scholarly journals Factors influencing the recurrence rate of operated chronic subdural hematomas

2016 ◽  
Vol 30 (2) ◽  
pp. 162-167 ◽  
Author(s):  
Toma Papacocea ◽  
Danil Adam ◽  
Raisa Croitoru ◽  
Ionut Rusu ◽  
Alexandru Papacocea
Keyword(s):  
Surgical Technique ◽  
Recurrence Rate ◽  
Surgical Techniques ◽  
Recurrence Risk ◽  
Bone Flap ◽  
Risk Of Recurrence ◽  
Predictors Of Recurrence ◽  
Factors Influencing ◽  
Subdural Hematomas

AbstractIn this study we are trying to establish a correlation between the surgical technique used for the treatment of chronic subdural hematomas and the risk of recurrence. Between 01.06.2008 and 31.05.2014, 123 patients with 138 chronic subdural hematomas (CSDH) were operated on and followed-up in our department. Among them, 16 hematomas (11,6%) recurred. Factors related to the patients (gender, age, location of the hematoma) are analyzed as possible predictors of recurrence. Several surgical techniques were used in the treatment of chronic subdural hematomas. Each of them is analyzed to find possibly connections with the recurrence risk of the size of the approach, the reposition of the bone flap, the suture of the dura and other aspects. There are obvious, statistically significant correlations between the risk of recurrence and some elements of the surgical technique employed.

scholarly journals Recurrence of Chronic Subdural Hematomas Requiring Reoperation: Could Small Trephination Be a Valid Alternative to Conventional Approaches?

2018 ◽  
Vol 32 (2) ◽  
pp. 187-204 ◽  
Author(s):  
Danil Adam ◽  
Dragos Iftimie ◽  
Cristiana Moisescu
Keyword(s):  
Surgical Technique ◽  
Management Strategies ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Hospital Length Of Stay ◽  
Bone Flap ◽  
Neurosurgical Department ◽  
Substantial Impact ◽  
Subdural Hematomas ◽  
Large Bone

Abstract Background: Chronic subdural hematomas (CSDHs) are one of the most common intracranial lesions treated in a neurosurgical department. They associate significant morbidity and mortality that increase in the case of recurrences requiring reoperation. Despite extensive published literature, there is still significant debate regarding optimal management of CSDHs and their potential recurrence. Objective: Identify factors for recurrence requiring reoperation of CSDHs in order to adjust our management strategies. Methods: A retrospective review of 64 cases harbouring 71 CSDHs that were surgically treated in the Neurosurgery Department of “Saint Pantelimon” Clinical Emergency Hospital over a period of two years (January 2016 - December 2017). Two main surgical techniques were used: small trephine and large bone flap craniotomy, according to the operating surgeon’s preference. CT scans were performed at admission and 24 hours postoperatively. Postoperative management was similar in all cases. Results: Recurrence requiring reoperation (RrR) was encountered in 16 (25%) of the reviewed cases. Reoperation was found to be significantly more often encountered in particular preoperative CT characteristics: laminar type (RrR=38,10%, p=0.027) and maximal thickness above 22 mm (43,75%, p = 0,013). Surgical technique had a substantial impact on recurrence: in trephinated cases, reoperation was required in only 8 of 51 patients (RrR=15,69%, p = 0.007), while large bone flap craniotomy associated a RrR of 61,54% (p = 0.008), which increased when associated with inner membranectomy (RrR=87,5%, p = 0,007) or subdural drain placement (88,89%, p = 0.007). Reoperations not only doubled the neurosurgical hospital length of stay, but also associated higher perioperative mortality rates (18.75% versus 14,58%). Conclusions: In our series, surgical technique had a decisive impact on the rate of recurrence. CSDH surgery is another example of “in medio stat virtus”, where finding the right balance between the least and most aggressive technique has the potential of providing the best outcomes, and thus small trephination could be taken into consideration.

Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty

2013 ◽  
Vol 154 (33) ◽  
pp. 1291-1296 ◽  
Author(s):  
László Romics Jr. ◽  
Sophie Barrett ◽  
Sheila Stallard ◽  
Eva Weiler-Mithoff
Keyword(s):  
Recurrence Rate ◽  
Tumour Size ◽  
Breast Conservation ◽  
Malignant Lesion ◽  
Surgical Techniques ◽  
Incomplete Resection ◽  
Immediate Reconstruction ◽  
Oncological Safety

Introduction: (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. Aim: The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. Method: 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. Results: Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29–31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1–88) mean follow-up. Conclusions: Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up. Orv. Hetil., 2013, 154, 1291–1296.

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

2021 ◽  
pp. 019459982110151
Author(s):  
Rahul G. Baijal ◽  
Karla E. Wyatt ◽  
Teniola Shittu ◽  
Eugenia Y. Chen ◽  
Eric Z. Wei ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Chart Review ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Airway Disease ◽  
Respiratory Complications ◽  
Patient Factors ◽  
Children's Hospital ◽  
Reactive Airway Disease ◽  
Children’S Hospital

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

Nasal Dermoids in Children: Factors Influencing the Distant Result

2021 ◽  
Author(s):  
Michal Kotowski ◽  
Paulina Adamczyk ◽  
Jaroslaw Szydlowski
Keyword(s):  
Pediatric Patients ◽  
Surgical Techniques ◽  
Intracranial Extension ◽  
Recurrence Rates ◽  
Local Conditions ◽  
Aesthetic Result ◽  
Factors Influencing ◽  
Vertical Incision ◽  
External Rhinoplasty

AbstractThe aim of the study was to present a single institution’s treatment strategy for nasal dermoids and to identify factors influencing distant results. The study covered 24 surgically treated pediatric patients with nasal dermoids (NDs). The medical data concerning demographics, preoperative local inflammations and surgical procedures, form of the abnormality, imaging, surgical techniques, and a role of osteotomies and reconstructions were analyzed. The recurrence rates and distant aesthetic outcomes were assessed. The surgical approach included vertical incision in 21 patients, the external rhinoplasty approach in 2 cases, and bicoronal incision in 1 child. The intracranial extension was confirmed in 6 patients. Seven out of 8 cases with preoperative local inflammations and 3 out of 4 with secondary fistulization were < 4 years old. Nine patients required osteotomies. Three children required reconstruction of the nasal skeleton. None of the distant cosmetic results was described as hideous or unsatisfactory. The incidence of local inflammatory complications is unrelated to the age of the patients. The distant aesthetic result depends on both the initial extent of the disease and preoperative local conditions or interventions. Prompt surgical intervention is highly recommended.

scholarly journals Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non–skull base meningiomas

2016 ◽  
Vol 125 (2) ◽  
pp. 431-440 ◽  
Author(s):  
Alireza Mansouri ◽  
George Klironomos ◽  
Shervin Taslimi ◽  
Alex Kilian ◽  
Fred Gentili ◽  
...  
Keyword(s):  
Skull Base ◽  
Recurrence Rate ◽  
Postoperative Recurrence ◽  
Prior History ◽  
Skull Base Tumors ◽  
Who Grade ◽  
Predictors Of Recurrence ◽  
History Of ◽  
Skull Base Meningiomas

OBJECTIVE The objective of this study was to identify the natural history and clinical predictors of postoperative recurrence of skull base and non–skull base meningiomas. METHODS The authors performed a retrospective hospital-based study of all patients with meningioma referred to their institution from September 1993 to January 2014. The cohort constituted both patients with a first-time presentation and those with evidence of recurrence. Kaplan-Meier curves were constructed for analysis of recurrence and differences were assessed using the log-rank test. Cox proportional hazard regression was used to identify potential predictors of recurrence. RESULTS Overall, 398 intracranial meningiomas were reviewed, including 269 (68%) non–skull base and 129 (32%) skull base meningiomas (median follow-up 30.2 months, interquartile range [IQR] 8.5–76 months). The 10-year recurrence-free survival rates for patients with gross-total resection (GTR) and subtotal resection (STR) were 90% and 43%, respectively. Skull base tumors were associated with a lower proliferation index (0.041 vs 0.062, p = 0.001), higher likelihood of WHO Grade I (85.3% vs 69.1%, p = 0.003), and younger patient age (55.2 vs 58.3 years, p = 0.01). Meningiomas in all locations demonstrated an average recurrence rate of 30% at 100 months of follow-up. Subsequently, the recurrence of skull base meningiomas plateaued whereas non–skull base lesions had an 80% recurrence rate at 230 months follow-up (p = 0.02). On univariate analysis, a prior history of recurrence (p < 0.001), initial WHO grade following resection (p < 0.001), and the inability to obtain GTR (p < 0.001) were predictors of future recurrence. On multivariate analysis a prior history of recurrence (p = 0.02) and an STR (p < 0.01) were independent predictors of a recurrence. Assessing only patients with primary presentations, STR and WHO Grades II and III were independent predictors of recurrence (p < 0.001 for both). CONCLUSIONS Patients with skull base meningiomas present at a younger age and have less aggressive lesions overall. Extent of resection is a key predictor of recurrence and long-term follow-up of meningiomas is necessary, especially for non–skull base tumors. In skull base meningiomas, recurrence risk plateaus approximately 100 months after surgery, suggesting that for this specific cohort, follow-up after 100 months can be less frequent.

scholarly journals Hospitalization time after open appendectomy by three different surgical techniques

2014 ◽  
Vol 27 (3) ◽  
pp. 188-190 ◽  
Author(s):  
Agláia Moreira Garcia XIMENES ◽  
Fernando Salvo Torres MELLO ◽  
Zailton Bezerra de LIMA-JÚNIOR ◽  
Cícero Faustino FERREIRA ◽  
Amanda Dantas Ferreira CAVALCANTI ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Open Appendectomy ◽  
Surgical Techniques ◽  
Conventional Technique ◽  
Site Infection ◽  
Hospitalization Time ◽  
Contingency Coefficient ◽  
Appendicular Stump

BACKGROUND: The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated. AIM: To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis. METHODS: Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days). RESULTS: A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186. CONCLUSION: There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller.

scholarly journals Retear rates after rotator cuff surgery: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Arianna Carnevale ◽  
Ilaria Piergentili ◽  
Alessandra Berton ◽  
Vincenzo Candela ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Meta Analysis ◽  
Fatty Infiltration ◽  
Surgical Techniques ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Factors Influencing ◽  
Main Factors ◽  
Tear Size

Abstract Background Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. Methods A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients’ age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. Results Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3–6 months follow-up, 16% at 6–12 months follow-up, 21% at 12–24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). Conclusions Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.

scholarly journals EVALUATION OF A TRAINING COURSE ON OPEN VASCULAR SURGICAL TECHNIQUES IN AORTOILIAC PATHOLOGY - 5 YEARS OF EXPERIENCE

2015 ◽  
Vol 88 (2) ◽  
pp. 196-202
Author(s):  
Bogdan Stancu ◽  
Florin Beteg ◽  
Aurel Mironiuc ◽  
Aurel Muste ◽  
Claudia Gherman
Keyword(s):  
Surgical Technique ◽  
Vascular Surgery ◽  
Prospective Study ◽  
Surgical Techniques ◽  
Surgical Skills ◽  
Technical Quality ◽  
Statistical Association ◽  
Abdominal Aortic

Introduction. The aim of this prospective study was to assess the efficacy of a vascular surgery course (2008-2012), and to verify the viability and the feasibility of the vascular anastomoses.Material and method. Vascular surgical techniques performed simultaneously on pigs were: enlargement prosthetic angioplasty, abdominal aortic interposition graft and aortoiliac bypass. Endpoints of the study were the surgical skills and the technical quality, evaluated on a scale ranging from 1 (satisfactory) to 3 (very good) for our participants.Result. A significant improvement in vascular surgical skills tasks was observed during the study years and we also found a semnificative statistical association between the quality of suture and the surgical technique used (Kendall coefficient=0.71, p=0.001<0.05).Conclusions. Our course contributed to the improvement of technical vascular surgical skills of the operator teams, reproducing in vivo, in pigs, the intraoperative environment as in human patients.

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