Current Issue : October - December Volume : 2017 Issue Number : 4 Articles : 7 Articles
Background: Mandibular reconstruction is performed after segmental mandibulectomy, and precise repositioning\nof the condylar head in the temporomandibular fossa is essential for maintaining preoperative occlusion.\nMethods: In cases without involvement of soft tissue around the mandibular bone, the autopolymer resin in a soft\nstate is pressed against the lower border of the mandible and buccal and lingual sides of the 3D model on the excised\nside. After hardening, it is shaved with a carbide bar to make the proximal and distal parts parallel to the resected\nsurface in order to determine the direction of mandibular resection. On the other hand, in cases that require resection\nof soft tissue around the mandible such as cases of a malignant tumor, right and left mandibular rami of the 3D model\nare connected with the autopolymer resin to keep the preoperative position between proximal and distal segments\nbefore surgical simulation. The device is made to fit the lower border of the anterior mandible and the posterior border\nof the mandibular ramus. The device has a U-shaped handle so that adaptation of the device will not interfere with the\nsoft tissue to be removed and has holes to be fixed on the mandible with screws.\nResults: We successfully performed the planned accurate segmental mandibulectomy and the precise repositioning of\nthe condylar head by the device.\nConclusions: The present technique and device that we developed proved to be simple and useful for restoring the\npreoperative condylar head positioning in the temporomandibular fossa and the precise resection of the mandible...
Background. This targeted chart review study reports the first ever detailed global account of clinical approaches adopted to\ndetect and manage anastomotic leaks identified during surgery in routine clinical practice. Method. 156 surgeons from eight\ncountries retrospectively extracted data from surgical records of 458 patients who underwent colorectal surgery with an identified\nintraoperative leak at the circular anastomosis. Demographic details, procedures, and outcomes were analyzed descriptively, by\ncountry. Results. Most surgeries were performed laparoscopically (57.6%), followed by open surgeries (35.8%). The burden of\nintraoperative leaks on the healthcare system is driven in large part by the additional interventions such as using a sealant,\nrecreating the anastomosis, and diverting the anastomosis to a colostomy bag, undertaken to manage the leak.The mean duration\nof hospitalization was 19.9 days. Postoperative anastomotic leaks occurred in 62 patients (13.5%), most frequently 4 to 7 days after\nsurgery. Overall, country-specific differences were observed in patient characteristics, surgical procedures, method of diagnosis\nof intraoperative leak, interventions, and length of hospital stay. Conclusion. The potential cost of time and material needed to\nrepair intraoperative leaks during surgery is substantial and often hidden to the healthcare system, potentially leading to an\nunderestimation of the impact of this complication....
Purpose. To evaluate the efficacy of subconjunctival bevacizumab injections, before and after surgical excision with bare sclera\ntechnique, in preventing postoperative pterygium recurrence. Material and Methods. 83 eyes of 83 patients affected with\nprimary pterygia underwent surgical excision. 42 eyes received two subconjunctival bevacizumab injections, at the dosage of\n2.5 mg/0.1 ml, one week prior surgery and one week after intervention. Recurrence rate was evaluated among the two groups.\nMoreover, modifications of pterygium size and grade one week after the first injection were evaluated. Results. At 6 months after\nsurgery, the recurrence rate was 7.14% in the bevacizumab group and 24.39% in the control group. Significant changes of\npterygium size and grade were reported after the first injection. No important complications related to bevacizumab\nsubconjunctival injections were registered. Conclusions. The application of subconjunctival bevacizumab injections, at the\ndosage of 2.5 mg/0.1 ml, before and after surgical pterygium excision, may be useful in preventing lesion recurrence after bare\nscleral procedures. Furthermore, bevacizumab subconjunctival administration is well tolerated and may represent a safer\nalternative if compared with other surgical techniques and adjunctive drugs. This trial is retrospectively registered with ISRCTN\nRegistry on 18 April 2017, TRN: ISRCTN11424742....
One of the known complications of cleft palate surgery is development of fistula.\nThis study highlights our experience with cleft palate surgery in relation\nto fistula occurrence at our center. This is one of the first studies of this kind\nin Oman. We retrospectively reviewed 362 records of cleft palate patients. The\nmost common technique used for cleft palate repair at our center was Veau-\nWardill-Kilner technique. In our series we have noticed palatal fistulae in 32%\nof cases. This high rate is partially due to inclusion of very anterior fistulas in\npatients with complete cleft lips and palates, which actually represent part of\nthe alveolar cleft rather than breakdown of the palatal repair. This will be\nclosed during time of alveolar bone grafting at a later stage. We recommend a\nfuture prospective controlled study to study the factors that lower the incidence\nof fistula in our population....
Background: Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative\noutcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes\nfollowing pancreaticoduodenectomy (PD).\nMethods: We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our\ninstitution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed\ntomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes,\nespecially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic\nfactors (including sarcopenia) on postoperative infections.\nResults: The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and\n47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a\nhigher incidence of in-hospital mortality (P = 0.004) and infectious complications (P < 0.001). In multivariate\nanalyses, sarcopenia (odds ratio = 3.43; P < 0.001), preoperative biliary drainage (odds ratio = 2.20; P = 0.014), blood\nloss (odds ratio = 1.92; P = 0.048), and soft pancreatic texture (odds ratio = 3.71; P < 0.001) were independent\npredictors of postoperative infections.\nConclusions: Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical\nassessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and\ndetermining perioperative management strategies....
Background: Postoperative operative pulmonary complications (PPCs) after hepatic surgery are associated with\nincreased length of hospital stays. Intraoperative blood transfusion, extensive resection and different comorbidities\nhave been identified. Other parameters, like time of hepatic ischemia, have neither been clinically studied, though\nexperimental studies show that hepatic ischemia can provide lung injury. The objective of this study was to\ndeterminate the risk factors of postoperative pulmonary complications (PPCs) after hepatic resection within 7\npostoperative days.\nMethod: Ninety-four patients consecutively who underwent elective hepatectomy between January and December\n2013. Demographic data, pathological variables, and preoperative, intraoperative, and postoperative variables had been\nprospectively collected in a data base. The dependant variables studied were the occurrence of PPCs, defined before\nanalysis of the data.\nResults: PPCs occurred in 32 (34%) patients. A multivariate analysis allowed identifying the risk factors for PPCs. On\nmultivariate analysis, preoperative gamma-glutamyltransferase (GGT) elevation OR =5,12 [1,85-15,69] p = 0,002, liver\nischemia duration OR = 1,03 [1,01-1,06] p = 0,01 and the intraoperative use of vasopressor OR = 4,40 [1,58-13,36]\np = 0,006 were independently associated with PPCs. For every 10 min added in ischemia duration, the OR of\nthe risk of PPCs was estimated to be 1.37 (CI95% = [1.08-1.81], p = 0.01).\nConclusion: Three risk factors for PPCs have been identified in a population undergoing liver resection: preoperative\nGGT elevation, ischemia duration and the intraoperative use of vasopressor. PPCs after liver surgery could be related to\nlung injury induced by liver ischemia reperfusion and not solely by direct infectious process. That could explain why\nfactors influencing directly or indirectly liver ischemia were independently associated with PPCs....
Background: An incisional hernia is a common complication following abdominal surgery. Polypropylene mesh is\nfrequently used in the repair of such defects and has nearly become the standard surgical treatment modality. Though\nthey are very effective in reducing recurrence, mesh materials exhibit a strong stimulating effect for intraabdominal\nadhesion. The thymoquinone (TQ) extracted from Nigella sativa seeds has potential medical properties. TQ has antiinflammatory,\nantioxidant and antibacterial properties. The aim of this study is to coat polypropylene mesh with TQ in\norder to investigate the effect of surface modification on intraabdominal adhesions.\nMethods: TQ-coated polypropylene mesh material was tested for cytotoxicity, contact angle, surface spectroscopy, TQ\ncontent, sterility, and electron microscopic surface properties. An experimental incisional hernia model was created in\nstudy groups, each consisting of 12 female Wistar rats. The defect was closed with uncoated mesh in control group,\nwith polylactic acid (PLA) coated mesh and PLA-TQ coated mesh in study groups. Adhesion scores and histopathologic\nproperties were evaluated after sacrifice on postoperative 21th day.\nResults: Granuloma formation, lymphocyte and polymorphonuclear leukocyte infiltration, histiocyte fibroblast and\ngiant cell formation, capillary infiltration, collagen content were significantly reduced in the PLA-TQ coated mesh group\n(p < 0.05). Though not statistically significant, likely due to the limited number of study animals, adhesion formation was\nalso reduced in the PLA-TQ coated mesh group (p: 0.067).\nConclusion: TQ coated mesh is shown to reduce adhesion formation and TQ is a promising coating material for mesh\nsurface modification....
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