Incidence and risk factors for incisional hernia after abdominal aortic aneurysm and aortic occlusive disease surgery.

BACKGROUND: This study aims to investigate incisional hernia incidence and risk factors after abdominal aortic aneurysm and aortic occlusive disease surgery via a midline laparotomy. METHODS: A total of 110 patients (66 males, 44 females; mean age: 69.3±8.8 years; range, 36 to 88 years) who underwent open elective surgery for aortoiliac occlusive diseases or abdominal aortic aneurysm between January 2005 and December 2016 were retrospectively analyzed. Both patient groups were compared in terms of surgical procedures, sex, age, American Society o f A nesthesiologists s core ( 1-3), b ody m ass i ndex (<25 vs. ≥25 kg/m2), smoking (non-smoker <1 pack/day, smoking ≥1 pack/day), and time to incisional hernia development. RESULTS: Incisional hernia occurred in 14.3% of the patients operated for aortoiliac occlusive disease and in 17.6% of the patients operated for abdominal aortic aneurysm (p=0.643). Incisional hernia was seen in three (5.7%) of 53 patients with a body mass index of <25 kg/m2 and was in 15 (26.3%) of 57 patients with a body mass index of ≥25 kg/m2 (p=0.03). CONCLUSION: High body mass index is a risk factor for incisional hernia in patients undergoing aortic reconstructive surgery.

Patient-centered oncosurgical planning with cancer models in subspecialty education.

BACKGROUND: A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery. METHODS: This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage. RESULTS: All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful. CONCLUSIONS: With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.

Surgical planning with patient-specific three-dimensional printed pancreaticobiliary disease models - Cross-sectional study.

BACKGROUND: Three-dimensional (3D) printing has been increasingly used in medical applications with the creation of accurate patient-specific 3D printed models in medical imaging data. This study has been planned based on the fact that research on 3D printing in pancreaticobiliary disease is limited due to lack of studies on validation of model accuracy. METHODS: This is an innovative study where general surgery residents are presented 5 distinct hepatopancreatobiliary disease scenarios to generate a perception and required to compare their perception level of these cases with magnetic resonance cholangiopancreatography (MRCP), 3D images and 1:1 solid models that the pathology, diverse diagnosis and presurgery diagnosis stages can be observed. This study is single-centered. RESULTS: The dilated pancreaticobiliary intervention based on scenarios for general surgery residency was more original since there was no prior study that includes both model building and the evaluation of the perception created by the model. Five scenarios provided qualitative assessment with results showing the usefulness of 3D models when used as clinical tools in preoperative planning, simulation of interventional procedures, surgical education, and training. The perception level in the 3D model, MRCP (Z: 3.854, p: 0.000) and the 3D image (Z: 2.865, p: 0.004) was higher; likewise, the 3D-STL image was higher compared to the MRCP image (Z: 3.779, p: 0.000). All subspecialists agree that 3D models provided better understanding of dilated pancreaticobiliary pathoanatomy and improved surgical planning. CONCLUSIONS: A thoroughly outlined genuine patient situation layout aimed for general surgery training can be installed and monitored with the support of 3D printing technology of this study. This can be utilized to develop the comprehension of pathoanatomical variations of complex pancreaticobiliary illness and to adopt a surgical approach.