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Acta Biomaterialia Jun 2024Surgical meshes play a significant role in the treatment of various medical conditions, such as hernias, pelvic floor issues, guided bone regeneration, and wound... (Review)
Review
Surgical meshes play a significant role in the treatment of various medical conditions, such as hernias, pelvic floor issues, guided bone regeneration, and wound healing. To date, commercial surgical meshes are typically made of non-absorbable synthetic polymers, notably polypropylene and polytetrafluoroethylene, which are associated with postoperative complications, such as infections. Biological meshes, based on native tissues, have been employed to overcome such complications, though mechanical strength has been a main disadvantage. The right balance in mechanical and biological performances has been achieved by the advent of bioresorbable meshes. Despite improvements, recurrence of clinical complications associated with surgical meshes raises significant concerns regarding the technical adequacy of current materials and designs, pointing to a crucial need for further development. To this end, current research focuses on the design of meshes capable of biomimicking native tissue and facilitating the healing process without post-operative complications. Researchers are actively investigating advanced bioresorbable materials, both synthetic and natural biopolymers, while also exploring the performance of therapeutic agents, surface modification methods and advanced manufacturing technologies such as 4D printing. This review seeks to evaluate emerging biomaterials and technologies for enhancing the performance and clinical applicability of the next-generation of surgical meshes. STATEMENT OF SIGNIFICANCE: In the ever-transforming landscape of regenerative medicine, the embracement of engineered bioabsorbable surgical meshes stands as a key borderline in addressing persistent challenges and complications associated with existing treatments. The urgency to move beyond conventional non-absorbable meshes, fraught with post-surgery complications, emphasises the necessity of using advanced biomaterials for engineered tissue regeneration. This review critically examines the growing field of absorbable surgical meshes, considering their potential to transform clinical practice. By strategically marrying mechanical strength with bioresorbable characteristics, these innovative meshes hold the promise of mitigating complications and improving patient outcomes across diverse medical applications. As we navigate the complexities of current medicine, this exploration of engineered absorbable meshes emerges as a light of hope, offering an overall perspective on biomaterials, technologies, and strategies adopted to redefine the future of surgical meshes.
PubMed: 38879102
DOI: 10.1016/j.actbio.2024.06.012 -
International Journal of Surgery Case... Jun 2024Craniocerebral wounds are potentially serious and life-threatening injuries. These are real medical and surgical emergencies. The authors report a case of craniocerebral...
INTRODUCTION AND IMPORTANCE
Craniocerebral wounds are potentially serious and life-threatening injuries. These are real medical and surgical emergencies. The authors report a case of craniocerebral injury in a child with extensive craniotomy and its management in a hospital with limited resources in Togo.
CASE REPORT
He was a young 11-year-old schoolboy who presented with an extensive craniocerebral injury with craniotomy after a road traffic accident. On admission, he had no focal neurological deficits or other signs related to an intracranial expansive process. After preoperative reanimation, antibiotic therapy and anti-tetanus serovaccination, he was taken to the operating room by general surgeons. He underwent lavage, suture of the dura mater, placement of the bone flap and suture of the scalp wound. The postoperative course was simple.
CLINICAL DISCUSSION
Cranioencephalic trauma is one of the main causes of pediatric mortality in developing countries. Cranio-cerebral wounds are a therapeutic emergency because of the risk of infection, which remains the main concern. Treatment consists of a medical component followed by a surgical component. Reanimation remains an essential component of medical treatment.
CONCLUSION
Craniocerebral wounds are serious injuries. It requires rapid and appropriate medical and surgical management to avoid complications, particularly infection.
PubMed: 38878734
DOI: 10.1016/j.ijscr.2024.109883 -
World Journal of Emergency Surgery :... Jun 2024Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes.
AIM
To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes.
METHODS
A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24-48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed.
RESULTS
Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups.
CONCLUSION
Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24-48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.
Topics: Humans; Appendectomy; Appendicitis; Length of Stay; Network Meta-Analysis; Time Factors; Postoperative Complications; Time-to-Treatment; Treatment Outcome; Operative Time
PubMed: 38877592
DOI: 10.1186/s13017-024-00549-4 -
Journal of Orthopaedic Surgery and... Jun 2024Postoperative pulmonary complications (PPCs) are among the most severe complications following total hip arthroplasty revision (THAR), imposing significant burdens on...
BACKGROUND
Postoperative pulmonary complications (PPCs) are among the most severe complications following total hip arthroplasty revision (THAR), imposing significant burdens on individuals and society. This study examined the prevalence and risk factors of PPCs following THAR using the NIS database, identifying specific pulmonary complications (SPCs) and their associated risks, including pneumonia, acute respiratory failure (ARF), and pulmonary embolism (PE).
METHODS
The National Inpatient Sample (NIS) database was used for this cross-sectional study. The analysis included patients undergoing THAR based on NIS from 2010 to 2019. Available data include demographic data, diagnostic and procedure codes, total charges, length of stay (LOS), hospital information, insurance information, and discharges.
RESULTS
From the NIS database, a total of 112,735 THAR patients in total were extracted. After THAR surgery, there was a 2.62% overall incidence of PPCs. Patients with PPCs after THAR demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. The following variables have been determined as potential risk factors for PPCs: advanced age, pulmonary circulation disorders, fluid and electrolyte disorders, weight loss, congestive heart failure, metastatic cancer, other neurological disorders (encephalopathy, cerebral edema, multiple sclerosis etc.), coagulopathy, paralysis, chronic pulmonary disease, renal failure, acute heart failure, deep vein thrombosis, acute myocardial infarction, peripheral vascular disease, stroke, continuous trauma ventilation, cardiac arrest, blood transfusion, dislocation of joint, and hemorrhage.
CONCLUSIONS
Our study revealed a 2.62% incidence of PPCs, with pneumonia, ARF, and PE accounting for 1.24%, 1.31%, and 0.41%, respectively. A multitude of risk factors for PPCs were identified, underscoring the importance of preoperative optimization to mitigate PPCs and enhance postoperative outcomes.
Topics: Humans; Arthroplasty, Replacement, Hip; Risk Factors; Postoperative Complications; Male; Female; Retrospective Studies; Incidence; Aged; Middle Aged; Cross-Sectional Studies; Databases, Factual; Pulmonary Embolism; Reoperation; Length of Stay; Lung Diseases; United States; Pneumonia; Adult; Aged, 80 and over; Respiratory Insufficiency; Inpatients
PubMed: 38877587
DOI: 10.1186/s13018-024-04836-3 -
BMC Urology Jun 2024Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis... (Comparative Study)
Comparative Study
PURPOSE
Circumcision is the most common surgical procedures performed in males. Medical circumcision is recommended for diseases such as phimosis, paraphimosis, balanoposthitis and common urinary tract infections, although there is no exact indication. Conversely, Jewish and Muslim individuals commonly undergo circumcision regardless of medical necessity. Circumcision devices are designed to shorten surgery time, achieve an aesthetic appearance and ensure safe surgery. The aim of this study is to evaluate the effectiveness of the NeoAlis clamp, a disposable circumcision device, by comparing it with the sleeve technique in children.
MATERIALS AND METHODS
Between 2017 and 2023, retrospective evaluation of 2626 patients who underwent circumcision using either the NeoAlis clamp (group 1) or the sleeve technique (group 2) was conducted. Operation time, results, cost, complications were compared between the two groups.
RESULTS
The study encompassed 2626 patients who fulfilled the inclusion criteria. Group 1 comprised 2403 patients, whereas Group 2 consisted of 223 patients. The overall complication rate, as denoted by n = 47, was 1.7%. Group 1 operation time was shorter than group 2. Bleeding, the most feared complication in the early period, was higher in the second group. No statistically significant difference was observed between the two groups regarding cost comparison.
CONCLUSION
The primary concern during circumcision is to avoid complications related to general anesthesia in newborns and infants. The use of disposable ring devices has been facilitated by the shorter operation time and the absence of the need for sutures when performing circumcision under local anesthesia. However, knowledge of advanced surgical circumcision techniques is necessary in cases of bleeding and inappropriate ring placement.
Topics: Circumcision, Male; Humans; Male; Retrospective Studies; Disposable Equipment; Child; Child, Preschool; Equipment Design; Infant; Operative Time; Adolescent; Postoperative Complications
PubMed: 38877524
DOI: 10.1186/s12894-024-01513-9 -
Challenges and outcomes of upper cervical spinal tuberculosis surgery in pandemic-Case series study.International Journal of Surgery Case... Jun 2024Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was...
INTRODUCTION AND IMPORTANCE
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, primarily affecting the lungs. Conversely, the incidence of spinal tuberculosis (TB) was limited to a mere 6 % of cases of extrapulmonary tuberculosis. Upper cervical spinal TB is an exceptionally uncommon condition, with an incidence rate of approximately 0.3-1 % among all cases of spinal tuberculosis.
CASE DESCRIPTION
Three patients diagnosed with upper cervical spinal tuberculosis who underwent Anterior Cervical Corpectomy Fusion (ACCF) or Occipitocervical fusion surgery were reviewed retrospectively. The data was obtained during the pandemic period in Indonesia. The patients were evaluated using pre-operative and post-operative Cobb's angles, Visual Analog Scale (VAS), Frankel scale, and Neck Pain and Disability (NPAD) scale.
CLINICAL DISCUSSION
The ACCF surgery was more favourable when the compression was extended to the vertebral body; it showed good clinical and radiological outcomes. Multilevel ACCF and pathologies affecting bone quality seemed to be risk factors for material subsidence and instability. In this case, all the patients had performed ACCF surgery. The mean Cobb's angle pre-operative was 15.30, and Cobb's angle post-operative was 6.50. The mean pre-operative VAS value was 6.3, and the post-operative VAS value was 3. Compared to the post-operative scale, the pre-operative Frankel scale experienced an average increase of 2 levels. In contrast, the mean value of good post-operative NPAD is 29.3.
CONCLUSION
Operative procedures on upper cervical spinal tuberculosis cases can improve patient's quality of life significantly, clinically and radiologically.
PubMed: 38875826
DOI: 10.1016/j.ijscr.2024.109858 -
Turkish Neurosurgery Sep 2023This study aimed to assess the safety and efficacy of utilizing dural suturing as an adjunctive procedure for saddle floor reconstruction in patients undergoing...
AIM
This study aimed to assess the safety and efficacy of utilizing dural suturing as an adjunctive procedure for saddle floor reconstruction in patients undergoing endoscopic surgery in the sellar region.
MATERIAL AND METHODS
According to the PRISMA guidelines, we searched the literature on sellar floor reconstruction in endoscopic sellar surgery. Fixed- or random-effects meta-analysis was used to pool the rate of return to postoperative cerebrospinal fluid (poCSF) leakage, repair operations, postoperative hospitalization, complete resection, infection, lumbar drainage (LD), and operative duration.
RESULTS
A total of six studies involving 723 participants were included in the current meta-analysis. The pooled results demonstrated that patients in the dural suturing group had a lower incidence of poCSF leakage [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.07 - 0.44; p = 0.0002] and repair operation [OR, 0.24; 95% CI, 0.07 - 0.78; p = 0.02], as well as a shorter hospitalization period [standardized mean difference (SMD), -0.45; 95% CI, -0.62 - -0.28; p 0.00001]. There was no significant difference between the two groups in terms of the complete resection [OR, 1.06; 95% CI, 0.62 - 1.80; po = 0.84], po infection [OR, 0.49; 95% CI, 0.21 - 1.15; p = 0.10] and lumbar drainage (LD) [OR, 0.28; 95% CI, 0.06 - 1.23; p = 0.09]. Additionally, the dural suturing group may require a longer operative duration [SMD, 0.29; 95% CI, 0.02 - 0.56; p = 0.03].
CONCLUSIONS
The results suggest that dural suturing can be advantageous in reducing postoperative complications and shortening postoperative hospitalization following neuroendoscopic surgery in the sellar region without increasing the risk of infection.
PubMed: 38874249
DOI: 10.5137/1019-5149.JTN.44252-23.2 -
Journal of Abdominal Wall Surgery : JAWS 2024Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but...
Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center. A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed. Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients' average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; < 0.001). IS patients had more smokers (12.1% vs. 3.2%; = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9 cm; < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; < 0.001), component separations (26.2% vs. 51.4%; < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3 cm; < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5 days; < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; = 0.009), overall wound complications (11.4% vs. 21.1%; = 0.016), readmissions (2.7% vs. 13.0%; = 0.001), and reoperations (3.4% vs. 11.4%; = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes. Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.
PubMed: 38873344
DOI: 10.3389/jaws.2024.12946 -
Frontiers in Oncology 2024Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in advanced stages, necessitating pancreaticoduodenectomy (PD) as a primary therapeutic approach....
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in advanced stages, necessitating pancreaticoduodenectomy (PD) as a primary therapeutic approach. However, PD surgery can engender intricate complications. Thus, understanding the factors influencing postoperative complications documented in electronic medical records and their impact on survival rates is crucial for improving overall patient outcomes.
METHODS
A total of 749 patients were divided into two groups: 598 (79.84%) chose the RPD (Robotic pancreaticoduodenectomy) procedure and 151 (20.16%) chose the LPD (Laparoscopic pancreaticoduodenectomy) procedure. We used correlation analysis, survival analysis, and decision tree models to find the similarities and differences about postoperative complications and prognostic survival.
RESULTS
Pancreatic cancer, known for its aggressiveness, often requires pancreaticoduodenectomy as an effective treatment. In predictive models, both BMI and surgery duration weigh heavily. Lower BMI correlates with longer survival, while patients with heart disease and diabetes have lower survival rates. Complications like delayed gastric emptying, pancreatic fistula, and infection are closely linked post-surgery, prompting conjectures about their causal mechanisms. Interestingly, we found no significant correlation between nasogastric tube removal timing and delayed gastric emptying, suggesting its prompt removal post-decompression.
CONCLUSION
This study aimed to explore predictive factors for postoperative complications and survival in PD patients. Effective predictive models enable early identification of high-risk individuals, allowing timely interventions. Higher BMI, heart disease, or diabetes significantly reduce survival rates in pancreatic cancer patients post-PD. Additionally, there's no significant correlation between DGE incidence and postoperative extubation time, necessitating further investigation into its interaction with pancreatic fistula and infection.
PubMed: 38873261
DOI: 10.3389/fonc.2024.1399297 -
Open Forum Infectious Diseases Jun 2024Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of and . Infections caused by...
Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of and . Infections caused by fungi are less common and are generally caused by species. Regardless of etiology, these infections are associated with significant morbidity and mortality. We present a case of postoperative mediastinitis that occurred following a 5-vessel coronary artery bypass graft and was caused by a filamentous fungus of the genus. The patient was treated with serial debridement, liposomal amphotericin B, and isavuconazonium and was discharged from the hospital in stable condition. Fungal mediastinitis is a rare entity, and clinicians must maintain a high level of suspicion to make the diagnosis. A fungal cause of postoperative mediastinitis should be considered in patients with negative bacterial cultures, uncontrolled diabetes, or current immunosuppression or those who present weeks after surgery with a subacute onset of symptoms.
PubMed: 38872847
DOI: 10.1093/ofid/ofae302