A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon.

We encountered a case of a large hematoma developing with perforation shortly after a cold snare polypectomy for a colorectal adenoma. The patient underwent cold snare polypectomy for a 3-mm type Is lesion in the transverse colon at another facility. Two hours later, she visited the emergency room due to abdominal pain. Contrast-enhanced computed tomography revealed a 70 mm, high-intensity mass in the transverse colon with contrast extravasation. We attempted transcatheter arterial embolization to stop the bleeding. Several hours later, the anemia had not worsened, but the severe abdominal pain persisted. Urgent laparoscopic right hemicolectomy was performed due to the possibility of gastrointestinal perforation. The surgery was successfully completed. Pathology reports confirmed the presence of an intramural hematoma in the proximal transverse colon with hemorrhagic infiltration of all layers, along with extensive ischemic changes. A perforation was identified in this area, with mucosal defects observed near the hole, possibly due to cold snare polypectomy.

Post-operative care for patients following surgical treatment of lymphedema.

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research.

Symptomatic Pneumorrhachis from Bronchial-Subarachnoid Fistula.

Bronchial-subarachnoid fistulas are rare occurrences, which are not well defined in the literature. This uncommon clinical phenomenon may result in symptomatic pneumorrhachis and presents unique clinical challenges. This report details a case of a 53-year-old female whose treatment for recurrent chondrosarcoma of the thoracic spine included multiple surgeries and radiotherapy. Two weeks after her most recent debulking surgery, she experienced a rapid onset of unusual symptoms, including headache, back and neck spasms, bladder incontinence, and confusion. The source of her symptoms was found to be secondary to pneumorrhachis from a pre-existing bronchial-pleural fistula that had fistulized to the subarachnoid space discovered on computed tomography (CT) and confirmed intraoperatively. The patient was treated successfully with high-flow oxygen therapy and bed rest, followed by surgical correction of both a pleural air leak and a dural defect with muscular flaps. The patient was discharged home in stable condition and remained clinically free of recurrent bronchial-subarachnoid fistula six months after surgical repair. This case contributes to the existing literature by providing detailed clinical insights into the diagnosis and successful management of a bronchial-subarachnoid fistula leading to pneumorrhachis, thereby highlighting the importance of early recognition and intervention and underscoring the need for further research in this area.

Assessment of Long- and Short-Term Outcomes of Hysteroscopic Polypectomy in Patients with Uterine Polyps.

Background: Polyps are a common diagnosis in women of different ages. They can cause a variety of symptoms from bleeding to infertility and can even be the progenitor for malignancies. Materials and Methods: This was a retrospective cohort study conducted in Isfahan. A total of 1004 patients were included in this study. After hysteroscopic polypectomy, patients had their information regarding the complications and recurrence recorded. Results: Symptoms improved in 639 (63.8%). Recurrence of polyps was seen in 143 (14.2%) patients. A total of 170 had a successful pregnancy, with 110 of them spontaneous. Using scissors had lower recurrence compared to graspers. Eight cases had complications during the treatment, two of which were major. Conclusion: Hysteroscopic polypectomy is the treatment of choice for uterine polyps. We show hysteroscopic polypectomy to have a high success rate and a low complications rate, with polypectomies done using scissors to have lower risk of complications or recurrence compared to graspers.

Effect of early ambulation on comfort and vascular complications following electrophysiological studies: A randomized controlled trial.

BACKGROUND: Imposed immobilization after electrophysiological studies (EPS) is known to cause different complications. The current study aims to assess the effect of early ambulation on comfort and vascular complications among patients undergoing transfemoral catheterization for EPS. MATERIALS AND METHODS: Hundred participants were assigned to control and intervention groups (50 each) using block randomization. The control group participants were ambulated at 6 hours after EPS. For the intervention group, participants were kept in the supine position with procedure-side leg extension for the first 2 hours, followed by 30° head-end elevation and turning to the left/right side for 30 min, and finally ambulation at the end of 3 hours. Both groups were assessed for vital signs, groin and back pain, satisfaction, bleeding, hematoma, and bladder pattern at the 6th and 24th hour after EPS. Data analysis was done on an intention-to-treat basis using the Chi-square test, Fisher's exact test, independent student t-test, and Mann-Whitney U test. RESULTS: The level of back pain and groin pain was significantly lower in intervention group after 6 hours (P < 0.001) and after 24 hours (P < 0.05). Urinary problem was not reported in intervention group, whereas Eleven (22%), participants in the control group did not void at 6 hours (P < 0.001). Two patients in intervention group developed bleeding at 6 hours, and one patient in control group developed bleeding at 24 hours. Hematoma development was absent for both groups. CONCLUSION: Early ambulation at 3 hours after EPS is suggested to reduce back pain, groin pain, and urinary problem, without risk for vascular complications.

What influences post-operative opioid requirements for tibial fractures?

Introduction: Currently there are few opioid prescribing guidelines for orthopaedic fractures. Long-term post-surgical analgesia requirements, understandably, vary between orthopaedic cases. Our study aims to provide detailed information to clinicians and policy makers, on the opioid requirement associations for patients sustaining tibial fractures. Methods: This study reviewed all patients sustaining an isolated tibial fracture at a major trauma centre that were operated on within 1 month of injury, from 2015 to 2022. The total opioid dosage used each month in morphine milligrams equivalents (MME) and the number of days opioids were used each month, within the first-year post-surgery were collected, representing the strength and coverage of opioid analgesia in the post-operative stage, respectively. We compared opioid strength and coverage requirements with types of definitive fracture fixations, location, fracture type and concurrent patient medical comorbidities to assess for any trends. Results: A total of 1814 patients sustaining a combined of 1970 fractures were included in the study. Tibial plateau fractures had the highest opioid strength and coverage requirements in each month and the entire year (p < .05). Across all fracture locations, Ex Fix frame showed higher opioid strength and coverage requirements compared to both IM nailing and plate ORIF. With regard to opioid coverage in the presence of specific comorbidities, only chronic kidney disease (quotient: 1.37, 95% Confidence interval [95%CI] = 1.19-1.55, p = .002) and hypertension (quotient: 1.34, 95%CI = 1.14-1.53, p = .009) showed significance at the 1-year overall level. For opioid strength, Chronic Kidney Disease (quotient: 1.72, 95%CI = 1.41-2.03 p = .005) and COPD (quotient: 1.90, 95%CI = 1.44-2.36, p = .014), show significance at the 1-year overall level. Conclusion: Our study details opioid requirements post-surgery amongst tibial fractures with subgroup analysis assessing opioid needs amongst specific fracture locations, types, surgical techniques and medical comorbidities. This framework aids clinicians in anticipating rehabilitation and assists in risk stratifying patients at injury onset.

Accuracy of Preoperative Lung Ultrasound Score for the prediction of Major Adverse Cardiac Events in elderly patients undergoing HIP Surgery under Spinal Anesthesia: the LUSHIP multicenter observational prospective study.

BACKGROUND AND OBJECTIVE: We hypothesize that lung ultrasound scores (LUS) can help stratify the cardiac risk of elderly patients undergoing orthopedic surgery for hip fracture, adding value to the Revised Cardiac Risk Index (RCRI), the American Society of Anesthesiologists Physical Status (ASA-PS) and the National Surgical Quality Improvement Program Myocardial infarction and Cardiac arrest (NSQIP-MICA). METHODS: Prospective, observational multicenter study of 11 Italian hospitals on patients aged >65 years with hip fractures needing urgent surgery. Subjects with major adverse cardiovascular events (MACE) in the previous 6 months or with ongoing acute heart failure were excluded. Trained anesthesiologists obtained preoperative LUS scores during preoperative evaluation. ROC curve analysis and comparison were used to evaluate test accuracy. RESULTS: A total of 877 patients were enrolled in the study period. 108 MACE events occurred in 98 patients, with an overall incidence of 11.2%. LUS score was higher in complicated than non-complicated patients, 11.6 ± 6.64 vs. 4.97 ± 4.90 (p < 0.001). Preoperative LUS score ≥8 showed both better AUC (0.78) and accuracy (0.76) in predicting MACE than the RCRI scores (p < 0.001), MICA scores (p = 0.001) and ASA classes (p < 0.001). LUS sensitivity was 0.71, specificity was 0.76, negative predictive value was 0.95. LUS score ≥8 showed an OR for MACE of 5.81[95% CI 3.55-9.69] at multivariate analysis. 91 patients (10.4%) experienced postoperative pneumonia showing a preoperative LUS score higher in the non-pneumonia group, p < 0.001. CONCLUSIONS: The preoperative LUS score, with its high negative predictive value, could improve patients' risk stratification when used alone or add further value to the RCRI score. REGISTRATION: Registered at clinicaltrials.gov as NCT04074876.

Efficacy of Transdermal Buprenorphine Patch in Postoperative Pain Management in Oral and Maxillofacial Surgery.

Aim: To evaluate the therapeutic efficacy of transdermal Buprenorphine patch in postoperative pain management in Major Oral and Maxillofacial surgeries done under general anesthesia. Materials and Method: A total number of 100 subjects, both males and females in the age group of 18-60 years were included in the study. At the screening visit, a brief medical history was recorded for each prospective subject. The subject was selected according to the inclusion and exclusion criteria and consent was taken before placing the patch. For a period of 7 days, 10 mg Buprenorphine patch was placed on the skin of the patient for 3 h before the surgery. Analgesic efficacy was recorded for the next 7 days by using visual analogue scale (hereinafter refered to as "VAS"). If the VAS score was above 5, the rescue analgesia inj. Dynapar I.V was administered to the patient. Results: The mean VAS score in females 4.4, was high when compared to males 3.9, which would suggest that the patch was more effective in males compared to females. Trauma patients showed mean VAS score of 3.9 and pathology patients showed a mean VAS score of 4.1. 36% of the patients required additional analgesics as the VAS score was more than 5. 20% of patients between age group of 20-30 years required additional analgesics, 66.7% in 31-40yrs, 0% of 41-50yrs and 13.3% in 51-60yrs required additional analgesics. 24% of the females patients required 37 additional analgesics compared to the 12% in male patients. 21.6% of patients treated for pathology required additional analgesics compared to the 8.2% in trauma patients. Thus, the sensitivity of this study was 94.1% and specificity was 33.3%. Conclusion: Buprenorphine has high analgesic potential, good safety profile, ease of opioids switches and reversibility by µ- antagonist. Transdermal route is cost effective and has increased patient compliance and ease of handling with less adverse effects. Thus, the efficacy of transdermal buprenorphine in postoperative pain management was good.

Comparative Analysis of Oral Clonidine Versus Oral Gabapentin on Subarachnoid Block Duration and Postoperative Analgesic Needs.

INTRODUCTION: Pain, an inherently subjective experience, plays a pivotal role in the body's defence mechanism by signalling tissue damage or potential harm. Thus, optimal postoperative pain management is a cornerstone of modern surgical practice, essential for improving recovery outcomes and overall patient well-being. METHODS: In this study, a total of 60 patients were randomly assigned to two groups of 30 each: Group C (clonidine) and Group G (gabapentin). Group C received oral clonidine 100 mcg and Group G received oral gabapentin 600 mg one hour prior to the subarachnoid block. Duration of sensory and motor block, hemodynamic parameters, Visual Analog Scale (VAS) scores, time to rescue analgesia and any side effect of both drugs were assessed in both groups. RESULTS: The duration of motor and sensory blockade, as well as intraoperative hemodynamics and respiratory rates, were comparable between the two groups. Group G exhibited significantly lower VAS scores from 150 minutes postoperatively up to 12 hours (p < 0.001). Additionally, Group G experienced longer duration of postoperative analgesia (16.8±3.9 hours) compared to Group C (9.27±1.7 hours). About 26.6% of the patients in Group C and 6.7% of the patients in Group G presented with postoperative nausea and vomiting (PONV). CONCLUSION: Oral gabapentin at a dosage of 600 mg demonstrates superior efficacy as a premedication compared to oral clonidine 100 mcg for patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia. Group G demonstrated extended postoperative analgesia, lower VAS scores, and a reduced incidence of PONV, indicating its superiority over clonidine as an analgesic adjunct.

Postoperative Pain after Laparoscopic Cholecystectomy in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Laparoscopic cholecystectomy, being minimally invasive, is widely accepted in comparison to open cholecystectomy. The major benefits are small incision, less wound pain, rapid recovery, shorter hospital stay and earlier return to activities. Although, trauma and injury are limited in laparoscopic cholecystectomy; it is not a pain free surgery. Hence, we aimed to find the prevalence of pain at wound site after laparoscopic cholecystectomy at various time intervals in post-operative period. METHODS: The descriptive cross-sectional study was conducted among 125 patients who belonged to American Society of Anesthesiologists grade I & II patients, with diagnosis of symptomatic gallstone disease from October, 2022 to September, 2023 in a tertiary care hospital after ethical approval was obtained from Institutional Review Board (Reference number: MEMG/483/IRC). Total sampling was done in this study. The post-operative pain at wound site was measured at 12, 24, 36 and 48 hours. Data were analyzed using Statistical Package of Social Sciences 21.0. RESULTS: At 12 hours postoperatively, 2 (1.60%) patients complained of severe pain, 120 (96%) patients reported moderate pain and 3 (2.40%) patients expressed their pain as being mild. Likewise, at 24, 36 and 48 hours postoperatively, none of the patients suffered from severe pain. At 24 hours post-operative, 105 (84%) patients reported moderate pain which gradually declined over 48 hours. At 36 and 48 hours post-operative mild pain was reported by 85 (68%) and 117 (93.60%) patients. The moderate pain was complained by 40 (32%) and 8 (6.40%) patients. CONCLUSIONS: The majority of patients suffered from mild to moderate pain after laparoscopic cholecystectomy, the intensity of which decreased over 48 hours.

Role of Pregabalin in Pre-Operative and Post-Operative Pain Management of Lower Limb Orthopedic Surgeries.

Introduction: Post-operative pain after orthopedic surgery has remained a challenging problem, which prolongs hospital stay and early rehabilitation. Pregabalin comes under the class of gabapentinoids that have been used in postoperative pain in arthroplasty and spine surgeries but studies regarding its role as pre-emptive analgesia in orthopedic limb surgeries are very few. Aims: To compare the efficacy of pre-operative pregabalin with a placebo drug in early post-operative pain management for lower limb orthopedics surgeries. Materials and Methods: A randomized double blinded prospective study was undertaken. Sixty patients were enrolled with age between 18 and 70 years and were divided into 2 groups. Group A - received 150 mg of oral pregabalin capsule, and Group B - received matched color empty capsules. Standard spinal anesthesia was given. Breakthrough analgesia was given with an injection of tramadol 50 mg intravenous. Assessment of pain was done with a Visual Analog Scale (VAS) at 6, 12, 24, and 48 h. Results: In comparison to Group B, Group A had a significantly lower postoperative VAS score and required much less breakthrough analgesia within the 1st 24 h after surgery. Conclusion: In orthopedic lower limb fracture surgeries, pre-emptive pregabalin of 150 mg provides adequate postoperative analgesia with relatively few unfavorable side effects.

Flexor Digitorum Profundus Avulsion With Distal Interphalangeal Joint Dorsal Dislocation: A Case Report.

An irreducible closed dorsal dislocation of the distal interphalangeal (DIP) joint of the finger is a rare injury, often caused by factors such as the interposition of the volar plate, entrapment of the flexor digitorum profundus (FDP) tendon behind the head of the middle phalanx, or the buttonholing of the middle phalanx head through the volar plate or flexor tendon. This case report presents a rare instance of FDP avulsion combined with dorsal dislocation of the DIP joint in a 42-year-old male who sustained trauma to his right middle finger during a workplace accident. Clinical examination and imaging confirmed FDP avulsion along with dorsal dislocation of the DIP joint. Urgent surgical intervention was performed, successfully reducing and repairing the FDP tendon and stabilizing the DIP joint. Subsequent follow-up showed satisfactory functional outcomes. This case highlights the importance of prompt diagnosis and appropriate surgical management in treating complex finger injuries.

Predictive modeling for post operative delirium in elderly.

Delirium, a complex neurocognitive syndrome, frequently emerges following surgery, presenting diverse manifestations and considerable obstacles, especially among the elderly. This editorial delves into the intricate phenomenon of postoperative delirium (POD), shedding light on a study that explores POD in elderly individuals undergoing abdominal malignancy surgery. The study examines pathophysiology and predictive determinants, offering valuable insights into this challenging clinical scenario. Employing the synthetic minority oversampling technique, a predictive model is developed, incorporating critical risk factors such as comorbidity index, anesthesia grade, and surgical duration. There is an urgent need for accurate risk factor identification to mitigate POD incidence. While specific to elderly patients with abdominal malignancies, the findings contribute significantly to understanding delirium pathophysiology and prediction. Further research is warranted to establish standardized predictive for enhanced generalizability.

Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding.

Hemorrhoids are a common and painful condition, with conventional treatments such as endoscopic rubber band ligation (ERBL) and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain. A clinical trial by Qu et al introduces a novel approach called endoscopic poli-docanol foam sclerobanding (EFSB). This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL. The study's strengths include its robust design, comprehensive outcome evaluation, and patient-centered approach. Despite limitations such as the single-blind design and relatively short follow-up period, the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option. Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.

Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis: A randomized clinical trial.

AIM: The aim of this study is to compare the outcomes of restricted partial pulpotomy (R-PP) versus extended partial pulpotomy (E-PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP). METHODOLOGY: This double-arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R-PP group, 2-3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de-roofed and 2-3 mm of superficial pulp tissue from entire chamber was removed in the E-PP group. Haemostasis was achieved using 3% sodium hypochlorite-soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin-modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre-operatively and daily for 7 post-operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi-square or Fisher's exact test. Tooth survival was analysed using Kaplan-Meier analysis. RESULTS: A total of 81 cases were analysed at 12 months follow-up. Comparable success was observed in both groups (97.6% in E-PP & 97.5% in R-PP; p > .05). The R-PP group reported significantly lower pain scores on the 1st and 2nd post-operative days than E-PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R-PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05). CONCLUSIONS: Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R-PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions.

Vasoactive-ventilation-renal (VVR) score: A potential tool for predicting early postoperative outcomes in adult mitral valve surgery.

Background and Aims: Vasoactive-ventilation-renal (VVR) score has been validated in predicting postoperative outcomes in pediatric cardiac surgery. The aim was to evaluate its potential in predicting early postoperative outcomes in adult patients undergoing mitral valve surgery. Material and Methods: A single-center prospective observational study involved 100 patients undergoing mitral valve surgery. We evaluated preoperative variables (Ambler score), VVR, and vasoactive-inotropic score (VIS) on admission to the intensive care unit (ICU) and then at 12, 24, and 48 hrs postoperatively. Outcomes assessed were length of stay in ICU (LOS-ICU), length of hospital stay (LOHS), and mortality. The data were analyzed using multivariable logistic regression model, receiver operating characteristic (ROC) curves, and areas under curve (AUC). Conclusion: Our study showed the potential utility of the VVR score as a powerful tool for predicting early outcomes after mitral valve surgery, with VVR at 48 hrs having superior predictive capability.

In operating room extubation after cardiac surgery is associated with decreased incidence of in hospital new postoperative atrial fibrillation.

OBJECTIVES: This study aims to characterize the risks and benefits of in-OR extubation after cardiac surgery. DESIGN: This is a retrospective chart review. SETTING: Single tertiary care hospital. PARTICIPANTS: Cardiac surgical patients >18 years. Exclusion criteria included patients extubated after 6 h in the ICU, those with a history of congenital heart disease (CHD), those intubated prior to arrival to the OR, procedures including circulatory arrest and/or selective cerebral perfusion, cardiothoracic transplantation, and intraoperative death. De-identified data was collected via the hospital's electronic medical record. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Perioperative data was collected for 726 patients, of which 303 (42 %) were extubated in the OR. Multivariable regression models were derived with covariates based on expert clinical reasoning. When compared to fast track extubation, in-OR extubation was independently associated with decreased index hospitalization length of stay (-1.74, 95 % CI [-2.22, -1.08], p < 0.001) and decreased incidence of in-hospital new post-operative atrial fibrillation (OR 0.56 95 % CI [0.37, 0.86], p < 0.01). There were no differences in persistent vasoactive therapy requirement, postoperative mechanical circulatory support or extubation failure. CONCLUSIONS: In-OR extubation is associated with decreased index hospitalization length of stay and decreased new onset in-hospital atrial fibrillation.

The Benefits of Silicone Laryngectomy Tubes at the Time of Laryngectomy-A Case Series Spanning 17 Years.

OBJECTIVES: Although total laryngectomy (TL) is a well-established surgical procedure with clear functional or oncologic indications, the peri- and postoperative care for those undergoing TL is variable, particularly regarding postlaryngectomy tracheostoma management. This study examined TL outcomes from a single institution with the immediate perioperative use of soft silicone laryngectomy tubes. More specifically, we explored potential complications associated with immediate perioperative use of a flexible laryngectomy tube (LaryTube and StomaSoft) and the use of heat and moisture exchange (HME) devices in association with peri- and postoperative care. METHODS: A case series including all patients undergoing TL by one primary surgeon at a tertiary care hospital between 2006 and 2023 were assessed. Variables of interest included hospital average length of stay (LOS) in hospital, use of laryngectomy tube and an HME, primary tracheoesophageal puncture voice restoration at time of TL, discharge feeding, stoma-related complications, and overall complications. RESULTS: Seventy-two patients were included over the study period, and all utilized a laryngectomy tube and HME in the perioperative period without complications. Fifty-six patients (77.7%) had concurrent neck dissections and nine (15%) underwent total laryngopharyngectomy. Sixty-two patients (86%) underwent TL for squamous cell carcinoma of the larynx or hypopharynx and 35 of these (56%) were salvage surgeries. Mean LOS was 8.4 (3-45) days, and 63 patients (88%) were discharged with nasal gastric tube feeding. Of the six patients (8%) who were readmitted for complications, zero (0%) were related to the laryngectomy tube or to stoma-related complications (e.g., dehiscence, infection, mucous plugging). No patient who utilized a laryngectomy tube and HME device in the perioperative period experienced stomal stenosis. CONCLUSIONS: Laryngectomy tubes combined with an HME can be employed safely and successfully in a high percentage of laryngectomy patients placed perioperative. No instances of postlaryngectomy tracheostoma stenosis occurred in association with perioperative laryngectomy tube with HME use. These collective data support the use of a laryngectomy tube with HME in the immediate perioperative period, with low risk of complications.

Open Surgical Implantation of Lumbosacral Dorsal Root Ganglion Stimulators for Chronic Pain: Analysis of Patient Outcomes and Operative Technique.

OBJECTIVE: Dorsal root ganglion (DRG) stimulator leads were designed to be placed percutaneously, yet open surgical placement via laminectomy is an option. We present the largest series to date of surgically-placed DRG stimulators and the first series where open surgical implantation was the chosen technique and not a salvage procedure. METHODS: A retrospective review of a prospective database of DRG implants identified 17 patients who had open lumbosacral DRG lead placement performed by a single surgeon (NDT) between October 2021 and April 2023. Descriptive statistics, fluoroscopy exposure times, and complications were reported. The window of data collection was 1 month pre-operatively to 12 months post-operatively. Phone interviews were conducted to collect information on pain outcomes and patient satisfaction. RESULTS: We identified 17 patients (12 women, 5 men) who had lumbosacral DRG placement. Phone interviews were conducted for 10/17 patients, with mean follow-up of 11.9 months. 53% reduction in mean pain score was achieved (n=10, p<0.001). There were no infections, hematomas, or symptomatic lead migrations. 1/17 experienced a superficial dehiscence and 2/17 had an intra-operative repairable durotomy with no post-operative sequelae. Mean fluoroscopy time per lead was 15.4±9.9s (n=10). CONCLUSION: Open DRG lead placement via laminotomy/laminectomy is reported as a salvage procedure but may have comparable safety and efficacy profile to percutaneous implantation when utilized as the primary implantation method. Before establishing open DRG as an alternative permanent implantation method, more studies are needed to determine whether such benefits as less migration outweigh the risks of a more invasive implantation procedure.

Endoscopic or combined management of post-surgical biliary leaks: a two-center recent experience.

BACKGROUND AND AIMS: Post-surgical biliary leaks (PSBL) are one of the most prevalent and significant adverse events emerging after liver or biliary tract surgeries. Endoscopic retrograde cholangiopancreatography (ERCP) alone or combined with another approach (Rendez Vous) as treatment of PSBL obtains optimal outcomes due to the possibility of modifying the resistances in the biliary tree. METHODS: A retrospective double-center study was conducted in two tertiary centers. Consecutive patients who underwent at least one attempt of PSBL correction by ERCP or Rendez Vous procedure between January 2018 and August 2023 were included. The primary outcome was overall endoscopic clinical success. In contrast, the secondary outcomes were hospital stay exceeding five days and endoscopic clinical success with the first endoscopic procedure at the tertiary center. Both univariate and multivariate analyses were used to assess outcomes. RESULTS: 65 patients were included. Patients with one or multiple) leaks had more possibility to achieve the endoscopic clinical success compared to those affected by the association of leaks and stricture (96% vs 67%, p value 0.005). Leaks occurring in the main biliary duct had less probability (67%) to achieve the overall endoscopic clinical success compared to those in the end-to-end anastomosis (90%), in the resection plane or biliary stump (96%) or first or secondary order biliary branches (100%, p value 0.038). A leak-bridging stent positioning had more probability of achieving the endoscopic clinical success than a not leak-bridging stent (91% vs 53%, p value 0.005). CONCLUSIONS: ERCP and Rendez Vous procedures are safe and effective for treating PSBL, regardless of the type of preceding surgery, even if technical or clinical success was not achieved on the first attempt. A stent should be placed, if feasible, leak-bridging to enhance treatment efficacy.