Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
In cases of auricular surgery, postoperative dressings are thought to be important for\nkeeping auricular contour and in helping to prevent from dressing failures due to\nedema or subcutaneous hematoma, which may result in fibrous or cartilaginous proliferation.\nHowever, it is often difficult to achieve success with standard dressings\nbecause of the complicated shape of the auricle. We used 2-octyl-cyanoacrylate skin\nadhesive to dress the auricle after different types of auricular procedures (five cases\nof cryptotia, two of prominent ear, two of severe auricular laceration, two of skin\ngrafting and one of flap repair of the partial auricle defect). The 2-octyl-cyanoacrlaate\nskin adhesive was applied to the suture line and the operated and peripheral\nareas for wider coverage. No dressing materials were placed over the surface. In all\ncases, the desired outcome was achieved, without subcutaneous hematoma, wound\ndehiscence, and wound infection. Contact dermatitis caused by the skin adhesive was\nnot observed in any of the cases. Dressing and splinting after auricular surgery can be\nsimply and successfully achieved using 2-octyl-cyanoacrylate skin adhesive. There is\nno need for more complicated dressings and post-surgical dressing changes, resulting\nin higher patient satisfaction....
Background: Unlike developed countries where adult primary cleft lip and palate\ncases are barely nonexistent, developing countries still have a backlog of adults with\nunrepaired cleft lip and palate. Method: A retrospective review of adult/adolescent\ncleft lip repair under local anesthesia was performed between 2012 and 2015. Results:\nFifty six (56) adolescent and adults were seen comprising 35 females and 21\nmales. Forty two patients presented with unrepaired unilateral cleft lip of which only\n6 were complete; 4 were unrepaired bilateral cleft lip and 10 were revisions. The lowest\nage was 13 years (two patients) and the highest age was 66 years (one patient).\nThe mean weight was 54 kg. The mean anaesthetic time including waiting time was\n12.94 minutes and mean operation time was 56.52 minutes. Majority of the patients\nwere discharged same day except for five who needed to stay overnight because of\ndistance from their home. There were no reported early postoperative complications\nand wound healing was uneventful for all the patients. Conclusion: Cleft lip repair in\nadults under local anesthesia is safe, effective and less expensive. A modification in\ntechnique with minimal dissection and efficiency is essential in such cases....
Background: To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices\n(MAD) in the treatment of persistent sleep apnea after surgery.\nMethods: Nineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and\nhyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at\nleast 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations.\nResults: After the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 Ã?± 13.1/h to 10.\n1 Ã?± 5.6/h in the responder group. The response rate was 57.9% (11/19). During sleep apnea/hypopnea acquired from\nsedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged\nsignificantly from 4.2 Ã?± 6.0 mm2 to 17.5 Ã?± 15.3 mm2, 1.9 Ã?± 2.3 mm to 6.5 Ã?± 4.1 mm, and 1.1 Ã?± 1.3 mm to 2.6 Ã?± 2.1 mm,\nrespectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly\nfrom 83.3 Ã?± 21.8% to 46.5 Ã?± 27.1%. The glossopharyngeal collapsibility decreased from 39.8 Ã?± 39.1% to âË?â??22.9 Ã?± 73.2% (P\n< 0.05).\nConclusion: MAD can be an effective alternative treatment for patients with moderate and severe OSAHS after\nsurgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the\nvelopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal\ncollapsibility, and the stabilization of the upper airway....
Background: Appendectomy is the most common surgical procedure performed in emergency surgery. Because\nof lack of consensus about the most appropriate technique, appendectomy is still being performed by both open\n(OA) and laparoscopic (LA) methods. In this retrospective analysis, we aimed to compare the laparoscopic approach\nand the conventional technique in the treatment of acute appendicitis.\nMethods: Retrospectively collected data from 593 consecutive patients with acute appendicitis were studied. These\ncomprised 310 patients who underwent conventional appendectomy and 283 patients treated laparoscopically. The\ntwo groups were compared for operative time, length of hospital stay, postoperative pain, complication rate, return\nto normal activity and cost.\nResults: Laparoscopic appendectomy was associated with a shorter hospital stay (2.7 Ã?± 2.5 days in LA and 1.4 Ã?± 0.6 days\nin OA), with a less need for analgesia and with a faster return to daily activities (11.5 Ã?± 3.1 days in LA and 16.1 Ã?± 3.3 in\nOA). Operative time was significantly shorter in the open group (31.36 Ã?± 11.13 min in OA and 54.9 Ã?± 14.2 in LA). Total\nnumber of complications was less in the LA group with a significantly lower incidence of wound infection (1.4 % vs\n10.6 %, P <0.001). The total cost of treatment was higher by 150 ââ??¬ in the laparoscopic group.\nConclusion: The laparoscopic approach is a safe and efficient operative procedure in appendectomy and it provides\nclinically beneficial advantages over open method (including shorter hospital stay, decreased need for postoperative\nanalgesia, early food tolerance, earlier return to work, lower rate of wound infection) against only marginally higher\nhospital costs....
latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). In this study, we aimed to\ndescribe a novel step-up approach for treating IPN consisting of four steps including negative pressure irrigation\n(NPI) and endoscopic necrosectomy (ED) as a bridge between percutaneous catheter drainage (PCD) and open\nnecrosectomy\nMethods: A retrospective review of a prospectively collected internal database of patients with a diagnosis of IPN\nbetween Jan, 2012 to Dec, 2012 at a single institution was performed. All patients underwent the same drainage\nstrategy including four steps: PCD, NPI, ED and open necrosectomy. The demographic characteristics and clinical\noutcomes of study patients were analyzed.\nResults: A total of 71 consecutive patients (48 males and 23 females) were included in the analysis. No significant\nprocedure-related complication was observed and the overall mortality was +21.1 % (15 of 71 patients). Seven\ndifferent strategies like PCD+ NPI, PCD+NPI+ED, PCD+open necrosectomy, etcetera, were applied in study patients\nand a half of them received PCD alone. In general, each patient underwent a median of 2 drainage procedures and\nthe median total drainage duration was 11 days (interquartile range, 6ââ?¬â??21days).\nConclusions: This four-step approach is effective in treating IPN and adds no extra risk to patients when compared\nwith other latest step-up strategies. The two novel techniques (NPI and ED) could offer distinct clinical benefits\nwithout posing unanticipated risks inherent to the procedures....
Background: Robotic surgery has been developed with the aim of improving surgical quality and overcoming the\nlimitations of conventional laparoscopy in the performance of complex mini-invasive procedures. The present study\nwas designed to compare robotic and laparoscopic distal gastrectomy in the treatment of gastric cancer.\nMethods: Between June 2008 and September 2015, 41 laparoscopic and 30 robotic distal gastrectomies were\nperformed by a single surgeon at the same institution. Clinicopathological characteristics of the patients, surgical\nperformance, postoperative morbidity/mortality and pathologic data were prospectively collected and compared\nbetween the laparoscopic and robotic groups by the Chi-square test and the Mann-Whitney test, as indicated.\nResults: There were no significant differences in patient characteristics between the two groups. Mean tumor size\nwas larger in the laparoscopic than in the robotic patients (5.3 �± 0.5 cm and 3.0 �± 0.4 cm, respectively; P = 0.02).\nHowever, tumor stage distribution was similar between the two groups. The mean number of dissected lymph\nnodes was higher in the robotic than in the laparoscopic patients (39.1 �± 3.7 and 30.5 �± 2.0, respectively; P = 0.02).\nThe mean operative time was 262.6 �± 8.6 min in the laparoscopic group and 312.6 �± 15.7 min in the robotic group\n(P < 0.001). The incidences of surgery-related and surgery-unrelated complications were similar in the laparoscopic\nand in the robotic patients. There were no significant differences in short-term clinical outcomes between the two\ngroups.\nConclusions: Within the limitation of a small-sized, non-randomized analysis, our study confirms that robotic distal\ngastrectomy is a feasible and safe surgical procedure. When compared with conventional laparoscopy, robotic\nsurgery shows evident benefits in the performance of lymphadenectomy with a higher number of retrieved and\nexamined lymph nodes....
Background: The aim of the study was to describe the technique of two-trocar laparoscopic appendectomy and\ncompare the outcome between two- and three-trocar techniques in children.\nMethods: All children who underwent laparoscopic surgery for suspected appendicitis from 2006 to 2014 in a\ncenter for pediatric surgery were included in the study. Converted surgeries and patients with appendiceal abscess\nor concomitant intestinal obstruction were excluded. A total of 259 children underwent appendectomy with either\ntwo (35 %) or three (65 %) laparoscopic trocars according to the surgeonsââ?¬â?¢ preference and intraoperative judgment.\nPatient demographics, clinical symptoms, surgery characteristics, and complications were reviewed.\nResults: The mean age of the children was 10.4 years (range, 1ââ?¬â??14 years). The mean follow-up time was 41.2 months\n(SD Ã?± 29.2). No significant differences in age, gender, weight, or signs and symptoms were found between the twoand\nthree-trocar groups. The mean surgery time was significantly shorter in the two-trocar group (47 min) than in the\nthree-trocar group (66 min; p < 0.001). The rates of surgical complications were 2 % vs. 4 %, (p = 0.501), and the rates of\npostoperative complications were 0 % vs. 5 % (p = 0.054), in the two- and three-trocar groups. The overall incidence of\npostoperative wound infection was low (<1 %) and did not differ between groups.\nConclusions: Two-trocar laparoscopic appendectomy seems to be a safe and feasible technique with a low rate of\npostoperative wound infections. The present findings demonstrate that when the two-trocar technique could be\napplied, it is a good complement to the conventional three-trocar technique....
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