Improvement of life after PVCR in complete paraplegic patients with posttraumatic severe kyphosis

AIM: To determine the effect of posterior vertebral column resection (PVCR) in patients with paraplegia by using the American Spinal Injury Association (ASIA) score and Scoliosis Research Society (SRS)-22 questionnaire. MATERIAL and METHODS: Twelve patients with posttraumatic paraplegia and severe angular kyphosis (>60°) had undergone PVCR between 6-24 months after the trauma for severe pain, persistent vertebral instability and difficulty in adherence to rehabilitation. ASIA scores and SRS-22 questionnaire results obtained in the preoperative and postoperative periods, and the last control were statistically compared to assess the presence of any change.RESULTS: The average age of twelve patients included in this study was 35.6 ± 10.2 (21-51) years. Female/male ratio was 2/10 (20.0%). The mean follow-up duration was 50.3 ± 17.6 (24-86) months. None of the patients had additional changes in neuromonitoring records during surgery. The mean preoperative kyphotic angle of the patients was 66.58° ± 7.1° (60°-82°) which decreased to 7.0° ± 5.4° in the postoperative period (p0.05).CONCLUSION: In the light of these data, it can be stated that PVCR is a safe and reliable procedure in paraplegic patients with rigid posttraumatic kyphosis and increases patient satisfaction

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

The surgical overcorrection of lenke type 1 deformities with selective fusion segments: What happens to the coronal balance?

Purpose: The aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively. Methods: Datas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months. Results: The mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5 mm (range, 1-30 mm). The mean early postoperative coronal balance was measured as 3.5 mm (range, 0-36 mm). The mean coronal balance was measured as 5.5 mm (range, 0-38 mm) during the last follow-up (p>0.05). Conclusion: We suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively

Previous stoma site for the extraction of specimen in patients undergoing laparoscopic rectal surgery: Report of two cases

An abdominal incision is generally accepted to be a necessity for the extraction of the specimen during laparoscopic colorectal surgery, except the cases receive an abdominoperineal excision. Exceptionally more minimally invasive incisions and natural orifice techniques have been reported. Current study aims to describe previous stoma site as a novel location for specimen extraction. We have reported two cases (a 80-year-old male and a 73-year-old female), for whom resection of rectal or rectosigmoidal tumors could not be achieved, and a diverting colostomy was decided at the time of previous laparotomy. Patients were referred to our hospital for further evaluation, and a laparoscopic anterior or low anterior resection was achieved in both cases. Previous stoma sites were used for the extraction of the tumor, however the stoma site was lengthened with 1.5 cm long incision in a case. Previous stoma site was used for the location of diverting ileostomy in the patient who received low anterior resection. No intra- or postoperative complication was occurred, and both cases were discharged from the hospital on day 6. We believe that previous stoma sites may be considered as the locations for specimen extraction in suitable patients in order to eliminate the necessity of an abdominal incision during laparoscopic colorectal surgery

Erken yaştaki çocuklarda skolyoz tedavisinde büyüyen rod tekniğinin klinik ve radyolojik sonuçları

Amaç: Bu çal›flman›n amac› skolyozu olan erken yafltaki çocuklarda büyüyen rod tedavisinin klinik ve radyolojik sonuçlar ve solunum fonksiyonlar› üzerine etkilerinin incelenmesidir. Çal›flma plan›: 1997-2007 y›llar› aras›nda ameliyat etti¤imiz 24 bayan, 1 erkek hasta geriye dönük ola- rak de¤erlendirildi. On alt› hastada çift büyüyen rod, 9 hastada ise tek büyüyen rod kullan›ld›. ‹lk cerra- hi esnas›nda hastalar›n yafl ortalamas› 7.38±3.8 idi. Konvansiyonel grafilerde Cobb aç›s›, T1-S1 omurga uzunlu¤u ve enstrümentasyon uzunlu¤u ölçüldü. Son kontrol esnas›nda hastalar›n solunum fonksiyonla- r› de¤erlendirildi. Bulgular: Hastalara ortalama 44.9 ayl›k süre içerisinde ortalama 4.2 say›da uzatma ifllemi uyguland›. Füzyon sonras› dönemde Cobb aç›s› ortalama 56.7 dereceden 25.1 dereceye geriledi. T1-S1 omurga uzunlu¤u bafllang›çta 27.2±3.4 cm iken, ilk ameliyat sonras› 34.9±3.6 cm, füzyon sonras›nda ise 38.6±3.7 cm olarak ölçüldü. Ortalama uzama miktar› y›lda 1±0.4 cm idi. Son kontroldeki solunum fonksiyonlar› ortalama de¤erleri FVC: 83.5±3.5, FEV: 84.8±5.3 ve FVC/FEV1: 1±0.046 olarak saptand›. On iki hasta- da komplikasyon görüldü. Komplikasyonlar›n sekizi materyal iliflkiliydi. Ç›kar›mlar: Omurga deformitelerinin tedavisinde büyüyen rod tedavisi, omurga yüksekli¤inin sa¤- lanmas› ve solunum fonksiyonlar›n›n gelifltirilmesi aç›s›ndan etkin bir tedavi yöntemidir

Ankilozan spondilitli hastalardaki kifotik deformitenin tedavisi için posterior kapalı kama osteotomisini takiben uzun segment posterior enstrümantasyon uygulaması

Ankilozan spondilit hastalığına bağlı omurgada görülen ilerleyici şeksiyon deformitesi sonucu gelişen kifozun tedavisi oldukça güçtür ve sagittal denge ve karşıya düz bakışın sağlanabilmesi için torakolomber osteotomiler göz önüne alınması gereken tedavi seçeneklerindendir. Bu geriye dönük çalışmadaki amaç, ankilozan spondilite bağlı olarak gelişmiş omurga kifozu tedavisi için uygulanan posterior kapalı kama osteotomisinin radyolojik ve klinik sonuçlarını değerlendirmektir. Bu çalışmaya 11 hasta dâhil edilmiştir. Ortalama 43.5 ± 18.7 aylık takip sonrası hastaların Cobb açısı ölçümleri ve klinik sonuçları değerlendirilmiştir. Ayrıca çalışmaya dahil edilen 11 hastadan 7’sinde SRS-22 anketiyle ağrı, klinik görünüm ve tedaviden tatmin düzeyleri de değerlendirilmiştir. Ameliyattan önce ortalama 87.3° ± 4.3° olan torakal kifozun, ameliyat sonrası 54.0° ± 9.5°’ye indirildiği (p<0.05) ve son takipte 4.2° ± 2.5° düzeltme kaybıyla 58.2° ± 9.1° olarak ölçüldüğü saptanmıştır. Ameliyattan önce ortalama 19.6° ± 6.3° olan lomber lordozun, ameliyat sonrası 39.6° ± 5.7°’ye yükseldiği ve son takipte ortalama 2.6° ± 2.3° kayıpla beraber 37.0° ± 5.5° olarak ölçüldüğü belirlenmiştir. Preoperatif, postoperatif ve final sagittal denge değerleri sırasıyla 6.6 ± 2.3 cm, 3.1 ± 1.5 cm ve 3.4 ± 1.6 cm olup, elde edilen düzelmenin istatistiki olarak anlamlı olduğu belirlenmiştir (p<0.05). Sagittal dengedeki düzelme kaybı, son kontrolde 0.23 ± 0.26 cm gibi oldukça düşük düzeyde olduğu anlaşılmıştır. Hiçbir hastada ölüm, nörolojik defisit, implant yetmezliği, enfeksiyon veya psödoartroz görülmedi, fakat bir hastada pulmoner emboli ve bir hastada kavşak kifozu tespit edildi. SRS-22 anketi uygulanan hastaların tamamında ağrı, görünüm, mental durum, fonksiyon ve tedaviden tatmin düzeylerinin 4 ve üzeri olduğu belirlenmiştir. Sonuç olarak ankilozan spondilite bağlı omurga kifozunun tedavisinde uygulanan kapalı kama osteotomisi ile birlikte uzun segment enstrümantasyon tatmin edici sagittal denge ve implant sağ kalımı açısından etkin bir yöntem olduğu fikri elde edilmiştir.The resulting spinal kyphosis due to the progressive flexion deformity in ankylosing spondylitis is a challenging issue where thoracolumbar osteotomies are to be of consideration in the correction of the global sagittal and gaze alignment as treatment modalities. The purpose of this retrospective clinical study was to evaluate the clinical and radiological results of posterior closing wedge osteotomy that we performed in the treatment of kyphotic deformities in the patients with ankylosing spondylitis. Eleven patients having kyphotic thoracolumbar deformities due to ankylosing spondylitis were included in the study and they were treated with posterior transpedicular closing wedge osteotomy followed by long-segment posterior instrumentation. After a mean follow-up period of 43.5 &plusmn; 18.7 months patients were evaluated in terms of Cobb angle measurements and clinical results. Additionaly, 7 of 11 patients were assessed in terms of SRS-22 questionnaire for pain, self image and satisfaction of treatment. The mean preoperative thoracic kyphosis which was 87.3&deg; &plusmn; 4.3&deg; improved to 54.0&deg; &plusmn; 9.5&deg; postoperatively (p&lt;0.05). At the final follow-up it was 58.2&deg; &plusmn; 9.1&deg; with an average correction loss of 4.2&deg; &plusmn; 2.5&deg;. The mean preoperative lumbar lordosis was 19.6&deg; &plusmn; 6.3&deg;. Than it improved to 39.6&deg; &plusmn; 5.7&deg; (p&lt;0.05) postoperatively and were 37.0&deg; &plusmn; 5.5&deg; at the final follow-up with an average correction loss of 2.6&deg; &plusmn; 2.3&deg;. Preoperative, postoperative and final mean sagittal balance values were 6.6 &plusmn; 2.3 cm, 3.1 &plusmn; 1.5 cm (p&lt;0.05) and 3.4 &plusmn; 1.6 cm, respectively. Loss of correction in sagittal balance was 0.23 &plusmn; 0.26 cm in the last control visit. In the all patients whom were applied SRS-22 questionnaire; the levels of pain, appearance, mental status, function and satisfaction of treatment revealed results of minimum 4 points. There was no death, neurological compromise, implant failure, pseudoarthrosis or infection, but one pulmonary embolism and one postoperative thoracic kyphosis proximally to the osteotomy level. We concluded that; posterior transpedicular closing wedge osteotomy followed by long-segment posterior instrumentation in the management of kyphotic deformities due to ankylosing spondylitis seems to be an effective procedure in terms of satisfactory sagittal balance and implant survival

J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results

WOS: 000414077500002PubMed ID: 28919097Purpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved

Delaying surgery for patients with a previous SARS-CoV-2 infection

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