scholarly journals Selection and perioperative management of patients undergoing an orthotopic ileal bladder substitution

2005 ◽  
Vol 52 (3) ◽  
pp. 25-31
Author(s):  
D.T. Basic ◽  
U.E. Studer
Keyword(s):  
Surgical Technique ◽  
Patient Selection ◽  
Perioperative Management ◽  
Spherical Shape ◽  
Preoperative Assessment ◽  
Successful Outcome ◽  
Metabolic Complications ◽  
Stricture Rate ◽  
Bladder Substitution

Orthotopic ileal bladder substitution (Studer pouch) has gained much popularity during the last decade, offering the best form of urinary diversion in appropriately selected patients. The superiority of this procedure is well known, with a low complication and high success rate. In the present study the most important details in patient selection, surgical technique, perioperative management with short- and long-term postoperative follow-up are described. Adequate preoperative assessment results in a proper indication for surgery and appropriate patient selection. The cystectomy should be performed with atraumatic dissection and preservation of the urethral autonomic innervation and sphincter apparatus. The bladder substitute is constructed from a terminal ileal segment of proper length formed into a spherical shape. Implantation of the ureters into the reservoir should not be performed using an anti- reflux technique to avoid a high stricture rate. Anastomosis of the bladder substitute to the urethra must be flat and wide open, avoiding a funnel- shaped outlet. In the immediate postoperative period, careful monitoring is necessary to minimize metabolic complications of acidosis and salt loss. To achieve successful voiding rehabilitation, with complete reservoir emptying, good functional reservoir capacity and satisfactory continence, it is necessary to educate the patients as to the physiological functioning of the bladder substitute. Careful lifelong follow up is essential for the successful outcome. Respecting strict patient selection criteria and proper surgical technique are of utmost importance for the successful outcome of the procedure, but only if combined with regular follow-up.

Our experience in orthotopic bladder substitution

1998 ◽  
Vol 65 (1) ◽  
pp. 180-184
Author(s):  
C. Del Boca ◽  
D. Colloi ◽  
C. Ferrari ◽  
M. Colecchia
Keyword(s):  
Quality Of Life ◽  
Surgical Technique ◽  
Patient Selection ◽  
Ileal Conduit ◽  
Operating Time ◽  
Orthotopic Neobladder ◽  
Rapid Preparation ◽  
Bladder Substitution

Research in the field of orthotopic neobladders springs from the need to improve their morphofunctional aspects and to simplify surgical procedures. The authors report their experience on a new method of orthotopic neobladder in 20 patients subjected to radical cystectomy for advanced bladder neoplasia between March 1991 and February 1996. The surgical technique consisted of preparing a reservoir with a simil Carney 2 type procedure modified by the authors using 45 cm of ileus, 30 cm of which are detubularised and reshaped into a spherical/ovoidal form with Poligya 75 staplers. The remaining segment was left intact for the ureteroileal anastomosis performed with the Wallace 1 procedure. This technique offers the following advantages: staplers enable rapid preparation of the neobladder, thus reducing operating time; the technique is easy to learn for urologists familiar with ureteroileostomy according to Wallace; an isoperistaltic segment of ileus for ureteral anastomosis reduces ureteral mobilisation and possibilities of reflux; reconversion into ileal conduit is easy in the event of reservoir failure or neoplastic urethral recurrence. The criteria for patient selection are given and the diagnostic follow-up algorithm done with biochemical, echographic, radiological and pressure studies. Particular attention was paid to the quality of life in relation to diurnal/nocturnal continence and micturitional interval. The authors conclude that this technique is surgically simple and rapid giving satisfactory clinical and urodynamic results.

scholarly journals Fixation of pelvic floor fractures in cats

2011 ◽  
Vol 24 (02) ◽  
pp. 137-141 ◽  
Author(s):  
P. M. Montavon ◽  
N. M. Kipfer
Keyword(s):  
Surgical Technique ◽  
Pelvic Floor ◽  
Neurological Deficits ◽  
Abdominal Hernia ◽  
Successful Outcome ◽  
Abdominal Approach ◽  
Pain Scores ◽  
Joint Luxation ◽  
Traumatic Abdominal Hernia

Summary Objectives: To retrospectively evaluate the outcome of internal fixation of trauma-related pelvic floor fractures using a ventral abdominal approach in cats. Methods: Clinical examination and radio-graphic findings at presentation, after surgery, and at follow-up were assessed. Information gathered included concurrent injuries, surgical technique used, lameness and pain scores, and radiographic signs of implant stability. Results: Ten European shorthair cats were included in the study. Pelvic floor fractures were stabilised using locking plates in nine cats, and symphyseal separation was fixated using hemicerclage wire in one cat. Additional procedures included reduction of sacroiliac luxation in nine cats with positional screws placed in six cats, and plate stabilization of sacral fractures in one cat.All cats were able to walk within five days of surgery. No orthopaedic or neurological deficits were observed in seven cats at follow-up. Neurological deficits were observed in one cat. Signs of pain at implant sites due to inadequate surgical technique were noted in two cats. Anatomical reduction of the pelvic floor was achieved in eight cats. Clinical significance: Stabilization of the pelvic floor and repair of sacroiliac luxation and other injuries by a ventral abdominal approach in cats led to an overall successful outcome. Fixation of the pelvic floor in cats with intact acetabular and ilial bones should be considered in patients with multiple pelvic fractures in combination with sacroiliac joint luxation or sacral fracture, pelvic canal narrowing, traumatic abdominal hernia, and other abdominal injuries.

scholarly journals P3 A closed loop audit on pre-operative anaemia in major elective orthopaedic surger

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Chan Hee Koh ◽  
Nicolai Gruner-Hegge ◽  
Dancho Ignatov ◽  
Aneesul Shakir ◽  
Chan Hee Koh
Keyword(s):  
Closed Loop ◽  
Perioperative Management ◽  
Consensus Statement ◽  
Preoperative Assessment ◽  
Action Plans ◽  
International Consensus ◽  
Change In Practice ◽  
International Consensus Statement ◽  
Preoperative Anaemia

Abstract Introduction The international consensus statement on perioperative management of anaemia advises that patients with haemoglobin (Hb) <130 be treated before undergoing elective operations. The advantages include reduced risk of acute kidney injuries, infections and transfusions, and quicker recovery. Methods Data was collected prospectively from 127 consecutive patients undergoing elective arthroplasties at Hinchingbrooke hospital. Baseline compliance with the consensus statement was first assessed in May 2018, and the results presented at a clinical governance meeting. Departmental action plans included early identification of anaemia and treatment to Hb 130, delaying operations where necessary. We then reassessed compliance in May 2019. Results There was a statistically significant change in practice (p = 0.036). The proportion of patients undergoing arthroplasties despite Hb < 130 reduced from 38% to 21%. Those operated with Hb < 120 decreased from 14% to 0%. The proportion of preoperative anaemias that were appropriately investigated during preoperative assessment increased from 11% to 80% (p < 0.001). The increase in attempted treatment of preoperative anaemia prior to surgery however was not significant (7% vs 20%; p = 0.279). Discussion Implementation of departmental action plans resulted in substantial improvements to clinical practice. For those that underwent arthroplasties despite mild preoperative anaemia, it may have been felt that delays in improvement to quality of life for treatment may be unacceptable, or the causes (e.g. chronic disease) difficult to treat. Further action plans should involve even earlier identification of anaemia, involving primary care at the point of referral.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

scholarly journals Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Xiaorong Yan ◽  
Huiqing Wang ◽  
Cai Li ◽  
Yuanxiang Lin ◽  
Lin Lin ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Spinal Deformity ◽  
Tumor Recurrence ◽  
Clinical Symptoms ◽  
Short Term ◽  
Before And After ◽  
Intradural Extramedullary ◽  
Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

Fixed-bearing medial partial knee replacement: patient selection and surgical technique

2021 ◽  
Vol 35 (1) ◽  
pp. 39-48
Author(s):  
Nick J. London ◽  
James B. Newman ◽  
Dave J. Duffy ◽  
Jon Smith
Keyword(s):  
Surgical Technique ◽  
Knee Replacement ◽  
Patient Selection ◽  
Fixed Bearing ◽  
Partial Knee Replacement

scholarly journals Modular tapered conical revision stem in hip revision surgery: mid- term results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Loris Perticarini ◽  
Stefano Marco Paolo Rossi ◽  
Alberto Fioruzzi ◽  
Eugenio Jannelli ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Preoperative Assessment ◽  
Bone Defects ◽  
Implant Design ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Stem Design ◽  
Additional Surgery ◽  
Prime Concern ◽  
Distal Fixation

Abstract Background The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern. Methods We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1–15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined. Results Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8–90%) for any complication and 92.3% (CI: 91.8–92.7%) according to revision for any causes at 81 months follow-up. Conclusions Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.

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