TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins

Aims The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure. Method Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet. Results A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure. 247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others. 40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure. Conclusion OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.

PROSPECTIVE EVALUATION OF IN SITU SCREW FIXATION FOR STABLE SLIPPED CAPITAL FEMORAL EPIPHYSIS

Background: In situ screw fixation is the standard of care for the treatment of stable slipped capital femoral epiphysis (SCFE), however, recent studies recommend treatment of all slip-related cam deformity to prevent degenerative changes due to femoroacetabular impingement (FAI). Hypothesis/Purpose: The purpose of this study was to prospectively evaluate radiographic and patient reported outcomes after in situ screw fixation for stable SCFE with minimum 2-year follow-up. Methods: After obtaining IRB approval, we prospectively collected data on all consecutive stable SCFE patients who underwent in situ screw fixation at a single institution. Demographic information, Southwick slip angle (SSA) and alpha angle were recorded. The Hip disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected. Basic descriptive statistics, the Mann-Whitney test, and correlation analysis was performed. Results: Forty-four hips in 38 patients with an average pre-op SSA of 41.1±20.0˚ were studied. Cohort characteristics can be found in Table 1. We observed no surgical complications of the index procedure and no cases of avascular necrosis (AVN). Twelve hips (27%) went on to have a secondary procedure (SSA range: 34˚ to 101˚) on average 2.6±2.4 years after the index surgery. These were performed to correct residual deformity, limited hip range of motion, or symptomatic impingement; one patient (2 hips) was referred for total hip arthroplasty due to significant degenerative osteoarthritis at 7.8 years follow-up. There were five complications of the secondary procedures (three implant failures and two mal-positioned implants). Our mean post-op HOOS and WOMAC scores were 84.2±16.8 and 87.8±13.9, respectively. Severe slips were 19.3 times more likely to undergo a secondary procedure than mild and moderate slips (p<0.001), however we found no correlation between slip severity and patient reported outcomes (p>0.6). Conclusion: With minimum 2-year follow-up, 27% of patients went on to require a secondary surgery after in situ screw fixation for stable SCFE. Patient reported outcomes did not correlate with slip severity (p>0.6) but were found to be significantly higher in SCFE patients that did not require a secondary procedure (p=0.023). Prophylactic treatment of all slip-related cam deformity was not found to be necessary in this prospective cohort. While in situ screw fixation can be used to safely treat mild to moderate stable slips, patients with moderate to severe stable slips may require secondary surgery and have a higher complication rate with worse patient reported outcomes. Level 2 [Table: see text]

CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS). Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi. Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free. Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

Thoracodorsal artery flaps for breast reconstruction–the variants and its approach

Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.

EFFECTIVITY OF PNEUMATIC RETINOPEXY PROCEDURE IN PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT (RRD

Aim : To evaluate the effectiveness of pneumatic retinopexy (PR) for repair of primary rhegmatogenous retinal detachment (RRD) with respect to single operation success (SOS) and best corrected visual acuity (BCVA). Method : This retrospective review comprised 8 eyes with primary rhegmatogenous retinal detachment with superior break that undergone pneumatic retinopexy as the initial procedure between 2009-2014 at Jakarta Eye Center, Indonesia. Result : The mean age of subjects was 49 ± 14.35 years. Four subjects (50%) had Single operation had only done success after 6 months of observation. The eyes that failed single procedure underwent vitrectomy and silicon oil tamponade. Subjects that only done single procedure had better BCVA (0.01 ± 1,3 logMAR) compare to subjects that done secondary procedure (0.3 ± 0.42 logMAR) after 6 months of observation. Conclusion : Pneumatic retinopexy is still an effective procedure for primary rhegmatogenous retinal detachment with superior breaks although in our study the single operation success was 50%.

Reconstruction of Mastoid Cortex Defects with Hydroxyapatite Cement for Negative Sequelae of Mastoidectomy

Objectives: Mastoid cortex defects resulting from mastoidectomy surgery can rarely lead to negative sequelae, including unsightly post-auricular depression and discomfort. This study sought to evaluate the use of hydroxyapatite cement (HAC) to reconstruct mastoidectomy cortex defects. Methods: Retrospective chart review was undertaken for all patients that underwent reconstruction of the mastoid cortex using HAC at a single tertiary medical center between 2013 and 2019. Collected data included demographics, indications for mastoidectomy, complications, and associated symptom status. Results: Twenty-nine patients that underwent mastoid cortex repair using HAC were included, and ten of these underwent mastoid revision in a secondary procedure to reconstruct the mastoid cortex with a specific goal to eliminate negative signs and symptoms. There were no associated postoperative complications and no instances of post-auricular depression following repair. All cases of secondary reconstruction resolved the primary signs and symptoms that prompted mastoid revision. Conclusions: HAC mastoid cortex reconstruction may be a safe and effective method to resolve negative sequelae resulting from previous mastoidectomy defects. Also, upfront HAC mastoid cortex reconstruction appears viable in select instances as an option to prevent potential future complications.

An analysis of 1386 periurethral bulking procedures with comparison to 18,763 retropubic tapes

Objective To use British Society of Urogynaecology surgical database to evaluate periurethral bulking agents and retropubic tapes. Study design Permission was granted to analyse 1386 periurethral bulking agents and 18,763 retropubic tapes. The primary outcome measure was patient reported global impression of improvement for incontinence with secondary outcomes of change in symptoms of stress incontinence, overactive bladder and complications. Results Patients undergoing periurethral bulking agents were older than retropubic tapes (mean 59.4 vs. 52.3 years). Urodynamic stress incontinence was the commonest urodynamic diagnosis (periurethral bulking agents 67%, retropubic tapes 77%) but there was a higher proportion of complex diagnoses in the periurethral bulking agents group. 59.2% patients reported ‘very much/much better’ on patient reported global impression of improvement for incontinence for periurethral bulking agents compared to 91% for retropubic tapes; 28% patients felt their symptoms of stress incontinence were cured following periurethral bulking agents compared to 77.6% for retropubic tapes and 0.8% developed de novo overactive bladder following periurethral bulking agents compared to 4% with retropubic tapes. There was no difference in outcomes when using periurethral bulking agents as a primary or secondary procedure. There were no intraoperative complications with periurethral bulking agents and fewer post-operative complications compared to retropubic tapes (3.6%). Conclusion Patient reported success of periurethral bulking agents is lower than retropubic tapes but this is offset by minimal complications despite being an older, more complex patient group. Periurethral bulking agents do appear equally efficacious as a secondary procedure. Information derived from databases can be used during counselling to allow clinicians to demonstrate their own success and complication rates to ensure patients make an informed choice. Patient choice is paramount so all options should be included in full counselling.