Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.

Exploring ideal operative time for best outcomes in gastric cancer surgery:A multi-institutional study based on KLASS-07 database

Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.

Driving pressure:A useful tool for reducing postoperative pulmonary complications

The operating room is a unique environment where surgery exposes patients to non-physiological changes that can compromise lung mechanics.Therefore,raising clinicians’awareness of the potential risk of ventilator-induced lung injury(VILI)is mandatory.Driving pressure is a useful tool for reducing lung complications in patients with acute respiratory distress syndrome and those undergoing elective surgery.Driving pressure has been most extensively studied in the context of single-lung ventilation during thoracic surgery.However,the awareness of association of VILI risk and patient positioning(prone,beach-chair,parkbench)and type of surgery must be raised.

Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

Effectiveness of an Underbody Forced Warm-Air Blanket during Coronary Artery Bypass Surgery in the Prevention of Postoperative Hypothermia: A Prospective Controlled Randomized Clinical Trial

Introduction: Perioperative hypothermia in cardiac surgery is associated with adverse outcome. The aim of this investigation was to study whether an underbody forced-air warming blanket during coronary artery bypass graft surgery with normothermic cardiopulmonary bypass can prevent postoperative hypothermia. Methods: After Medical Ethics Committee approval, 60 low-risk cardiac surgery patients at random were assigned into a group that received standard thermal care management (control group n = 30) and a group that received the underbody forced-air warming system plus the standard thermal care (intervention group n = 30). Results: The temperature after-drop from the end of cardiopulmonary bypass to arrival in the ICU was less in the intervention group versus control group (0.4°C ± 0.3°C vs 0.6°C ± 0.4°C;P = 0.027). Out of the intervention group, 27 patients arrived in the ICU with a bladder temperature ? 36°C (90%) as compared to 14 patients (46.7%) from the control group (P < 0.001). The peripheral temperature was significantly higher in the intervention group as compared to the control group (P < 0.001). Conclusions: A full underbody forced-air warming blanket prevents postoperative hypothermia in normothermic coronary artery bypass graft surgery patients.

Experts consensus on the procedure of dental operative microscope in endodontics and operative dentistry

The dental operative microscope has been widely employed in the field of dentistry,particularly in endodontics and operative dentistry,resulting in significant advancements in the effectiveness of root canal therapy,endodontic surgery,and dental restoration.However,the improper use of this microscope continues to be common in clinical settings,primarily due to operators’insufficient understanding and proficiency in both the features and established operating procedures of this equipment.In October 2019,Professor Jingping Liang,Vice Chairman of the Society of Cariology and Endodontology,Chinese Stomatological Association,organized a consensus meeting with Chinese experts in endodontics and operative dentistry.The objective of this meeting was to establish a standard operation procedure for the dental operative microscope.Subsequently,a consensus was reached and officially issued.Over the span of about four years,the content of this consensus has been further developed and improved through practical experience.

The Effect of Acupuncture on Post-operative Oral Surgery Pain

An important problem in the eviluation of acupuncture has been the difficulty in defining and designingan appropriate control group.In order to examine our methodoly for a control group,patientswith one mandibular third molar extraction were randomly assigned to an acupuncture group or aplacebo acupuncture group.The following acupuncture points were used in which the needles werePlaced ipsilateral to the tooth extraction side:Hegu（LI4）,Jiache（ST 6）,Xiaguan（ST

Advances in surgery procedures for convergence insufficiency-type intermittent exotropia

Intermittent exotropia with convergence insufficiency is defined as a greater exodeviation measured at near than at distance of at least 10 prism diopters and it is harmful to binocular vision at earlier time. This paper mainly introduces three operation patterns including lateral rectus recession(s) with or without a slanting procedure, unilateral lateral rectus recession with medial rectus resection, and medial rectus resection(s) with or without a slanting procedure.

Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.

Strengthening Post-Operative Pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.

Non-operative management of pancreatic trauma in adults

To the Editor:Pancreatic trauma accounts for 0.4%-2.0%of all trauma-related injuries worldwide[1-3].The American Association for the Surgery of Trauma(AAST)categorizes pancreatic injury according to the severity[4].Pancreatic injury involving transection of the gland(grades III to V)typically requires surgical management[4].However,pancreatic trauma,especially in children and young adults,can be managed without surgery[5].This study reports the outcome of a policy of preferential non-operative management of pancreatic trauma in adults.

Early Post-Operative Complications in Surgeries Pertaining Oral and Maxillofacial Region in MNH, Tanzania

The Oral and maxillofacial region is one of the complex regions of the body considering the vast anatomical structures that are found in this region;head and neck surgery has potential for many complications, yet inadequate information on occurrence of post-operative complications in oral and maxillofacial surgeries in our setting has been documented. The aim of this study was to determine the occurrence of common early post-operative complications after oral and maxillofacial surgery in relationship to the underlying systemic condition. A descriptive postoperative study was done whereby patients who underwent oral and maxillofacial surgery were included. The included patients were those who underwent surgery for different pathological conditions, trauma, developmental/congenital conditions and inflammatory conditions to mention few. Demographic data, complications developed within one week post operative, and underlying systemic comorbidities before and after surgery were documented and analysed. A total of 102 patients were included in the study. The mean age of participants was 30.00 ± 17.01 years with a range of 2 to 81 years. Majority 43.1% (n = 44) had benign tumors with a leading diagnosis of ameloblastoma. In general, the most common complications which were noted in the cases included Pain 98% (n = 100) and Post-operative Swelling 97.1% (n = 99). The presence of underlying systemic comorbid conditions has a significant role in occurrence of some severe complications. The occurrence of complications does increase the duration of stay in the hospital hence increasing cost of treatment for which bearers are both patients and the hospital.

Relevance of fecal calprotectin and lactoferrin in the postoperative management of inflammatory bowel diseases

The role of fecal lactoferrin and calprotectin has been extensively studied in many areas of inflammatory bowel disease(IBD) patients' management. The postoperative setting in both Crohn's disease(CD) and ulcerative colitis(UC) patients has been less investigated although few promising results come from small, crosssectional studies. Therefore, the current post-operative management still requires endoscopy 6-12 mo after intestinal resection for CD in order to exclude endoscopic recurrence and plan the therapeutic strategy. In patients who underwent restorative proctocolectomy, endoscopy is required whenever symptoms includes the possibility of pouchitis. There is emerging evidence that fecal calprotectin and lactoferrin are useful surrogate markers of inflammation in the post-operative setting, they correlate with the presence and severity of endoscopic recurrence according to Rutgeerts' score and possibly predict the subsequent clinical recurrence and response to therapy in CD patients. Similarly, fecal markers show a good correlation with the presence of pouchitis, as confirmed by endoscopy in operated UC patients. Fecal calprotectin seems to be able to predict the short-term development of pouchitis in asymptomatic patients and to vary according to response to medical treatment. The possibility of both fecal markers to used in the routine clinical practice for monitoring IBD patients in the postoperative setting should be confirmed in multicentric clinical trial with large sample set. An algorithm that can predict the optimal use and timing of fecal markers testing, the effective need and timing of endoscopy and the cost-effectiveness of these as a strategy of care would be of great interest.

Analysis on relative factors of lymph node metastasis and pattern of postoperative locoreginal relapse of esophageal carcinoma

Objective: We aimed to study the relative factors of lymph node metastasis of esophageal carcinoma, and to analyze the distribution rule of lymph node metastasis of post esophagectomy patients for guiding the radiotherapy. Methods: To collect the patients' data (102 cases) in our hospital from 2001 to 2009, who were found lymph node metastasis confirmed by pathologic in a certain period of time after esophageal cancer surgery. The factors affected the lymph node metastasis in esophageal cancer were analysed by single logistic regression and Logistic Regression Method. To analyze the rule of post-operative lymph node metastasis in different regions, according to the lymph node partition, in accordance with paragraphs of esophageal cancer in different groups. Results: Of the 102 patients after esophageal cancer surgery, who were confirmed by pathological examination, 50 cases had positive lymph node metastasis and 52 cases had negative, the lymph node metastasis rate was 49.0%. Lymph node metastasis rates of different depth, length and paragraph of tumor invasion had statistical difference (P < 0.05). The impact on lymph node metastasis rates of the different age and degree of differentiation had no statistical difference (P > 0.05). Multivariate analysis showed that the lesion length, depth of invasion and paragraph of tumor were meaningful factors affecting the lymph node metastasis. Of the 102 patients, 132 sites node metastasis were found by imaging study and histopathology with lower neck and supraclavicular node 59 (44.70%), upper mediastinum node 51 (38.64%), A-P windows node 1 (0.76%), anterior mediastinum node 1 (0.76%), Subcarinal node 5 (3.79%), paraesopha- geal node 3 (2.27%), hilar node 3 (2.27%), abdominal node 9 (6.82%). Conclusion: The length and depth of invasion, and paragraph of esophageal cancer are meaningful factors that affect the lymph node metastasis. The longer of lesion, deeper of infiltration and lower of paragraph, the easier to get independently lymph node metastasis. The postoperative lymph node metastasis was mainly distributed in the lower neck and supraclavicular region and upper mediastinal region, which is the focus of postoperative radiotherapy.

Comparative analysis of therapeutic efficacy of 131I in different clinical stages postoperative patients with papillary thyroid carcinoma

Objective： The aim of this study was to compare the effect of 131I therapy of different clinical stages in postopera- tive patients with papillary thyroid carcinoma （PTC）. Methods： Eighty-seven PTC patients after surgery ablated with high doses of 131I from 2004 to 2010 were retrospectively reviewed. The efficacy of 131I therapy was assessed by three diagnostics that serum thyroglobulin （Tg） was normal or significantly reduced, 131I whole body scan （131I-WBS） was negative or the metas- tases shrank or the number of them decreased and new metastases was not found in cervical ultrasound examination. The x2 test was used to analyze 3 factors which might affect the therapeutic efficacy of 131I in patients of different clinical period, including different surgical ways （total or subtotal thyroidectomy along with half or double sides neck lymph node dissection）, age （〈 45 years and 〉 45 years） and ablative 131I dose. Results： Of 87 patients, the effective rate of 46 patients I stage was 89.13% （41）; the effective rate of 22 cases III stage was 77.27% （17）; the effective rate of 19 cases IV stage was 36.84% （7）. The corresponding intra-groups statistical difference of 3 stages was significant by x2 test （x2 = 1.72, 19.03, 6.87; P 〉 0.25, P 〈 0.005, P 〈 0.01）. The effective rate was 91.67% （44） in 48 cases undergoing total thyroidectomy; the effective rate was 53.85% （21） in 39 patients undergoing subtotal thyroidectomy. There was a significant difference between the two groups above by x2 test （x2 = 16.291; P 〈 0.005）. Conclusion： The efficacy of 131I ablation of stage I and stage III in postoperative PTC patients was almost alike, while the efficacy of stage IV descended markedly. The results was mainly determined by residual thyroid tissue size because of different surgical modus.

The Utility of Telemedicine to Manage Post-Operative Pain

Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).

Risk Factor of Postoperative Lumbar Surgical Site Infection: A Literature Review

Nowadays there have been various advanced techniques to overcome disparate types of lumbar degenerative diseases. However, post-operation complications such as Surgical Site Infection (SSI) still give the surgeon with a big challenge. This article is going to study the risk factor that causes the lumbar SSI by reviewing all the articles that can be assessed through PubMed, websites of science and other internet data base. Numerous articles have stated different reported prevalence rates of 0.7% to 16% for surgical site infection. This article will document the most common and significant risk factors for SSI. At last, we suggest that there should be preoperative patient screening and postoperative internal environment maintenance, this will be the best way to reduce postoperative SSI rate or prevent SSI from happening.

Midwives’ Adherence to Preoperative Care Guidelines Prior to Emergency Caesarean Section at Bwaila Maternity Hospital in Malawi

A study was conducted to describe midwives’ adherence to preoperative care during emergency caesarian section at Bwaila Maternity Wing in 2012 in Malawi. The study utilized a descriptive prospective and retrospective design. A structured questionnaire was administered to all 28 midwives who were directly involved in the preparation of clients for emergency caesarean section. Clients charts were also reviewed using a standard checklist to determine adherence to preoperative care. Data were analyzed using SPSS version 16.0 and descriptive statistics in the form of frequencies and percentages were computed for the dataset. A midwife was supposed to score at least 80% on each component of preoperative care guidelines to be compliant to the stipulated pre-operation standards. The midwives scored above 80% on only four of the 14 preoperative care guidelines which were;bladder catheterization (100%, n = 14), obtaining informed consent (92.9%, n = 12), administration of IV (96.4%, n = 13) and administration of preoperative antibiotics (82.1%, n = 11). Midwives however scored less than 80% on preoperative procedures that dealt with vital signs (28.6%, n = 4): BP check (28.6%, n = 4);Pulse rate check (25%, n = 3.5);respiration check (25%, n = 3.5) and temperature check (25%, n = 3.5). The midwives scored further below standard on blood specimen collection (78.6%, n = 11). Psychological support to clients was also below standard at 60.7%, n = 8. Other components of psychological support such as surgery information (57.1%, n = 8), allowing clients ask questions (28.6%, n = 4) and answering clients’ questions (25%, n = 3.5) were also scored below standard. Overall the standard of preoperative care was below standard at the facility. Most of the midwives were new graduates, who had never received any in-service training on preoperative care. Therefore in service training it is recommended for the midwives to provide good quality of care.

Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision:A case report

BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood loss.The objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for APE.CASE SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal tenesmus.The patient was diagnosed with bulky adenocarcinoma limited to the rectum.As the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was indicated.The patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral artery.The tumor was successfully devascularized and no major bleeding was noted during APE.Postoperative recovery was uneventful and a one-year follow-up showed no signs of recurrence.CONCLUSION Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic prognoses.We describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.