Search results for: cardiovascular surgery

Authors: Parnaz Boodagh, Danila Vella, Antonio Damore, Laura Modica De Mohac, Sang-Ho Ye, Garret Coyan, Gaetano Burriesci, William Wagner, Federica Cosentino

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The use of cardiac patches is among the main therapeutic solution for cardiovascular diseases, a leading mortality cause in the world with an increasing trend, responsible of 19 millions deaths in 2020. Several classes of biomaterials serve that purpose, both of synthetic origin and biological derivation, and many bioengineered treatment alternatives were proposed to satisfy two main requirements, providing structural support and promoting tissue remodeling. The objective of this paper is to compare the mechanical properties and the characterization of four cardiac patches: the Adeka, PhotoFix, CorPatch, and CardioCel patches. In vitro and in vivo tests included: biaxial, uniaxial, ball burst, suture retention for mechanical characterization; 2D surface topography, 3D volume and microstructure, and histology assessments for structure characterization; in vitro test to evaluate platelet deposition, calcium deposition, and macrophage polarization; rat right ventricular outflow tract (RVOT) models at 8- and 16-week time points to characterize the patch-host interaction. Lastly, the four patches were used to produce four stented aortic valve prosthesis, subjected to hydrodynamic assessment as well as durability testing to verify compliance with the standard ISO.

Keywords: cardiac patch, cardiovascular disease, cardiac repair, blood contact biomaterial

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Authors: Hernán A. Perez, Luis J. Armando, Néstor H. García

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Background and aims Cardiovascular disease rates are very high in patients with renal failure (CRF), but the underlying mechanisms are incompletely understood. Traditional cardiovascular risk factors do not explain the increased risk, and observational studies have observed paradoxical or absent associations between classical risk factors and mortality in dialysis patients. A large randomized controlled trial, the 4D Study, the AURORA and the ALERT study found that statin therapy in CRF do not reduce cardiovascular events. These results may be the results of ‘accelerated atherosclerosis’ observed on these patients. The objective of this study was to investigate if carotid total plaque area (TPA), a measure of carotid plaque burden growth is increased at progressively lower creatinine clearance in patients with CRF. We studied a cohort of patients with CRF not on dialysis, reasoning that risk factor associations might be more easily discerned before end stage renal disease. Methods: The Blossom DMO Argentina ethics committee approved the study and informed consent from each participant was obtained. We performed a cohort study in 412 patients with Stage 1, 2 and 3 CRF. Clinical and laboratory data were obtained. TPA was determined using bilateral carotid ultrasonography. Modification of Diet in Renal Disease estimation formula was used to determine renal function. ANOVA was used when appropriate. Results: Stage 1 CRF group (n= 16, 43±2yo) had a blood pressure of 123±2/78±2 mmHg, BMI 30±1, LDL col 145±10 mg/dl, HbA1c 5.8±0.4% and had the lowest TPA 25.8±6.9 mm2. Stage 2 CRF (n=231, 50±1 yo) had a blood pressure of 132±1/81±1 mmHg, LDL col 125±2 mg/dl, HbA1c 6±0.1% and TPA 48±10mm2 ( p< 0.05 vs CRF stage 1) while Stage 3 CRF (n=165, 59±1 yo) had a blood pressure of 134±1/81±1, LDL col 125±3 mg/dl, HbA1c 6±0.1% and TPA 71±6mm2 (p < 0.05 vs CRF stage 1 and 2). Conclusion: Our data indicate that TPA increases along the renal function deterioration, and it is not related with the LDL cholesterol and triglycerides levels. We suggest that mechanisms other than the classics are responsible for the observed excess of cardiovascular disease in CKD patients and finally, determination of total plaque area should be used to measure effects of antiatherosclerotic therapy.

Keywords: hypertension, chronic renal failure, atherosclerosis, cholesterol

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Authors: Mustafa M. Donma, Orkide Donma

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Cardiovascular pathology is one of the expected consequences of excessive fat gain. The role of zinc in thyroid hormone metabolism is an important matter. The concentrations of both thyroid stimulating hormone (TSH) and zinc are subject to variation in obese individuals. Zinc exhibits protective effects on cardiovascular health and is inversely correlated with cardiovascular markers in childhood obesity. The association between subclinical hypothyroidism (SCHT) and metabolic disorders is under investigation due to its clinical importance. Underactive thyroid gland causes high TSH levels. Subclinical hypothyroidism is defined as the elevated serum TSH levels in the presence of normal free thyroxin (T4) concentrations. The aim of this study was to evaluate the associations between TSH levels and zinc concentrations in morbid obese (MO) children exhibiting SCHT. The possibility of using the probable association between these parameters was also evaluated for the discrimination of metabolic syndrome positive (MetS+) and metabolic syndrome negative (MetS-) groups. Forty-two children were present in each group. Informed consent forms were obtained. Institutional Ethics Committee approved the study protocol. Tables prepared by World Health Organization were used for the definition of MO children. Children, whose age- and sex-dependent body mass index percentile values were above 99, were defined as MO. Children with at least two MetS components were included in MOMetS+ group. Elevated systolic/diastolic blood pressure values, increased fasting blood glucose, triglycerides (TRG)/decreased high density lipoprotein-cholesterol (HDL-C) concentrations in addition to central obesity were listed as MetS components. Anthropometric measures were recorded. Routine biochemical analyses were performed. Thirteen and fifteen children had SCHT in MOMetS- and MOMetS+ groups, respectively. Statistical analyses were performed. p<0.05 was accepted as statistically significant. In MOMetS- and MOMetS+ groups, TSH levels were 4.1±2.9 mU/L and 4.6±3.1 mU/L, respectively. Corresponding values for SCHT cases in these groups were 7.3±3.1 mU/L and 8.0±2.7 mU/L. Free T4 levels were within normal limits. Zinc concentrations were negatively correlated with TSH levels in both groups. The significant negative correlation calculated in MOMetS+ group (r= -0.909; p<0.001) was much stronger than that found in MOMetS- group (r= -0.706; p<0.05). This strong correlation (r= -0.909; p<0.001) calculated for cases with SCHT in MOMetS+ group was much lower (r= -0.793; p<0.001) when all MOMetS+ cases were considered. Zinc is closely related to T4 and TSH therefore, it participates in thyroid hormone metabolism. Since thyroid hormones are required for zinc absorption, hypothyroidism can lead to zinc deficiency. The presence of strong correlations between TSH and zinc in SCHT cases found in both MOMetS- and MOMetS+ groups pointed out that MO children were under the threat of cardiovascular pathologies. The detection of the much stronger correlation in MOMetS+ group in comparison with the correlation found in MOMetS- group was the indicator of greater cardiovascular risk due to the presence of MetS. In MOMetS+ group, correlation in SCHT cases found higher than correlation calculated for all cases confirmed much higher cardiovascular risk due to the contribution of SCHT.

Keywords: cardiovascular risk, children, morbid obesity, subclinical hypothyroidism, zinc

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Authors: H. A. Algahtani, A. S. Khan, O. Alzahrani, N. Hussein, M. A. Khan, Loudhi Y. I. Soliman

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Objective: To report on the Saudi experience (developing country) of neurological complications from bariatric surgery. The literature on the subject is reviewed. Method: This is a cross sectional study done in King Abdul Aziz Medical City Jeddah, WR, where we reviewed all charts of the patients who underwent bariatric surgery between January 1st, 2009 to December 31st , 2014. Personal and clinical data including age, sex, BMI, comorbidities, type of procedure, duration of stay in hospital, complications and postoperative follow up were collected. In addition follow up visit and remote complication if present were collected. All patients with neurological complications were reviewed in details including their clinical examination, laboratory and imaging results, treatment and prognosis. This report is essentially descriptive with no statistical analysis performed. Results: Fifteen cases were collected in this study (3%). Axonal polyneuropathy was the most frequent neurological complica¬tion, but cases of Wernicke syndrome, vitamin B12 deficiency, Guillain-Barre syndrome and cupper deficiency were also identified. Fourteen patients (93.3%) had full recovery from the neurological signs and symptoms but unfortunately one patient died. Conclusion: Bariatric surgery, a procedure that is continuously increasing in popularity, is not free of potential neurological complications. A clear education, guidelines and follow-up program should be planned and practiced. Facts should be clearly presented to the individual undergoing this type of surgery. Although a clear cause-effect relation cannot be established for the present cases, the cumulative literature on the subject makes it important to warn the patient of the potential risks of this procedure.

Keywords: bariatric surgery, neurological complications, neuropathy, Wenicke syndrome

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Authors: Ahmed Gendia, Waseem Kamran

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Objective: Total Laparoscopic hysterectomy (TLH) remains a common approach among laparoscopic surgeons. However, this approach depends on the use of uterine manipulator to facilitate the surgery. Although many studies reported the effectiveness of TLH with uterine manipulator, only few reported TLH without the use of any uterine or vaginal manipulation. the aim of this report is to demonstrate our Technique (kamran's TLH) in performing TLH without the use of any uterine or vaginal manipulation in benign conditions and report our intra- and post-operative outcomes. Methodology : surgical technique will be demonstrated through a short video highlighting the easy and safe to learn surgical steps. Additionally, the data of 86 patients who underwent KTLH for benign condition were retrospectively analyzed. the data included intra- and postoperative finding and complications. Results : A total of 86 hysterectomies were performed utilizing the Kamran's TLH ( KTHL). Mean age was 52.2 (±11) years old and BMI was 28.2(±7). Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence. Conclusion & Significance: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.

Keywords: laparoscopic hystrectomy, TLH, uterine manipulator, surgery

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Authors: Pei-Ru Yang, Yu-Chen Lin, Jia-Min Wu

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Background: A 58-year-old man with a history of osteoporosis and diabetes presented with chronic pain in his left knee due to severe knee joint degeneration. The knee replacement surgery was recommended by the doctor. But the patient suffered from low pain tolerance and wondered if virtual reality could relieve acute postoperative wound pain. Methods: We used the PICO (patient, intervention, comparison, and outcome) approach to generate indexed keywords and searched systematic review articles from 2017 to 2021 on the Cochran Library, PubMed, and Clinical Key databases. Results: The initial literature results included 38 articles, including 12 Cochrane library articles and 26 PubMed articles. One article was selected for further analysis after removing duplicates and off-topic articles. The eight trials included in this article were published between 2013 and 2019 and recruited a total of 723 participants. The studies, conducted in India, Lebanon, Iran, South Korea, Spain, and China, included adults who underwent hemorrhoidectomy, dental surgery, craniotomy or spine surgery, episiotomy repair, and knee surgery, with a mean age (24.1 ± 4.1 to 73.3 ± 6.5). Virtual reality is an emerging non-drug postoperative analgesia method. The findings showed that pain control was reduced by a mean of 1.48 points (95% CI: -2.02 to -0.95, p-value < 0.0001) in minor surgery and 0.32 points in major surgery (95% CI: -0.53 to -0.11, p-value < 0.03), and the overall postoperative satisfaction has improved. Discussion: Postoperative pain is a common clinical problem in surgical patients. Research has confirmed that virtual reality can create an immersive interactive environment, communicate with patients, and effectively relieve postoperative pain. However, virtual reality requires the purchase of hardware and software and other related computer equipment, and its high cost is a disadvantage. We selected the best literature based on clinical questions to answer the patient's question and used share decision making (SDM) to help the patient make decisions based on the clinical situation after knee replacement surgery to improve the quality of patient-centered care.

Keywords: knee replacement surgery, postoperative pain, share decision making, virtual reality

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Authors: Sunita Patel

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Cardiovascular diseases are the leading cause of morbidity as well as mortality in India. Objective of this study is to examine CVDs prevalence and identify their behavioral and cultural risk factors with the help of SAGE-2007 data conducted on 6th states in India. Findings reveal that 18.3% of people diagnosed with CVDs in India. Higher disease occurs in an increasing rate between ages of 30-39 having OR 2.45 (CI: 1.66-3.63) and 70+ age OR 7.45 (CI: 4.82-11.49) times higher compare to 18-29 age group respectively. Wealth quintile higher CVD occurs as 3rd in 60% (CI: 1.16-2.21) and in richest 5th quintile 58% (CI: 1.13-2.21) contrast to lowest quintile. Relative risk depicted that 22.4% in moderate and 44% in vigorous activity have less chance of diseases compare to who performed no work and those who consumed alcohol. Results reveal that policy prospect should be recommended and that it would be beneficial for awareness of people and their future.

Keywords: behavioral risk, cultural risk, cardio-vascular diseases, wealth quintile

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Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

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Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

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Authors: Aline Giardin, Ana Fontoura, Thomas Anderson

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Transsexuality is a condition that requires the work of professionals from various fields for diagnosis and treatment. The correct diagnosis is very important because the surgery is irreversible. Diagnostic elements are essentially clinical and an observation period of two years prior to surgery is recommended. In this review article, we discuss the importance of psychiatric nursing for the care of transgender patients, as well as their mental health. Transsexuality is a phenomenon that contrasts our common understandings of sexuality, but it is not a sexual issue. Also called gender dysphoria is a mismatch between the anatomical sex of an individual and their gender identity. In relation to mental health, among transsexuals, we find variations ranging from psychoses to total normality. As the etiology is still controversial, there is no biological marker and only the clinical criteria can be used. Portaria nº 2803, of November 19, 2013, Brazil, regulates the surgical reassignment of sex by the SUS and the nurse started to work also in operational groups (transsexuals who wish to perform surgery and other procedures of reassignment of sex). Health and education, establishes links and guides the care that female and male transsexual patients will have to have before and after surgery. It is also important to say that the work of health education is not only concerned with aspects related to the sexual reassignment surgery, but also with the mental health of its patients and with the family. One of the main complaints of patients is the impression that professionals seem to find them strange and feel extremely uncomfortable when they talk about their desire to undergo sex-change surgery: Investigate the role of nursing in the process of change sexual. Our methodology was a review of articles produced between 1994 and 2015. It was concluded that nursing should specialize for this new demand, which is growing more and more in our health services. We believe that nursing is specializing to enter this context and the expectations are good for the professionals and for the reception of the transsexual patient.

Keywords: transex, nursing, importance, patient

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Authors: Titap Yazicioglu

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Purpose: To determine the etiological factors responsible for the eye removal surgery and to evaluate our surgical results. Material and Methods: Medical records of 226 patients, who underwent eye removal surgery, were analyzed retrospectively. Demographic information, clinical history, surgical procedure, and histopathological data were all collected. Evisceration surgery was performed under general anesthesia in all patients except tumor cases and one patient with rhino-orbital mucormycosis. The patients were followed for an average of 16.46±10.78 months and checked for the possible complications, cosmesis, and functional results.Results: 144 men, and 82 women,with a mean age of 41.78±22.6 years, were underwent enucleation (n=15) or evisceration (n=211) due to traumatic (n=169) and non-traumatic (n=57) causes. In the traumatic group, 79.8% of 169 patients were injured by penetrating and 14.2% by blunt trauma.3.6% of the patients were injured in a traffic accident, and 2.4% of them were injured by explosives. In the non-traumatic group, 40% of 25 patients had post-traumatic endophthalmitis, 32% had endophthalmitis due to corneal ulceration and melting, and 24% had endophthalmitis after cataract surgery. One patient had panophthalmitis due to rhino-orbital mucormycosis. Another cause in the non-traumatic group was glaucoma, of which 92.3% had neovascular glaucoma, and 8.7% had congenital glaucoma. Of the 14 patients who were enucleated for tumor, 35.7% had retinoblastoma, 14.3% had medulloepithelioma, 42.9% had uveal melanoma, and 7.1% had metastatic tumor from paranasal sinuses.The most common complaint in the follow-up period was discharging, seen in all prosthesis-wearing patients. 13.3% of the patients had itching due to ocular prosthesis. 4.4% of the patients were complaining about deep superior sulcus. 4.4% had pyogenic granuloma, and 17.8% had implant exposure. Conclusion: Etiological factors should be carefully evaluated, and precautions should be taken in order to reduce the devastating effect of the physical loss of the eye.

Keywords: enucleation, evisceration, ocular injury, etiology, frequency

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Authors: M. M. Akhmediev, J. R. Ashrapov, T. M. Akhmediev

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Hydrocephalus frequently occurs with spina bifida, and up to 80% of such patients need to be shunted. Objective: It’s sought to improve the results of the surgical treatment of hydrocephalus in children with spina bifida. Methods: We have analyzed the results of the surgical treatment of 80 patients aged between 1 month and 1,5-year-old with hydrocephalus and myelomeningocele. All patients underwent surgery in the period of 2013-2018. Results: In all patients, spina bifida was associated with hydrocephalus with a predominant extension of the posterior horns of the lateral ventricles in the form of colpocephaly, Chiari malformation type 2. Based on the method “Choose right shunt” the determination of the point of critical deformation of the ventricular system was established, 47 (58.8%) patients for the 1st stage underwent ventriculoperitoneal (VP) shunt surgery with a low-pressure valve, 28 (35.0%) patients with medium pressure and 5 (6.2%) with high-pressure valve. Under or over drainage complications were not observed in the postoperative period. The 2nd stage of surgery for myelomeningocele repair was planned in 1-2 months with the follow-up head ultrasonography and electromyography study. Conclusion: The implantable shunt systems parameters chosen before surgery in the surgical management of hydrocephalus in children with myelomeningocele are important in the causes of under or over drainage states, cerebrospinal fluid leakage from the myelomeningocele sac. Management of hydrocephalus should be performed by considering myelomeningocele affecting craniospinal compliance.

Keywords: hydrocephalus, spina bifida, myelomeningocele, ventriculoperitoneal (VP) shunt

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Authors: Sergei Kosarev

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Wrong treatment tactics for hand and wrist sport-related injuries can lead to the inability to play sports in the future. It is especially important for professional athletes. The members of the Russian Olympic Team are treated in our hospital -Federal Clinical Research Center (Moscow). For their treatment, we use minimally invasive methods such as wrist arthroscopy and also orthobiologics procedures. In 2022 we had cases with scaphoid fracture and TFCC injuries. In all the cases, we were using the arthroscopy technic for treatment. The scaphoid fracture was fixed by K-wires with free bone grafting. For TFCC injures we used transossal sutures. Rehabilitation started the next day after surgery. Rehabilitation included hand therapy and physiotherapy. All athletes returned to the sport after 8-12 weeks after surgery. One of them had pain in the wrist after 12 weeks after surgery, not more than 4 point VAS. Pain syndrome was blocked after 2 PRP injections in the ulnar side of the wrist.

Keywords: sport trauma, wrist arthroscopy, wrist pain, scaphoid fracture

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Authors: Arthi Ganapathy, Arithra Banerjee, Saroj Kaler

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Abdominal aorta is the sole purveyor of all organs in the abdomen. Anomalies of its main trunk or its branches are to be meticulously observed as it effects the perfusion of an organ. Varying patterns of the testicular artery is one of them. The origin and course of testicular arteries have to be identified carefully during various surgical procedures like renal transplant, intra abdominal surgeries and even in orthopedic surgery like spine surgery. With the advent of new intra-abdominal therapeutic and diagnostic techniques, the anatomy of testicular arteries has assumed much more significance. Though the variations of the testicular vein are well documented, the variations of the testicular artery are not so frequent in incidence. We report a case of the bilateral aberrant origin of the testicular artery from polar renal arteries. We also discuss its developmental basis. Such anomalies if left unnoticed will lead to serious intraoperative complications during procedures on retroperitoneal organs. Any damage to testicular arteries will compromise the function of the gonads.

Keywords: cadaver, gonadal, renal, surgery

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Authors: Daifeng Hao, Guang Feng, Jingfeng Zhao, Tao Li, Xiaoye Tuo

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Objective: To retrospectively analyze the clinical characteristics of incision infection with sternal osteomyelitis sinus tract after cardiac surgery and the operation method and therapeutic effect of filling and repairing with activated PRP gel. Methods: From March 2011 to October 2022, 142 cases of incision infection after cardiac surgery with sternal osteomyelitis sinus were retrospectively analyzed, and the causes of poor wound healing after surgery, wound characteristics, perioperative wound management were summarized. Treatment during operation, collection and storage process of autologous PRP before debridement surgery, PRP filling repair and activation method after debridement surgery, effect of anticoagulant drugs on surgery, postoperative complications and average wound healing time, etc.. Results: Among the cases in this group, 53.3% underwent coronary artery bypass grafting, 36.8% underwent artificial heart valve replacement, 8.2% underwent aortic artificial vessel replacement, and 1.7% underwent allogeneic heart transplantation. The main causes of poor incision healing were suture reaction, fat liquefaction, osteoporosis, diabetes, and metal allergy in sequence. The wound is characterized by an infected sinus tract. Before the operation, 100-150ml of PRP with 4 times the physiological concentration was collected separately with a blood component separation device. After sinus debridement, PRP was perfused to fill the bony defect in the middle of the sternum, activated with thrombin freeze-dried powder and calcium gluconate injection to form a gel, and the outer skin and subcutaneous tissue were sutured freely. 62.9% of patients discontinued warfarin during the perioperative period, and 37.1% of patients maintained warfarin treatment. There was no significant difference in the incidence of postoperative wound hematoma. The average postoperative wound healing time was 12.9±4.7 days, and there was no obvious postoperative complication. Conclusions: Application of activated PRP gel to fill incision infection with sternal osteomyelitis sinus after cardiac surgery has a less surgical injury and satisfactory and stable curative effect. It can completely replace the previously used pectoralis major muscle flap transplantation operation scheme.

Keywords: platelet-rich plasma, negative-pressure wound therapy, sternal osteomyelitis, cardiac surgery

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Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity-related health conditions impose a substantial economic burden on payers due to increased healthcare use. Estimates of healthcare resource use and costs associated with obesity-related comorbidities are needed to inform policies and interventions targeting these conditions. Methods: Adults living with obesity were identified (a procedure-related body mass index code for class 2/3 obesity between 2012 and 2019 in Alberta, Canada; excluding those with bariatric surgery), and outcomes were compared over 1-year (2019/2020) between those who had and did not have specific obesity-related comorbidities. The probability of using a healthcare service (based on the odds ratio of a zero [OR-zero] cost) was compared; 95% confidence intervals (CI) were reported. Logistic regression and a generalized linear model with log link and gamma distribution were used for total healthcare cost comparisons ($CDN); cost ratios and estimated cost differences (95% CI) were reported. Potential socio-demographic and clinical confounders were adjusted for, and incremental cost differences were representative of a referent case. Results: A total of 220,190 adults living with obesity were included; 44% had hypertension, 25% had osteoarthritis, 24% had type-2 diabetes, 17% had cardiovascular disease, 12% had insulin resistance, 9% had chronic back pain, and 4% of females had polycystic ovarian syndrome (PCOS). The probability of hospitalization, ED visit, and ambulatory care was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (hospitalization: 1.8-times [OR-zero: 0.57 [0.55/0.59]] / ED visit: 1.9-times [OR-zero: 0.54 [0.53/0.56]] / ambulatory care visit: 2.4-times [OR-zero: 0.41 [0.40/0.43]]), cardiovascular disease (2.7-times [OR-zero: 0.37 [0.36/0.38]] / 1.9-times [OR-zero: 0.52 [0.51/0.53]] / 2.8-times [OR-zero: 0.36 [0.35/0.36]]), osteoarthritis (2.0-times [OR-zero: 0.51 [0.50/0.53]] / 1.4-times [OR-zero: 0.74 [0.73/0.76]] / 2.5-times [OR-zero: 0.40 [0.40/0.41]]), type-2 diabetes (1.9-times [OR-zero: 0.54 [0.52/0.55]] / 1.4-times [OR-zero: 0.72 [0.70/0.73]] / 2.1-times [OR-zero: 0.47 [0.46/0.47]]), hypertension (1.8-times [OR-zero: 0.56 [0.54/0.57]] / 1.3-times [OR-zero: 0.79 [0.77/0.80]] / 2.2-times [OR-zero: 0.46 [0.45/0.47]]), PCOS (not significant / 1.2-times [OR-zero: 0.83 [0.79/0.88]] / not significant), and insulin resistance (1.1-times [OR-zero: 0.88 [0.84/0.91]] / 1.1-times [OR-zero: 0.92 [0.89/0.94]] / 1.8-times [OR-zero: 0.56 [0.54/0.57]]). After fully adjusting for potential confounders, the total healthcare cost ratio was higher in those with a following obesity-related comorbidity versus those without: chronic back pain (1.54-times [1.51/1.56]), cardiovascular disease (1.45-times [1.43/1.47]), osteoarthritis (1.36-times [1.35/1.38]), type-2 diabetes (1.30-times [1.28/1.31]), hypertension (1.27-times [1.26/1.28]), PCOS (1.08-times [1.05/1.11]), and insulin resistance (1.03-times [1.01/1.04]). Conclusions: Adults with obesity who have specific disease-related health conditions have a higher probability of healthcare use and incur greater costs than those without specific comorbidities; incremental costs are larger when other obesity-related health conditions are not adjusted for. In a specific referent case, hypertension was costliest (44% had this condition with an additional annual cost of $715 [$678/$753]). If these findings hold for the Canadian population, hypertension in persons with obesity represents an estimated additional annual healthcare cost of $2.5 billion among adults living with obesity (based on an adult obesity rate of 26%). Results of this study can inform decision making on investment in interventions that are effective in treating obesity and its complications.

Keywords: administrative data, healthcare cost, obesity-related comorbidities, real world evidence

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Authors: Maatouk Mohamed, Nouira Mariem, Hamdi Kbir Gh, Mahjoubi M. F., Ben Moussa M.

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Background and aim: Preoperative biliary drainage (PBD) has been introduced to lower bilirubin levels and to control the negative effects of obstructive jaundice in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD is still not clear. Delaying surgery by 4 to 6 weeks is the commonly accepted practice. However, delayed PD has been shown to decrease the rate of resection and adversely affect the tumor grading and prognosis. Thus, the purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD prior to PD: short or prolonged in terms of postoperative morbidity and survival outcomes. Methods: Trials were searched in PubMed, Science Direct, Google Scholar, and Cochrane Library until November 2022. Studies using PBD in patients with malignant obstructive jaundice that compared short duration group (SDG) (surgery performed within 3-4 weeks) with prolonged duration group (PDG) (at least 3-4 weeks after PBD) were included in this study. The risk of bias was assessed using the Rob v2 and Robins-I tools. The priori protocol was published in PROSPERO (ID: CRD42022381405). Results: Seven studies comprising 1625 patients (SDG 870, PDG 882) were included. All studies were non-randomized, and only one was prospective. No significant differences were observed between the SDG and PDG in mortality (OR= 0.59; 95% CI [0.30, 1.17], p=0.13), major morbidity (Chi² = 30.28, p <0.00001; I² = 87%), pancreatic fistula (Chi² = 6.61, p = 0.25); I² = 24%), post pancreatectomy haemorrhage (OR= 1.16; 95% CI [0.67, 2.01], p=0.59), positive drainage culture (OR= 0.36; 95% CI [0.10, 1.32], p=0.12), septic complications (OR= 0.78; 95% CI [0.23, 2.72], p=0.70), wound infection (OR= 0.08, p=0.07), operative time (MD= 0.21; p=0.21). Conclusion: Early surgery within 3 or 4 weeks after biliary drainage is both safe and effective. Thus, it is reasonable to suggest early surgery following PBD for patients having resectable periampullary cancers.

Keywords: preoperative biliary drainage, pancreatic cancer, pancreatic surgery, complication

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Authors: S. Fazelifar, M. Ghasemi

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Aim: Recent studies on cardiovascular risk factors have been focused on the new markers of inflammatory diseases such as C-reactive protein (CRP). Research evidence shows that physical activity along with other factors such as reduced smoking, controlling blood pressure, control blood lipids TC, LDL-c, HDL-c and having a healthy weight can reduce the risk of chronic heart disease (CHD) .Therefore, the aim of this study was to determine the effect of twelve weeks aerobic exercise and consumption of apple vinegar on cardiovascular risk factor in older women. Methodology: 28 inactive women (mean body weight 72.13 ± 8.6 kg, height 157 ± 7.4cm, age 48.06 ± 5.18 years and BMI 28.2 ± 3.2 kg/m2) by recall and notice of investigation, among of the eligible voters recruited and randomly divided in 4 groups: control, apple vinegar, exercise, exercise + apple vinegar. The training program includes a 20-minute warm-up and stretching, running for 15 minutes in the first session with an intensity of 80% of maximum heart rate and an increase in one-minute run time in next training session. Also, subjects in experimental groups received daily specified amount of 50 ml apple vinegar. Blood samples were collected from the brachial vein in before and after training to measure CRP and blood lipids (cholesterol, HDL, VLDL, LDL). The levels of CRP were measured by ELISA way. K-S test to determine the normality of the data and analysis of variance for repeated measures was used to analyze the data. A significant difference in the p < 0/05 accepted. Results: The results indicated that individual characteristics including height, weight, age, and body mass index were not significantly different among the four groups. The results showed that levels of CRP and LDL cholesterol were significantly reduced in all groups at post-test compared to the pre-test. The HDL levels increased significantly in all groups in post-test compared to the pre-test. Analysis of the data indicates that levels of CRP, TC, and LDL were significantly reduced in all groups compared to the control group, while the changes in the other groups were not significant relative to each other. Conclusion: Results of this study showed that twelve weeks of aerobic exercise with apple vinegar cause a significant decrease in CRP, cholesterol, LDL, and significantly increased HDL levels. According to the results of this study, it is possible that aerobic exercise with apple vinegar can inhibit CRP and undesirable fats. Considering the strong association between the inflammatory indices and the prevalence of cardiovascular diseases, every factor that decreases these indices can reduce the cardiovascular complications.

Keywords: aerobic exercise, apple vinegar, CRP, older women

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Authors: Seon-Young Lee, Harkiran Sagoo, Katherine Whitehurst, Georgina Wellstead, Alexander Fowler, Riaz Agha, Dennis Orgill

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Introduction: Systematic reviews attempt to answer research questions by synthesising the data within primary papers. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research and healthcare policy. We sought to determine the reporting quality of recent systematic reviews in plastic surgery. Methods: This systematic review was conducted in line with the Cochrane handbook, reported in line with the PRISMA statement and registered at the ResearchRegistry (UIN: reviewregistry18). MEDLINE and EMBASE databases were searched in 2013 and 2014 for systematic reviews by five major plastic surgery journals. Screening, identification and data extraction was performed independently by two teams. Results: From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 out of 27 items (59.3%; range 6-26, 95% CI 14-17). Compliance between individual PRISMA items showed high variability. It was poorest for items related to the use of review protocol (item 5; 5%) and presentation of data on risk of bias of each study (item 19; 18%), while being the highest for description of rationale (item 3; 99%) and sources of funding and other support (item 27; 95%), and for structured summary in the abstract (item 2; 95%). Conclusion: The reporting quality of systematic reviews in plastic surgery requires improvement. ‘Hard-wiring’ of compliance through journal submission systems, as well as improved education, awareness and a cohesive strategy among all stakeholders is called for.

Keywords: PRISMA, reporting quality, plastic surgery, systematic review, meta-analysis

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Authors: Katherine van Kampen, Reva Qiu, Patricia Farrugia

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Orthopedic surgery has fallen behind when it comes to gender diversity despite medical school classes reaching gender parity. Studies have shown that orthopedic surgery would require 117 years to reach gender parity with the trainee population, the longest time than any other specialty, including neurosurgery, urology, and otolaryngology. The barriers that face women in orthopedic surgery have been well researched, with contributing factors being on-going stereotypes of the field, lack of women mentors, and gender roles outside of the hospital. Furthermore, women in orthopedic surgery face barriers to achieve promotion, publications, and leadership roles leading to a “leaky pipeline,” resulting in less and less women in key academic roles in the field. It is a complex topic with barriers and challenges faced in medical school, residency, and throughout employment. Our scoping review seeks to understand these challenges across a temporal timeline and to further characterize such barriers and the driving factors behind them. To this date, authors did not find a scoping review that seeks to look broadly at factors impacting the decreased amount of women entering orthopedics and the factors that cause women to hit a “glass ceiling”, the idea that women will not achieve the same success as men despite the same qualifications, upon entering the field. This scoping review is the first of its kind to attempt to summarize the large body of research focusing on women in orthopedic surgery from the preconceptions in medical school impacting their desire to pursue orthopedics all the way to employment, including challenges to academic success and financial success. Literature databases will be searched with the following key terms: women, gender inequity, workforce, orthopedics, and citations will be hand searched and collected. Articles included will discuss gender inequality within orthopedics with non-english, patient related articles excluded. Full-text review will seek to characterize the specific barriers faced by women across medical school, residency, and employment. Themes that are expected to be highlighted are workforce data, women in orthopedic leadership, medical student perspectives on the specialty, and gender bias and discrimination in the field.

Keywords: orthopedics, gender equity, workforce, women in surgery

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Authors: Hacer Y. Teke, Sultan Pehlivan, Mustafa Karapırlı, Asude Gökmen, Sait Özsoy

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The case is here presented of a patient with DMD with electrocardiograph findings within normal limits who underwent spinal surgery then developed the rarely seen complication of cardiac tamponade which resulted in death. A 17-year old male with DMD was admitted to hospital for spinal surgery. Due to a postoperative drop in hemoglobin, blood transfusion was administered to the patient, no complication developed and he was discharged on the third day. Four days after discharge, the patient worsened at home and an ambulance was called. Before the nearest hospital was reached, the patient died in the ambulance. An autopsy was performed. A fatal but rarely seen complication of Acute Myocardial Infarction (AMI) is myocardial rupture. 85% of ruptures occur in the first week of AMI but just as they can be seen on the day of the infarct, they can also be seen 2 weeks later. The case presented here had infarction findings related to different times and in different areas.

Keywords: duchenne muscular dystrophy, myocardial infarction, myocardial rupture, anesthesia

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Authors: I. A. Harris, J. M. Naylor

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Antibiotic guidelines are published in order to reduce the risk of perioperative infection in orthopaedics. We surveyed 20 orthopaedic hospitals in Australia to determine their protocols for antibiotic prophylaxis around joint replacement surgery. We tested the protocols against Australian guidelines. We found that less than half of all protocols adhered to Australian guidelines. This indicates that current practice may lead to increased infection rates and increased antibiotic resistance.

Keywords: antibiotics, practice guidelines, orthopaedic surgery, joint replacement

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Vidya Iyer, Suresh Babu Loganathan, Yuan Hwa Lee, Kwong Fah Koh

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Introduction: It has been recommended that every patient undergoes careful preoperative evaluation in a preoperative clinic to improve theatre utilization, reduce bed occupancy and avoid unnecessary cancellation due to inadequate optimisation, communication and administrative errors. It also gives an opportunity to counsel patients regarding different aspects of anaesthesia. Methodology: A retrospective audit of all the patients seen in preoperative assessment clinic, referral letters of all the patients postponed / referred to other sub specialities in the perioperative period from June 2012 - June 2013 was done. In our clinic, we retrieved patient records who were awaiting surgery pending clearance by other sub specialities. Those patients, who could continue with their scheduled date of surgery after having been referred, were not included in the file. We also studied details of same day cancellations from the data base, during the same study period. The reasons for cancellation were examined and defined as avoidable and unavoidable. Results: Less than 0.5% was postponed from the scheduled day of surgery. Less than 0.5% was cancelled on the day of surgery. Conclusions: Patients who undergo pre anaesthetic evaluation in a well-established clinic results in adequate preoperative patient optimisation, avoids unnecessary preoperative admission, efficient theatre utilisation and greater patient satisfaction. The benefits are the result of guidelines and timely update of them which are used by the junior doctors and trainees who run the clinic and a dedicated specialist to supervise them.

Keywords: preoperative assessment, clinic, referrals, cancellation

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Authors: Boshra Mozaffar, Iskandar Idris

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Taste change is a common complication after Bariatric surgery (BS). However, the cause of this is still not clear. Since zinc is important fortaste perception, zinc deficiency, which is common after BS, may play an important role for taste change after BS. In this review, we aimto collate evidence relating to taste change and zinc deficiencyin relation to BS; effects of zinc replacement on taste perception in general and thereafter discuss the possible role of zinc deficiency to induce taste change after BS. A literature search was conducted, using four electronic bibliographical databases—EMBASE, PubMed, AMED and MEDLINE. We identified all available and relevant articles published before 30th February 2021.In total, 33 studies were included. The total number of participants analysed was N= 3264. We showed that taste change is a frequent complication after BS, especially after Roux-en-Y gastric bypass RYGBP comparing to other types of procedures. Patients' taste sensitivity differs among studies, but the most important decline in taste preference was observed for sweet food. Twelve studies investigating zinc deficiency following BS showed a significant decrease in zinc levels at six months after surgery. Supplementation with 45–50 mg of zinc sulphate was effective in improving taste, except in cancer patients, who showed no improvement in taste following zinc supplementation. Zinc deficiency appears to be associated with taste change after BS. Supplementation with much higher levels of zinc, at 45–50 mg, was effective in taste change treatment for many cases of taste disorder. The currently recommended levels of zinc replacements currently prescribed to patients following BS were not effective for avoiding zinc deficiency after BS—and thus not effective for averting taste change. It is therefore suggested that taste change following BS is closely related to zinc deficiency induced by the surgery.

Keywords: taste change, taste disorder, bariatric surgery, zinc, zinc sulphate or Zn, deficiency, supplementation, and micro-nutrient deficiencies

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Authors: Vignesh Ratnaraj, Jaewon Chang

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Background: Frailty is associated with poorer outcomes in cardiac surgery, but the heterogeneity in frailty assessment tools makes it difficult to ascertain its true impact in cardiac surgery. Slow gait speed is a simple, validated, and reliable marker of frailty. We performed a systematic review and meta-analysis to examine the effect of slow gait speed on postoperative cardiac surgical patients. Methods: PubMED, MEDLINE, and EMBASE databases were searched from January 2000 to August 2021 for studies comparing slow gait speed and “normal” gait speed. The primary outcome was in-hospital mortality. Secondary outcomes were composite mortality and major morbidity, AKI, stroke, deep sternal wound infection, prolonged ventilation, discharge to a healthcare facility, and ICU length of stay. Results: There were seven eligible studies with 36,697 patients. Slow gait speed was associated with an increased likelihood of in-hospital mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]: 1.87–2.87). Additionally, they were more likely to suffer from composite mortality and major morbidity (RR: 1.52; 95% CI: 1.38–1.66), AKI (RR: 2.81; 95% CI: 1.44–5.49), deep sternal wound infection (RR: 1.77; 95% CI: 1.59–1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48–2.63), reoperation (RR: 1.38; 95% CI: 1.05–1.82), institutional discharge (RR: 2.08; 95% CI: 1.61–2.69), and longer ICU length of stay (MD: 21.69; 95% CI: 17.32–26.05). Conclusion: Slow gait speed is associated with poorer outcomes in cardiac surgery. Frail patients are twofold more likely to die during hospital admission than non-frail counterparts and are at an increased risk of developing various perioperative complications.

Keywords: cardiac surgery, gait speed, recovery, frailty

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Authors: Ratna Farida Soenarto, Anas Alatas, Made Ryan Kharmayani

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Background: Conventional ultrafiltration (CUF) system was shown to be helpful in reducing anti-inflammatory mediators for patients who underwent open heart surgery. Additionally, modified ultrafiltration (MUF) has been shown to reduce anti-inflammatory mediators further while reducing interstitial fluid volume at the same time. However, there has been minimal data concerning the efficacy of combining both ultrafiltration methods. This study aims to compare inflammation marker, vascular resistance, and cardiac index on CUF+MUF patients with CUF only patients undergoing open heart surgery. Method: This is a single blind randomized controlled trial on patients undergoing open heart surgery between June 2021 - October 2021 in CiptoMangunkusumo National Referral Hospital and Jakarta Heart Hospital. Patients wererandomized using block randomization into modified ultrafiltration following conventional ultrafiltration (CUF+MUF) and conventional ultrafiltration (CUF) only. Outcome assessed in this study were 24-hoursinterleukin-6 levels, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and cardiac index. Results: A total of 38patients were included (19 CUF+MUF and 19 CUF subjects). There was no difference in postoperative IL-6 level between groups (p > 0.05).No difference in PVR was observed between groups.Higher difference in SVR was observed in CUF+MUF group (-646 vs. -261dyn/s/cm-5, p < 0.05). Higher cardiac index was observed on CUF+MUF group (0.93 vs. 0.48, p < 0.05). Conclusion: Patients undergoing open heart surgery with modified ultrafiltration following conventional ultrafiltration had similar systemic inflammatory response and better cardiac response than those having conventional ultrafiltration.

Keywords: open-heart, CUF, MUF, SVR, PVR, IL-6

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Authors: Nitesh Kumar, Adel Elrasheed, Antonio Gagliardilugo

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Introduction and aims: PRP has been increasing in popularity over the past decade. It is used in many facets of medicine and dentistry such as osteoarthritis, hair loss, skin rejunavation, healing of tendons after injury. Due to the increasing popularity of PRP in third molar surgery in dentistry, this study aims to identify the role of platelet rich plasma and its function in third molar surgery. Methodology: Three databases were chosen to source the articles for review: pubmed, science direct, and Cochrane. The keywords “platelet rich plasma”, “third molar extraction” and “wisdom tooth extraction” and literature review were used to search for relevant articles. Articles that were not in English were omitted and only systematic reviews relevant to the study were collected. All systematic reviews abstracts pertinent to the study were read by two reviewers to avoid bias. Results/statistics: 20 review articles were obtained of which 13 fulfilled the criteria. The Amstar tool validified the strength of these review articles. There is strong evidence in the literature that PRP in third molar surgery decreases post op pain, swelling and recovery time. 20 review articles were obtained of which 13 fulfilled the criteria. The Amstar tool validified the strength of these review articles. There is strong evidence in the literature that PRP in third molar surgery decreases post op pain, swelling and recovery time. Conclusions/clinical relevance: Platelet rich plasma plays a crucial role in patient recovery following the extraction of third molars and should be considered and offered as a routine part of third molar therapy.

Keywords: PRP, third molar, extractions, wisdom teeth

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Authors: Jitaree Tantiyasawatdikul, Bantita Jadnok, Sarunya Tijana

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Background: Nutritional status is an important factor before, during, and after an operation. It can help wound healing. If the patients have good nutritional status before and after an operation, wound healing can occur more easily. It can strengthen the immune system leading to decreased infection, reduced length of stay, and reducing the cost to patients and caregivers. Therefore, screening to evaluate the nutritional status of patients in 3B becomes the database for further developing the treatment and also will lead to excellent service from the interdisciplinary team. Objective: To study the nutritional status of patients in surgical ward 3B at Surgical and Orthopedics Nursing Division, Srinagarind Hospital. Method: A descriptive study, to evaluate the nutritional status of 86 patients admitted in 3B between October 2014 and March 2015.The instruments used in this study consisted of two parts: 1) personal data, 2) Screening nutritional status. The data were analyzed by percentage and mean. Results: A sample population of 86 patients aged 22-81 years old, mean age 52.59years, 90.69% are married, female were 55.81%, regular diet 70.93%, patients with no problem oral cavity was 87.21%.The sample population had high incidence of CA 47.67% and secondly cardiovascular disease 36.05 %. Patients with high-risk nutrition was 12.79 % including 45.45% cardiovascular disease and 36.36% CA. Screening of nutritional status of high-risk nutrition was 39.36% severe triceps skinfold (TSF), severe mid-arm muscle circumference(MAMC) 9.09% and severe total lymphocyte 39.36%. Conclusion: The result of nutritional status screening of surgical ward 3B found 12.79% patients with high-risk nutrition including 45.45% with cardiovascular disease .There was no problem with oral cavity and eating.

Keywords: nutritional status, screening, surgical patients, 3B ward, Srinagarind Hospital

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Authors: Estelle Démoulin, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu Van Steenberghe, Jalal Jolou, Haran Burri, Christoph Huber, Mustafa Cikirikcioglu

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Background & objective: Mitral valve surgeries are mainly performed by median sternotomy with conventional direct atriotomy. Good exposure to the mitral valve is challenging, especially for acute pathologies, where left atrium dilation does not occur. Other atriotomies, such as transseptal or superior septal, are used as they allow better access and visualization. Peri- and postoperative outcomes of these three different left atriotomies were compared. Methods: Patients undergoing mitral valve surgery between January 2010 and December 2020 were included and divided into three groups: group 1 (conventional direct, n=115), group 2 (transseptal, n=33) and group 3 (superior septal, n=59). To improve the sampling size, all patients underwent mitral valve surgery with or without associated procedures (CABG, aortic-tricuspid surgery, Maze procedure). The study protocol was approved by SwissEthics. Results: No difference was shown for the etiology of mitral valve disease, except endocarditis, which was more frequent in group 3 (p = 0.014). Elective surgeries and isolated mitral valve surgery were more frequent in group 1 (p = 0.008, p = 0.011) and aortic clamping and cardiopulmonary bypass were shorter (p = 0.002, p<0.001). Group 3 had more emergency procedures (p = 0.011) and longer lengths of intensive care unit and hospital stay (p = 0.000, p = 0.003). There was no difference in permanent pacemaker implantation, postoperative complications and mortality between the groups. Conclusion: Mitral valve surgeries can be safely performed using those three left atriotomies. Conventional direct may lead to shorter aortic clamping and cardiopulmonary bypass times. Superior septal is mostly used for acute pathologies, and it does not increase postoperative arrhythmias and permanent pacemaker implantation. However, intensive care unit and hospital lengths of stay were found to be longer in this group. In our opinion, this outcome is more related to the pathology and type of surgery than the incision itself.

Keywords: Mitral valve surgery, cardiac surgery, atriotomy, Operative outcomes

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Authors: Arun Prasad

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Background: Robotic Bariatric Surgery is a good option for the super obese where laparoscopy demands challenging technical skills. Gastric bypass can be difficult due to inability of the robot to work in two quadrants at the same time. Lonroth technique of gastric bypass involves a totally supracolic surgery where all anastomosis are done in one quadrant only. Methods: We have done 78 robotic gastric bypass surgeries using the modified Lonroth technique. The robot is docked above the head of the patient in the midline. Camera port is placed supra umbilically. Two ports are placed on the left side of the patient and one port on the right side of the patient. An assistant port is placed between the camera port and right sided robotic port for use of stapler. Gastric pouch is made first followed by the gastrojejunostomy that is a four layered sutured anastomosis. Jejuno jejunostomy is then performed followed by a leak test and then the jejunum is divided. A 150 cm biliopancreatic limb and a 75 cm alimentary limb are finally obtained. Mesenteric and Petersen’s defects are then closed. Results: All patients had a successful robotic procedure. Mean time taken in the first 5 cases was 130 minutes. This reduced to a mean of 95 minutes in the last five cases. There were no intraoperative or post operative complications. Conclusions: While a hybrid technique of partly laparoscopic and partly robotic gastric bypass has been done at many centres, we feel using the modified Lonroth technique, a totally robotic gastric bypass surgery fully utilizes the potential of robotic bariatric surgery.

Keywords: robot, bariatric, totally robotic, gastric bypass

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