective review of 125 patients who underwent surgical treatment for intraorbital masses between January 2012 and December 2021 was performed. Outcome measures included postoperative diplopia, exophthalmos, decimal visual acuity, eyeball position, ocular motility, operative time, complications, and aesthetic results. A total of 107 patients were included. All cases were discussed with a neuroradiologist to determine the best therapeutic approach based on preoperative imaging. Preoperative diplopia was linked to extraconal (p = 0.03) and anterior (p = 0.001) lesions, and exophthalmos and visual acuity deterioration were associated with intraconal (p = 0.02; p = 0.03) and retrobulbar (p = 0.001; p = 0.02) lesions. Complications (11.2%) included diplopia, worsened visual acuity, postoperative blepharoptosis, and postoperative ectropion. Of the patients, 80.4% reported an "excellent" aesthetic outcome. This study underscores the importance of a multidisciplinary approach based on a thorough analysis of preoperative imaging. Periorbital approaches tailored to the lesion's three-dimensional location enables safe access to most intraorbital lesions, resulting in minimal complications and good aesthetic results.
PubMed: 38876957
DOI: 10.1016/j.jcms.2024.06.019 -
International Journal of Surgery Case... Jul 2024Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical...
INTRODUCTION AND IMPORTANCE
Perineal hernias are protrusions of intra-abdominal contents resulting from weakness of the pelvic floor muscles. They are an uncommon complication after ultraradical pelvic surgeries, with no established gold standard for surgical treatment. This case describes a rare anterior perineal hernia that developed after radical surgery for bladder carcinoma.
CASE PRESENTATION
A 77-year-old Caucasian woman presented with a painful 10 cm bulge in the perineal region. The hernial sac involved the entire left labia majora and developed 4 years after radical surgery for bladder carcinoma. She had been misdiagnosed twice in the past with vaginal prolapse, leading to two unsuccessful vaginoplasty procedures due to recurrence. She underwent hernia repair with perineal approach and polypropylene mesh placement. The postoperative period was uncomplicated, and the patient was discharged after five days, with histology showing no malignancy.
CLINICAL DISCUSSION
Perineal hernias are protrusions of intra- or extraperitoneal contents into the perineum due to a defect in the pelvic musculature. Various surgical modalities exist for perineal hernia repair, which adhere to the fundamental principles of hernia surgery: sac mobilization, precise incision, sac debridement and excision, and defect repair. Here, we successfully applied the perineal approach in a complicated case of a misdiagnosed perineal hernia after radical surgery.
CONCLUSION
The perineal approach for hernia repair, involving an implantation of a polypropylene mesh and tissue flap was successfully applied, confirming its main place in the surgical treatment of perineal hernias. During the two-year follow-up no postoperative complications or recurrence hernia were registered.
PubMed: 38875825
DOI: 10.1016/j.ijscr.2024.109859 -
Medicine Jun 2024Oculomotor nerve palsy (ONP) is often discovered in the ophthalmology department, manifested as ptosis with the same side, eyeball in the fixed external booth, or...
INTRODUCTION
Oculomotor nerve palsy (ONP) is often discovered in the ophthalmology department, manifested as ptosis with the same side, eyeball in the fixed external booth, or accompanied by limited inward, upward, and downward movements. The present case report described the effect of electroacupuncture (EA) on a breast cancer patient with ONP after chemotherapy.
PATIENT CONCERNS
A 56-year-old breast cancer patient presented with severe ptosis and fixed right eye exotropia. Besides, it is challenging to perform the movement inward, upward, and downward, and with obvious diplopia.
DIAGNOSES
The breast cancer patient was diagnosed with ONP, chemotherapy history.
INTERVENTIONS
The patient was introduced to acupuncture department to receiving EA treatment.
OUTCOMES
After 12 times of EA treatments, the symptom of ptosis was significantly improved, and the right upper eyelid can lift autonomously as same as the left eye. Besides, the patient's right lateral eye could move freely, and the symptoms of double vision disappeared.
CONCLUSION
The case suggests that EA may be an effective alternative treatment for ONP.
Topics: Humans; Female; Middle Aged; Electroacupuncture; Oculomotor Nerve Diseases; Breast Neoplasms; Blepharoptosis; Antineoplastic Agents
PubMed: 38875429
DOI: 10.1097/MD.0000000000038547 -
Frontiers in Neurology 2024The pattern of extraocular muscle involvement in ocular myasthenia gravis varies across different reports, diverging from our own observations. Thus, we employed two...
Investigation of the differential susceptibility of extraocular muscles in patients diagnosed with ocular myasthenia gravis based on the computerized diplopia test and the Ocular Motor Nerve Palsy Scale.
INTRODUCTION
The pattern of extraocular muscle involvement in ocular myasthenia gravis varies across different reports, diverging from our own observations. Thus, we employed two novel tools to discern this pattern.
METHODS
A retrospective analysis was conducted to collect and organize clinical data from 43 patients diagnosed with ocular myasthenia gravis. Each patient underwent both the computerized diplopia test and the Ocular Motor Nerve Palsy Scale assessment to evaluate the involvement of extraocular muscles.
RESULTS
Among the patients, there were 30 male and 13 female individuals, with a total of 113 affected extraocular muscles identified. Among all the affected extraocular muscles, the involvement of the levator palpebrae superioris muscle accounted for 35.40%, medial rectus muscle 7.7%, lateral rectus muscle 16.81%, superior rectus muscle 13.27%, inferior rectus muscle 12.39%, superior oblique muscle 1.77%, and inferior oblique muscle 2.65% of the total affected extraocular muscles. The positivity rates of the Neostigmine test were 89.19%, AChR antibody detection was 59.38%, and repetitive nerve stimulation was 34.38%. The AChR antibody positive rate among patients with only diplopia was 100%; among those with only ptosis, it was 80%; and among those with both diplopia and ptosis, it was 86.67%.
CONCLUSION
The involvement of the extraocular muscles is not uniform. The levator palpebrae superioris exhibits the highest incidence rate, followed by the four rectus muscles and two oblique muscles. The inferior oblique involvement typically occurs when four or more EOMs are affected. Moreover, the levator palpebrae superioris and medial rectus show a higher tendency for bilateral involvement compared with other extraocular muscles.
PubMed: 38872815
DOI: 10.3389/fneur.2024.1353248 -
Journal of the Turkish German... Jun 2024The objective of this study was to evaluate the sexual function and quality of life in female patients diagnosed with stress urinary incontinence (SUI) and pelvic organ...
OBJECTIVE
The objective of this study was to evaluate the sexual function and quality of life in female patients diagnosed with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) after undergoing transobturator tape (TOT) or TOT with POP surgery and perineoplasty.
MATERIAL AND METHODS
This prospective study population (n=86) consisted of sexually active women who had been diagnosed with SUI. Forty-six patients diagnosed with SUI with no POP (group 1) underwent TOT procedure only. Forty patients had a diagnosis of stage 2 and higher POP, based on POP quantification system with SUI (group 2). The second group was randomized as TOT-POP surgery (n=20) and TOT-POP surgery with perineoplasty (n=20). Prior to and six months after the surgical procedure, all female participants underwent assessment using the validated Urinary Distress Pre-Operative Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ).
RESULTS
Post-operative IIQ-7 and UDI-6 scores were significantly lower for all three groups compared to the preoperative period, while a significant increase was observed in PISQ scores (p<0.01). The dissimilarity in preoperative and postoperative IIQ-7 and UDI-6 scores exhibited comparable results across the groups, whereas the variance in PISQ scores was notably greater in the TOT + POP surgery + perineoplasty group (p=0.03).
CONCLUSION
Women with SUI or SUI with POP have better quality of life and sexual dysfunction after surgery. Perineoplasty may enhance sexual life in patients with perineal defect and vaginal enlargement.
PubMed: 38869033
DOI: 10.4274/jtgga.galenos.2024.2023-1-13 -
Plastic and Reconstructive Surgery.... Jun 2024Patients with previous breast augmentation may need implant removal for mechanical complications or other causes. After prosthesis removal, the residual parenchyma can...
BACKGROUND
Patients with previous breast augmentation may need implant removal for mechanical complications or other causes. After prosthesis removal, the residual parenchyma can be reshaped through a mastopexy with rearrangement of breast tissue. Several techniques have been described in the literature, but none of them can be considered the gold standard. In this study, we present our preliminary experience in breast tissue rearranging after implant removal through a novel technique: the "octopus head" dermoglandular flap.
METHODS
From January 2019 to October 2022, nine patients (18 breasts) underwent implant removal and simultaneous breast remodeling with the tissue obtained from the dermoglandular excess of the breast and shaped like an octopus head. Patient's demographic and clinical characteristics, postoperative complications, and patient-reported satisfaction were recorded.
RESULTS
Mean age was 46.7 years. Body mass index ranged between 22.5 and 27.6 kg per m. The majority of patients had moderate ptosis (67%). Breast implants were removed due to bilateral capsular contracture (n = 3), unilateral implant rupture with contralateral capsular contracture (n = 2), bilateral implant rupture (n = 3), and unilateral periprosthetic seroma (n = 1). We observed two minor complications: one postoperative hemorrhage with subsequent hematoma that was managed conservatively, and one nipple-areola complex malposition that underwent revision surgery. All patients were satisfied with the aesthetic and functional result.
CONCLUSIONS
The octopus head dermoglandular flap has proved to be a safe and reliable option for breast tissue rearranging after implant removal, providing a good and stable cosmetic result, a low complication rate, and high patient-reported satisfaction.
PubMed: 38868620
DOI: 10.1097/GOX.0000000000005882 -
Stem Cell Research Aug 2024Human iPSC line, SDHi001-A, was generated from 65-year-old male patient with mitral valve prolapse, using non-integrative reprogramming method. This cell line shows...
Human iPSC line, SDHi001-A, was generated from 65-year-old male patient with mitral valve prolapse, using non-integrative reprogramming method. This cell line shows pluripotency both in vitro and in vivo, and has a normal karyotype.
Topics: Humans; Induced Pluripotent Stem Cells; Mitral Valve Prolapse; Aged; Male; Cell Line; Cell Differentiation
PubMed: 38865834
DOI: 10.1016/j.scr.2024.103464 -
Laryngoscope Investigative... Jun 2024During the COVID-19 pandemic, elective surgeries faced cancelations due to quarantine measures. The objective of this study was to assess facial plastic and...
OBJECTIVE
During the COVID-19 pandemic, elective surgeries faced cancelations due to quarantine measures. The objective of this study was to assess facial plastic and reconstructive surgery (FPRS) volume before, during, and after the height of the pandemic on a national scale.
METHODS
The TriNetX Research Network identified 68,101,098 individuals aged 18+ with healthcare interactions from 2017 to 2022. Rates of common FPRS surgeries and procedures were compared during March-August of each year, aligning with the pandemic lockdown.
RESULTS
Compared to immediately before the pandemic in 2019, the 2020 pandemic peak saw an overall surgical volume reduction of -36.8%, with specific surgeries decreasing significantly: rhinoplasty (-28.6%), septoplasty (-34.0%), rhytidectomy (-54.9%), blepharoplasty (-40.7%), brow lift (-43.8%), ectropion/entropion repair (-35.6%), repair of blepharoptosis (-45.6%), correction of lagophthalmos (-29.9%), correction of lid retraction (-36.8%), and lipectomy (-41.8%) ( < .001). The procedural volume also decreased by 28.6%, encompassing reductions in various procedures: botulinum toxin A (-18.7%), facial filler (-40.7%), dermabrasion (-62.3%), chemical peel (-36.6%), and intralesional injection (-33.3%) ( < .001). In contrast to 2020, 2021 witnessed an increase of +75.0% in total surgical and +61.3% procedural volume: rhinoplasty (+81.0%), septoplasty (+74.7%), rhytidectomy (+143.4%), blepharoplasty (+81.7%), brow lift (+64.5%), ectropion/entropion repair (+55.2%), repair of blepharoptosis (+62.7%), correction of lagophthalmos (+39.0%), correction of lid retraction (+73.0%), lipectomy (+121.2%), botulinum toxin A (+52.4%), filler (+59.6%), dermabrasion (+91.8%), chemical peel (+78.8%), and intralesional injection (+67.3%) ( < .001). In 2022, rates of total surgeries (+8.5%) and procedures (+12.8%) surpassed pre-pandemic levels from 2019 ( < .001).
CONCLUSIONS
FPRS experienced significant pandemic-induced decreases, followed by a notable recovery in subsequent years, with certain surgeries and procedures surpassing pre-pandemic levels.
LEVEL OF EVIDENCE
4.
PubMed: 38864000
DOI: 10.1002/lio2.1292