Predictive value of SinoSCORE on in-hospital mortality and postoperative complications after coronary artery bypass surgery

Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation (SinoSCORE) on in hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008,clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to

Analysis of complications of transsphenoidal surgery for pituitary adenomas

Objective To analyze the complications of transsphenoidal operation for pituitary adenomas. Methods Postoperative complications of 323 patients underwent transphenoidal surgery for pituitary adenoma between January 2001 and December 2009 in our department were retrospectively reviewed. Results Insipidus was the most common complication after

Complications's prophylaxis in neuroendoscopic endonasal transsphenoidal surgery for pituitary adenomas

Objective To discuss the complicatiaons’s prophylaxis of removing pituitary adenomas by neuroendoscopy in tranasphenoidal surgery. Methods Clinical data of 253 cases treated by endoscopic endanasal transsphenoidal surgery were analysed. Results The total tumor removal was done in 216 (85.38%) cases,subtotal in

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Surgical complications in COVID-19 patients in the setting of moderate to severe disease

The coronavirus disease 2019(COVID-19)pandemic has had a considerable impact on the work of physicians and surgeons.The connection between the patient and the surgeon cannot be replaced by telemedicine.For example,the surgical staff faces more serious difficulties compared to non-surgical specialists during the COVID-19 pandemic.The primary concerns include the safest solutions for protecting healthcare staff and patients and the ability to provide adequate surgical care.Additionally,the adverse effects of any surgery delays and the financial consequences complicate the picture.Therefore,patients’admission during the COVID-19 pandemic should be taken into consideration,as well as preoperative measures.The COVID-19 situation brings particular risk to patients during surgery,where preoperative morbidity and mortality rise in either asymptomatic or symptomatic COVID-19 patients.This review discusses the recent factors associated with surgical complications,mortality rates,outcomes,and experience in COVID-19 surgical patients.

Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet?

The most dreaded complication in head and necksurgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing wellvascularized tissue to an area of poor wound healing. Most often, the surgeon's preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a wellknown flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.

Incidence and risk factors for vitreous loss in residents performing manual small-incision cataract surgery

AIM: To assess the incidence of vitreous loss and associated risk factors in residents performing manual small-incision cataract surgery(MSICS). METHODS: The present retrospective record review study was performed on 490 patients who underwent MSICS performed between November 2018 and December 2019 by 7 third-year postgraduate residents. The study group comprised of patients having intraoperative vitreous prolapse. All the surgeries were performed under supervision of a trained assistant. RESULTS: The mean age of the participants at the time of surgery was 68.42±2.05 y. Of the 490 patients, 250 patients were male, and 240 patients were female(P=0.23). A total of 215(43.9%) eyes had mature white cataract, 185(37.8%) eyes had brown cataract, and 90(18.3%) eyes had immature senile cataract. The incidence of intraoperative vitreous loss among residents was 2%(10/490). Vitreous loss occurred during hydrodissection [1/10(10%)], nucleus delivery [3/10(30%)], irrigation and aspiration [5/10(50%)], and intraocular lens insertion [1/10(10%)]. Multivariate stepwise Logistic regression analysis confirmed immature senile cataract [odds ratio(OR)=3.99;P=0.02], irrigation and aspiration of cortical material(OR=3.07;P=0.03), and anterior capsular extension(OR=3.22, P=0.03) as independent risk factors for vitreous loss. CONCLUSION: Immature senile cataract, irrigation and aspiration of cortical material, and anterior capsular extension are independent risk factors for vitreous loss. Our findings may serve as a guide for future trainers or residents learning MSICS.

Ureteroscopic holmium laser to transect the greater omentum to remove an abdominal drain:Four case reports

BACKGROUND Drainage tube removal is difficult when the greater omentum becomes incarcerated in the drainage tube through the side holes.Currently,known removal methods are either ineffective or will cause additional damage to the patient in a secondary operation.Ureteroscopy and the holmium laser have been used in various surgical techniques in urology,and in theory,they are expected to be a good strategy for solving the problem of tissue incarceration.CASE SUMMARY Four patients diagnosed with difficult removal of an abdominal drainage tube following abdominal surgery are reported.All patients underwent surgery to remove the incarcerated greater omentum in the drainage tube using a holmium laser and a ureteroscope,and a new 16-F drain was then placed in the abdominal or pelvic cavity.The efficacy of this technique was evaluated by intraoperative conditions,success rate,and operating time;safety was evaluated by perioperative conditions and the probability of postoperative complications.All four operations went smoothly,and the drains were successfully removed in all patients.The average operating time was 24.5 min.Intraoperatively,the average irrigation volume was 892.0 mL,the average drainage volume was 638.5 mL,and no bleeding or damage to surrounding tissues was observed.Postoperatively,the average drainage volume was 32.8 mL and the new drains were removed within 36 h.All patients were able to get out of bed and move around within 12 h.Their visual analogue pain scores were all below 3.The average follow-up duration was 12.5 mo and no complications such as fever or bleeding were noted.CONCLUSION Ureteroscopic holmium laser surgery is an effective,safe and minimally invasive technique for removing drains where the greater omentum is incarcerated in the abdominal drain.

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

Objective To compare clinical curative effects of open surgery （OS） or endovascular repair （EVAR） for patients with abdominal aortic aneurysm （AAA） in China. Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010. Study selection According to the inclusion criteria, 76 articles were finally analyzed to compare patient characteristics, clinical success, complications, and prognosis. Results We analyzed a total of 2862 patients with 1757 undergoing OS （OS group） and 1105 undergoing EVAR （EVAR group）. There was no significant difference in the success rate of the procedures. Operative time, length of ICU stay, fasting time, duration of total postoperative stay, blood loss, and blood transfusion requirements during the procedure were significantly lower in the EVAR group. A 30-day follow up revealed more cardiac, renal, pulmonary, and visceral complications in the OS group （P 〈0.01）. Low-limb ischemia, however, was more common in the EVAR group （P 〈0.05）. The 30-day mortality rate, including aorta-related and non-aorta related mortality, was significantly lower in the EVAR group （P 〈0.01）. In the follow-up period, there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group （P 〈0.01）. The overall late mortality rate was higher in the OS group （P 〈0.01）, especially non-aorta-related late mortality and mortality during the fourth to the sixth year （P 〈0.01）. Conclusions EVAR was safer and less invasive for AAA patients. Patients suffered fewer complications and recovered sooner. However, complications such as artificial vessel occlusion, low-limb ischemia, and endoleak were common in EVAR. Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

From open to laparoscopic adrenalectomy: a review of 16-year experience

Objective To review the experience with adrenal surgery which was associated with significant morbidity and notable mortality in the past, although laparoscopic approach is beginning to be accepted as the procedure of choice Methods The indications and results of adrenalectomy in 104 patients (36 men, 68 women) over the past 16 years were reviewed Any potential improvement of surgical results over time was analyzed Results Ninety three patients (89%) had functional problems while malignancy was present in 11 patients (11%) Anterior approach was employed in 27 patients, posterior in 56, lateral in 10, and laparoscopic in 11 One patient required conversion from laparoscopic to anterior approach No operative mortality was seen, but the morbidity occurred in 16 7% Complication rate decreased significantly in this study period (1981 1990 versus 1991 1996, 22% versus 5%; P =0 02) Laparoscopic adrenalec^tomy was successfully performed for 59% of the patients requiring adrenalectomy recently, compared to 68% of posterior adrenalectomy in the past Conclusions Adrenal surgery is a safe procedure, associated with acceptable morbidity, which has decreased over time Laparoscopic adrenalectomy is becoming the preferred approach for the majority of patients requiring adrenalectomy