Evaluation of Surgical Complications of Mandibulectomy

Mandibulectomy is a surgery that leads to heavy aesthetic and functional sequelae. Surgical complications have been noted but have not yet been evaluated. The aim of this study was to evaluate the surgical complications of mandibulectomy. This is a retrospective descriptive and analytical study of patients who underwent mandibulectomy in the Department of Maxillofacial Surgery of the CHU JDR Befelatanana between January 2017 and December 2020. A correlation between the occurrence of complications, parameters related to the patients and those related to the surgery was sought. Patient-related parameters were: age and sex, comorbidities, toxic habits and body mass index. The parameters related to the surgery which were studied were the duration of the intervention, the size and the seat of the bone defect, the interruption or not of the mandibular continuity. Forty-six cases were selected. The average age was 36.98 years and the sex ratio was 0.7. Fifty percent of patients developed surgical complications. The total number of complications was 38. Salivary fistula was the most frequent complication (26.32%). No correlation was found between the occurrence of complications and patient-related parameters. There were 69.57% of complications when the procedure lasted more than 180 minutes (p = 0.003). A correlation was found between the occurrence of complications and the size of the resected bone (p = 0.009). Among the complications, 56.52% occurred when the size exceeded 130 mm (p = 0.03). The complication rate is high. The size of the resected bone and the duration of the operation influence the occurrence of complications.

Complications of Surgical Treatment of Anterior Shoulder Dislocation:A Systematic Review

Introduction: shoulder joint has the greatest range of motion in the human body. The shoulder anatomy promotes high mobility and favors relative sacrifice of articular stability, making it susceptible and more prone to events of instability and dislocation. This review aimed at identifying main complications of surgical treatment of anterior shoulder dislocation. Methodology: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Studies which were eligible for this systematic review included: English or Spanish language, studies published from 2000, which mentioned surgical complications of anterior shoulder dislocation in their results, both in open and arthroscopic surgery. Included studies which were required to have at least 1 complication following surgical repair. Only studies from original data were included. Results: We found 228 potentially eligible studies for the survey. Through the inclusion and exclusion criteria and after consensus among reviewers, we chose 9 studies to compose the systematic review. Conclusion: Important information emerges: recurring instability, recurring dislocation, external rotation limitation and arthritis are main surgical complications of anterior shoulder dislocation.

Surgical chest complications after liver transplantation

Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity.Furthermore,chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications.This review aims to identify the potential chest complications of surgical interest during or after liver transplantation.Complications of surgical interest are defined as those conditions that necessitate an invasive procedure(such as thoracocentesis or a chest tube placement)in the chest or a surgical intervention performed by a thoracic surgeon.These complications will be classified as perioperative and postoperative;the latter will be categorized as early and late.Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary,in some patients,thoracic surgical interventions are warranted.A high index of suspicion is needed to recognize and treat these conditions promptly.A close collaboration between abdominal surgeons,intensive care unit physicians and thoracic surgeons is of paramount importance.

Long-term complications of the transmeatal approach (Open Transcanal) in cochlear implants: A follow-up study

Objective: Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach.Transmeatal(open trnascanal) approach has not been adapted since first described in the clinical field.we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.Methods: This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal(open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital(Riyadh, Saudi Arabia), which were conducted by the same surgeon.Results: Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16%(21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows:cholesteatoma in 5(3.8%) patients, extrusion of the electrode in 5(3.8%) patients, and tympanic membrane perforation or deep retractions in 5(3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4(3%) patients, recurrent otitis externa infections in 7(5%) patients, and weakness of the posterior canal wall in 1 patient.Conclusion: The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.

Urological Complications of Gynecological and Obstetric Interventions: Management at the Ignace Deen National Hospital—University Hospital of Conakry (Guinea)

Introduction: pelvic abdominal surgery may be associated with urological complications requiring reoperation. The aim of this study was to evaluate the urological surgical complications of gynecological and obstetric procedures conducted at the Ignace Deen University Hospital of Conakry in Guinea. Methodology: This was a retrospective, cross-sectional, descriptive study of ten years, from 1 January 2006 to 21 December 2015. Results: Of 14,500 patients hospitalized in the maternity ward during the study period, 31 patients had secondary urological complications during gynecological or obstetric intervention 0.2%). The mean age of the patients was 34.77 years (range: 17 to 58 years). The mean duration of hospital stay was 13.29 days (range: 3 to 28 days). Signs of complication were mainly postoperative abdominal pain (64%, n = 20), vaginal urine leakage (19.35%, n = 6) and vaginal bleeding (9.68% n = 3). The diagnosis was mainly confirmed by ultrasound (70.45%, n = 31). The lesions were primarily ureteric (77.42%, n = 17) or on the urethral wounds (8.12%, n = 12). Urological complications mostly occurred during hysterectomy (41.94%, n = 13) and caesarean section (32.26%, n = 10). Repair procedures included uretero-vesical reimplantation (58.06%, n = 18), vesico-vaginal fistuloraphy (22.58%, n = 7), vesico-uterine fistuloraphy (12.90%, n = 4) and temporary ureterostomy (6.45%, n = 2). Treatment were successful in 28 patients (90.32%) and a lethality of 9.68% (n = 3) was recorded. Conclusion: Urological surgical complications of obstetric gynecological surgeries were mostly related to hysterectomy and Caesarean section performed by low-skilled surgeons, from peripheral facilities. Prevention measures should include better training and follow-up of practitioners from peripheral health facilities.

Intraoperative laparoscopic complications for urological cancer procedures

AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery(radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery(radical prostatectomy and radical cystectomy).CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.

Spondylodiscitis, epidural abscess, and meningitis after transoral robotic surgical resection of a squamous cell carcinoma of the posterior pharyngeal wall

Transoral robotic surgery(TORS)is a minimally invasive technique for resection of tumors of the posterior pharyngeal wall.Rarely,post-TORS cervical spondylodiscitis has been reported in the literature,with high morbidity and mortality.A 64-year-old female with underlying cervical disk disease underwent TORS resection of a posterior pharyngeal wall carcinoma without reconstruction in April 2020.Roughly one month post-operatively,the patient presented with clinical and radiographic signs of spondylodiscitis,epidural abscess,and meningitis.The patient was treated with antibiotic therapy and anterior cervical discectomy and fusion.The patient recovered without neurologic deficit.A three-month post-treatment PET-CT scan showed no evidence of residual disease.Post-operative cervical spondylodiscitis and meningitis are rare complications of TORS resection for posterior pharyngeal wall carcinomas,but the risk is increased in patients with underlying cervical disk disease.In such patients,perioperative antibiotic treatment and/or reconstruction should be considered to prevent neurologic complications and death.

Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma： a retrospective multicenter study

AIM： To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma （POAG） patients. METHODS： This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure （IOP） reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as： 1） IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2） no additional glaucoma surgery required. RESULTS： A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y （P=0.05）. The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery （P=0.04）. The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone （100% vs 76%）. In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. CONCLUSION： Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

Simultaneous kidney transplantation and ipsilateral native nephrectomy in patients with autosomal dominant polycystic kidney disease

The simultaneous kidney transplantation and ipsilateral native nephrectomy for autosomal dominant polycystic kidney disease does not seem to be associated with increased rates of comorbidity and complications.This outcome can efficiently be achieved when the indication and surgical approach of native nephrectomy are properly justified.

Classic Ehlers-Danlos syndrome and cardiac transplantation-Is there a connection?

Ehlers-Danlos syndrome(EDS)is a heterogeneous group of connective tissue disorders comprised of several types.Classic EDS is an autosomal dominant disorder with stretchable skin,delayed wound healing with poor scarring,joint hypermobility with subluxations or dislocations,easy bruisability,hernias,aneurysms and cardiac abnormalities.Advances in genomics technology using next-generation sequencing has led to the discovery of causative genes for connective tissue disorders,hereditary cardiomyopathies and cardiovascular diseases including several genes for connective tissue disorders.A 55 year-old male exhibited thin stretchable skin,atrophic scars,easy bruising,joint pain and dislocations requiring multiple knee surgeries and a Beighton hyperflexibility score of 6 out of 7.He was found to have a heterozygous missense COL5A1 gene variant involving exon 3 at nucleotide c:305T>A with an amino acid position change at p.lle102Asn consistent with classic EDS.He had a heart transplant at 43 years of age due to cardiac failure of unknown cause.This patient with classic EDS is brought to medical attention and should be of interest to cardiologists,heart transplant specialists and surgeons,particularly in individuals with unexplained cardiac failure and then diagnosed prior to surgical intervention to avoid poor wound healing,scarring and other tissue involvement(e.g.,vascular anomalies,blood pressure instability,aneurysms)as components of EDS.

Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients

BACKGROUND In orthotopic liver transplantation(OLT)recipients,median arcuate ligament syndrome(MALS)is considered a risk factor for hepatic arterial thrombosis(HAT),which is dreadful for OLT recipients.Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation,but clinical evidence is still scarce.AIM To evaluate the feasible surgical management of MALS to reduce complications in OLT patients.METHODS Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed.The surgical management of median arcuate ligament(MAL)and modifications to the arterial anastomosis were recorded.The perioperative and long-term prognosis of MALS recipients were noted.Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner.RESULTS Eight patients with MALS were included in this study.The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT.Salvage liver transplantation with MAL division was successfully performed.Gastroduodenal artery(GDA)preservation with splenic artery ligation was performed on three patients,only GDA preservation was performed on two patients,and no intervention was performed on two patients.No patient developed HAT after surgery and postoperative recovery was satisfactory.CONCLUSION The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.

Analogies between medusa and single port surgery in gastroenterology and hepatology:A review

Single port surgery(SPS)was introduced as an attractive,minimally invasive surgical technique that ensures esthetic results for many types of visceral surgery.Initially,surgeons immediately set about performing SPS without preliminary knowledge or training,which resulted in higher complication rates.Today,current studies conclusively show that SPS is scientifically rehabilitated and indicated for simple and complex laparoscopic procedures.We here describe the astonishing analogies between Greek mythology and modern surgery.

Computed tomography-guided percutaneous radiofrequency thermocoagulation for primary trigeminal neuralgia in older and younger patients

We evaluated the immediate and long-term clinical efficacy of computed tomography （CT）-guided radiofrequency thermocoagulation for primary trigeminal neuralgia （RTPTN） in 852 patients including 502 patients aged -〉 60 years and 350 patients aged 〈 60 years. After discharge, the incidence of complications was 1.0% and 0.9% in patients aged 〉 60 years and patients aged 〈 60 years, respectively. Over 3-year follow-up after CT-guided RTPTN, 96.8% of the patients aged 〉 60 years and 98.6% of the patients aged 〈 60 years were completely pain-free, and there was no significant difference between these two age brackets. In addition, there were no significant differences in quality of life scores and numbness scores between these two age brackets. These findings suggest that CT-guided RTPTN is a safe and effective method and is recommended for older and poor-risk patients.

Polyacrylamide gel migration after injection for breast augmentation:A case report

Polyacrylamide hydrogel(PAAG)was once considered a safe,reliable,and compatible injected filler and was widely used in breast augmentation,rhinoplasty,and other cosmetic surgeries.However,numerous complications,such as implant migration,have been observed after PAAG injections.Herein,we report a rare case of distant implant migration after PAAG injection for breast augmentation in which the material became displaced along the abdominal wall to the perineum and pelvic extraperitoneal space.After a well-prepared preoperative evaluation involving magnetic resonance imaging(MRI)and computed tomography(CT)examinations and threedimensional hologram,debridement surgery was performed to remove the injected material.After the operation,the patient was followed up for two years and was not scheduled for a second operation.Postoperative complications of breast augmentation after PAAG injection,especially gel migration,still affect thousands of patients.Once material migration occurs,surgical removal becomes difficult.Early diagnosis and treatment are recommended.

Network prediction of surgical complication clusters:a prospective multicenter cohort study

Complicated relationships exist in both occurrence and progression of surgical complications,which are difficult to account for using a separate quantitative method such as prediction or grading.Data of 51,030 surgical inpatients were collected from four academic/teaching hospitals in a prospective cohort study in China.The relationship between preoperative factors,22 common complications,and death was analyzed.With input from 54 senior clinicians and following a Bayesian network approach,a complication grading,cluster-visualization,and prediction(GCP)system was designed to model pathways between grades of complication and preoperative risk factor clusters.In the GCP system,there were 11 nodes representing six grades of complication and five preoperative risk factor clusters,and 32 arcs representing a direct association.Several critical targets were pinpointed on the pathway.Malnourished status was a fundamental cause widely associated(7/32 arcs)with other risk factor clusters and complications.American Society of Anesthesiologists(ASA)score≥3 was directly dependent on all other risk factor clusters and influenced all severe complications.Grade III complications(mainly pneumonia)were directly dependent on4/5 risk factor clusters and affected all other grades of complication.Irrespective of grade,complication occurrence was more likely to increase the risk of other grades of complication than risk factor clusters.

Preservation of aberrant right hepatic artery during pancreaticoduodenectomy

The standard surgery for distal common bile duct adenocarcinoma,pancreatic adenocarcinoma,and ampullary adenocarcinoma is pancreaticoduodenectomy(PD).PD is a technically challenging procedure with high mortality(0-3.5%)and morbidity(38-50%)rates(1-5).It is essential to recognize the anatomy preoperatively,especially of the hepatic artery and positions of the tumors,to avoid adverse events(6,7).The aberrant right hepatic artery(aRHA)originating from the superior mesenteric artery(SMA)is the most frequent and considerable hepatic artery variation(8-10).

Established and experimental techniques to improve phalloplasty outcomes/optimization of a hypercomplex surgery

An increasing number of transgender and gender non-conforming patients are seeking genital gender affirming surgeries in order to better align their physical characteristics with their innate gender identity and treat gender dysphoria.Phalloplasty is the most complex of these surgeries,and this complexity creates a wide range of potential complications.Some of the most common complications and therefore,targets for improvement in outcomes,concern neourethral fistula/stricture,efficacy of reinnervation of the phalloplasty flap,postoperative flap monitoring,and donor site morbidity.In the setting of no established"gold standard",this review seeks to describe the components and staging of phalloplasty,with an emphasis on established and experimental solutions to the most common and vexing problems.

人工耳蜗植入术并发症及其预防

目前，人工耳蜗植入（cochlear implantation，CI）是双耳重度和极重度感音神经性聋的首选治疗方式。自1995年多道人工耳蜗进人中国内地以来，CI在适应证选择、手术操作及术后处理等方面都已基本规范化，然而严重并发症仍是困扰CI的主要问题之一。用“cochlearimplantation”、“complication”作为关键词在Medline搜索，已有近百篇文章报道，而国内相关报道甚少。