Platelet-rich plasma (PRP) treatment has gained popularity among different surgical specialities ... more Platelet-rich plasma (PRP) treatment has gained popularity among different surgical specialities for improving various conditions. Androgenetic alopecia (AGA) is a common disorder, with possible psychosocial implications. Plastic surgeons have increased the practice of PRP injections for hair restoration. A meta-analysis on this topic was performed comparing local injection of PRP versus control to investigate the efficacy of local PRP injections in AGA. We performed a systematic literature search. The increase in number of hairs was the primary outcome. Secondary outcomes were the increase of hair thickness and the percentage increase in hair number and thickness. Seven studies involving 194 patients were retrieved and included in the present analysis. A significantly locally increased hair number per cm was observed after PRP injections versus control (mean difference [MD] 14.38, 95% confidence interval [CI] 6.38-22.38, < 0.001). Similarly, a significantly increased hair thickn...
Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wo... more Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wound healing complications and hernia recurrence rates. However, studies of AWR with concurrent panniculectomy (AWR+PAN) have reported contradictory results. We hypothesized that patients undergoing AWR+PAN experience more wound healing complications but similar rates of hernia recurrence compared to AWR alone. In this retrospective study of 548 consecutive patients, 305 (52.5%) patients underwent AWR alone and 243 (42.4%) underwent AWR+PAN. Mean follow-up was 30 months. We compared these two groups' postoperative complications and outcomes before and after propensity score analysis. The primary outcome measures were surgical site occurrence (SSO), overall complications, surgical site infections (SSI), and hernia recurrence. AWR+PAN patients had a significantly higher overall complication rate (38.3% vs. 29.2%, p=0.025) and a trend toward a higher SSO rate (27.6% vs. 20.7%, p=0.06) co...
Background and Aims. Vascular malformations are a vast group of congenital malformations that are... more Background and Aims. Vascular malformations are a vast group of congenital malformations that are present at birth. These malformations can cause pain, pressure, and cosmetic annoyance as well as downturn growth and development in a child in the case of high flow. Sclerotherapy has become an important tool in the treatment of vascular malformations. However, little is known about the success rate of sclerotherapy. Material and Methods. In this study, the efficiency of sclerotherapy in the treatment of vascular anomalies was investigated retrospectively in 63 patients treated in Turku University Hospital between 2003 and 2013. Results. Out of the 63 patients investigated, 83% (53) had venous malformations (VMs) and 9% (5) were defined as having arteriovenous malformations (AVMs). Patients with a VM were operated on, in 14% (8) out of all VM cases. Hence 86% (45) of patients with a VM received adequate help to their symptoms solely from sclerotherapy. The duration of treatment for the...
Obesity and higher body mass index may be associated with higher rates of wound healing complicat... more Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients. The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m (nonobese), 30 to 34.9 kg/m (class I obesity), and 35 kg/m or greater (class II/III obesity). The authors compared postoperative outcomes among these groups. Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall com...
Optimum excision margins used in the removal of intermediate thickness melanomas remain unclear. ... more Optimum excision margins used in the removal of intermediate thickness melanomas remain unclear. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim was to compare the clinical outcomes of 1-cm margins with 2-cm margins in patients with a tumor thickness of 1.1- to 4.0-mm. This was a retrospective study, which was based on a matched-pairs design. Equal patient cohorts were constructed in terms of gender, age, Breslow thickness, and the anatomic location of the primary lesion. There were 80 patients whom underwent an excision with a 1-cm margin and 80 patients with a 2-cm margin. Follow-up data were analyzed by the Kaplan-Meier method and a Cox regression model. After a median follow-up time of 41 months, there were no differences in relapse-free survival or melanoma-specific survival between study groups. The wound was closed directly in 62 patients (78%) in the 1-cm group and in 36 patients (45%) in the 2-cm group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). A 1-cm excision margin may be sufficient in melanomas of 1.1 to 2.0 mm in Breslow thickness based on these findings of low recurrence. With thicker tumors (2.1-4.0 mm), this recommendation cannot be given due to inherent study limitations.
We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal w... more We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal wall reconstruction (AWR) for hernia or oncologic resection. We included all consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) between 2005 and 2015. Propensity score analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The primary outcome was hernia recurrence; the secondary outcomes included surgical site occurrence (SSO) and bulging. Mean follow-up for the 511 patients was 31.4 months; 184 (36%) patients were elderly. The elderly and non-elderly groups had similar rates of hernia recurrence (7.6% vs 10.1%, respectively; p = 0.43) and SSO (24.5% vs 23.5%, respectively; p = 0.82). Bulging occurred significantly more often in elderly patients (6.5% vs 2.8%, respectively; p = 0.04). After adjustment through the propensity score, which included 130 pairs, these results persisted. Contrary to our hypothesis, elderl...
Journal of the American College of Surgeons, Jan 10, 2016
The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is... more The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared to reinforced repairs regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center during 2000-2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the two groups. Multivariable Cox proporti...
Journal of the American College of Surgeons, Jan 16, 2016
Long-term outcomes data for hernia recurrence rates following abdominal wall reconstruction (AWR)... more Long-term outcomes data for hernia recurrence rates following abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM. We studied patients who underwent AWR with ADM at a single center in 2005-2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary outcome and surgical site occurrence (SSO) was a secondary outcome. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively. A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included with a median follow-up was 52.9 months (range 36-104 months). Twenty-six of 191 patients had ...
Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on ... more Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. The purpose of this study was to determine whether prior abdominal wall radiotherapy is associated with a higher incidence of complications following AWR for a hernia or oncologic resection defect. We performed a retrospective study of consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We compared outcomes between patients who underwent prior XRT that directly involved the abdominal wall and those who did not receive XRT. Propensity score match-paired and multivariate analyses were performed. A total of 511 patients (130 [25.4 %] with prior XRT; 381 [74.6 %] without prior XRT) underwent AWR with ADM for repair of a complex hernia or oncologic resection defect. Mean follow-up was 31.4 months, mean XRT dose was 48.9 Gy, and mean time between XRT and reconstruction was ...
Synmastia is a condition of aberrant communication of the breasts. Apart from the rare congenital... more Synmastia is a condition of aberrant communication of the breasts. Apart from the rare congenital cases, this is usually a result of technical complications during breast augmentation surgery caused by an overdissection at the medial side of the pocket, over the sternum, in the subglandular plane; or overdivision of the major pectoralis muscle insertion along the sternum, in the submuscular plane. A multidatabase search about synmastia has been performed. Between November 2004 and April 2009, the senior author (G.S.) has performed 924 breast augmentations and his experience in preventing synmastia is discussed and compared with the literature. Accurate surgical plan, correct choice of implants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; size, and correct surgical technique are the most important rules to prevent synmastia. It is difficult to correct synmastia: additional reoperations expose patient to risks, cost, and dissatisfaction. On the basis of the recent literature and personal experience, we propose some classifications and guidelines to prevent synmastia.
Interactive cardiovascular and thoracic surgery, 2009
The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynami... more The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA). This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction. The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 l/min/m(2) (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke volume index was 27 ml/m(2) (23.1% vs. 62.1%, OR 5.46, 95% CI 1.90-15.70) and of...
Acute haemorrhage following pelvic reconstructive surgery is a complication that requires immedia... more Acute haemorrhage following pelvic reconstructive surgery is a complication that requires immediate evaluation and treatment. Most researchers describe the perioperative morbidity associated with complex surgery for prolapsed pelvic organs, but to date, no studies have reported on the management of acute haemorrhage during surgery. This case study describes two cases of acute bleeding during complex repair prolapsed pelvic organs and different management approaches.
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2010
there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric... more there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience. from March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic by-pass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34-63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected. intra-operative complications occurr...
Interactive cardiovascular and thoracic surgery, 2009
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. T... more A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any benefit with the use of carbon dioxide (CO(2)) field flooding techniques in heart valve surgery, in order to reduce postoperative neurological complications. Altogether 202 articles were found using the reported search, and six of them were used to answer the clinical question. All but one trial, were prospective, randomised. Four studies reported a significantly lower intracardiac bubble count in the CO(2) group. A significant reduction of p300 peak latencies in the CO(2) group was observed in one study. Otherwise, neurocognitive test batteries did not reveal any advantages of CO(2) field flooding in two studies. Three studies reported on postoperative cerebrovascular complications and the overall rate of stroke, transient ischemic attack (TIA) or prolonged reversible ischemic neurological deficit was 1.2% in the CO(2) group and 2.5% in the...
Platelet-rich plasma (PRP) treatment has gained popularity among different surgical specialities ... more Platelet-rich plasma (PRP) treatment has gained popularity among different surgical specialities for improving various conditions. Androgenetic alopecia (AGA) is a common disorder, with possible psychosocial implications. Plastic surgeons have increased the practice of PRP injections for hair restoration. A meta-analysis on this topic was performed comparing local injection of PRP versus control to investigate the efficacy of local PRP injections in AGA. We performed a systematic literature search. The increase in number of hairs was the primary outcome. Secondary outcomes were the increase of hair thickness and the percentage increase in hair number and thickness. Seven studies involving 194 patients were retrieved and included in the present analysis. A significantly locally increased hair number per cm was observed after PRP injections versus control (mean difference [MD] 14.38, 95% confidence interval [CI] 6.38-22.38, < 0.001). Similarly, a significantly increased hair thickn...
Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wo... more Panniculectomy (PAN) is often performed during abdominal wall reconstruction (AWR) to decrease wound healing complications and hernia recurrence rates. However, studies of AWR with concurrent panniculectomy (AWR+PAN) have reported contradictory results. We hypothesized that patients undergoing AWR+PAN experience more wound healing complications but similar rates of hernia recurrence compared to AWR alone. In this retrospective study of 548 consecutive patients, 305 (52.5%) patients underwent AWR alone and 243 (42.4%) underwent AWR+PAN. Mean follow-up was 30 months. We compared these two groups' postoperative complications and outcomes before and after propensity score analysis. The primary outcome measures were surgical site occurrence (SSO), overall complications, surgical site infections (SSI), and hernia recurrence. AWR+PAN patients had a significantly higher overall complication rate (38.3% vs. 29.2%, p=0.025) and a trend toward a higher SSO rate (27.6% vs. 20.7%, p=0.06) co...
Background and Aims. Vascular malformations are a vast group of congenital malformations that are... more Background and Aims. Vascular malformations are a vast group of congenital malformations that are present at birth. These malformations can cause pain, pressure, and cosmetic annoyance as well as downturn growth and development in a child in the case of high flow. Sclerotherapy has become an important tool in the treatment of vascular malformations. However, little is known about the success rate of sclerotherapy. Material and Methods. In this study, the efficiency of sclerotherapy in the treatment of vascular anomalies was investigated retrospectively in 63 patients treated in Turku University Hospital between 2003 and 2013. Results. Out of the 63 patients investigated, 83% (53) had venous malformations (VMs) and 9% (5) were defined as having arteriovenous malformations (AVMs). Patients with a VM were operated on, in 14% (8) out of all VM cases. Hence 86% (45) of patients with a VM received adequate help to their symptoms solely from sclerotherapy. The duration of treatment for the...
Obesity and higher body mass index may be associated with higher rates of wound healing complicat... more Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients. The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m (nonobese), 30 to 34.9 kg/m (class I obesity), and 35 kg/m or greater (class II/III obesity). The authors compared postoperative outcomes among these groups. Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall com...
Optimum excision margins used in the removal of intermediate thickness melanomas remain unclear. ... more Optimum excision margins used in the removal of intermediate thickness melanomas remain unclear. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s aim was to compare the clinical outcomes of 1-cm margins with 2-cm margins in patients with a tumor thickness of 1.1- to 4.0-mm. This was a retrospective study, which was based on a matched-pairs design. Equal patient cohorts were constructed in terms of gender, age, Breslow thickness, and the anatomic location of the primary lesion. There were 80 patients whom underwent an excision with a 1-cm margin and 80 patients with a 2-cm margin. Follow-up data were analyzed by the Kaplan-Meier method and a Cox regression model. After a median follow-up time of 41 months, there were no differences in relapse-free survival or melanoma-specific survival between study groups. The wound was closed directly in 62 patients (78%) in the 1-cm group and in 36 patients (45%) in the 2-cm group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). A 1-cm excision margin may be sufficient in melanomas of 1.1 to 2.0 mm in Breslow thickness based on these findings of low recurrence. With thicker tumors (2.1-4.0 mm), this recommendation cannot be given due to inherent study limitations.
We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal w... more We hypothesized that elderly patients (≥65 years) experience worse outcomes following abdominal wall reconstruction (AWR) for hernia or oncologic resection. We included all consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) between 2005 and 2015. Propensity score analysis was performed for risk adjustment in multivariable analysis and for one-to-one matching. The primary outcome was hernia recurrence; the secondary outcomes included surgical site occurrence (SSO) and bulging. Mean follow-up for the 511 patients was 31.4 months; 184 (36%) patients were elderly. The elderly and non-elderly groups had similar rates of hernia recurrence (7.6% vs 10.1%, respectively; p = 0.43) and SSO (24.5% vs 23.5%, respectively; p = 0.82). Bulging occurred significantly more often in elderly patients (6.5% vs 2.8%, respectively; p = 0.04). After adjustment through the propensity score, which included 130 pairs, these results persisted. Contrary to our hypothesis, elderl...
Journal of the American College of Surgeons, Jan 10, 2016
The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is... more The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared to reinforced repairs regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center during 2000-2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the two groups. Multivariable Cox proporti...
Journal of the American College of Surgeons, Jan 16, 2016
Long-term outcomes data for hernia recurrence rates following abdominal wall reconstruction (AWR)... more Long-term outcomes data for hernia recurrence rates following abdominal wall reconstruction (AWR) with acellular dermal matrix (ADM) are lacking. The aim of this study was to assess the long-term durability of AWR using ADM. We studied patients who underwent AWR with ADM at a single center in 2005-2015 with a minimum follow-up of 36 months. Hernia recurrence was the primary outcome and surgical site occurrence (SSO) was a secondary outcome. The recurrence-free survival curves were estimated by Kaplan-Meier product limit method. Univariate and multivariable Cox proportional hazards regression models and logistic regression models were used to evaluate the associations of risk factors at surgery with subsequent risks for hernia recurrence and SSO, respectively. A total of 512 patients underwent AWR with ADM. After excluding those with follow-up less than 36 months, 191 patients were included with a median follow-up was 52.9 months (range 36-104 months). Twenty-six of 191 patients had ...
Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on ... more Prior abdominal wall radiotherapy (XRT) adversely affects wound healing, but data are limited on how prior XRT may affect abdominal wall reconstruction (AWR) outcomes. The purpose of this study was to determine whether prior abdominal wall radiotherapy is associated with a higher incidence of complications following AWR for a hernia or oncologic resection defect. We performed a retrospective study of consecutive patients who underwent complex AWR using acellular dermal matrix (ADM) at a single center. We compared outcomes between patients who underwent prior XRT that directly involved the abdominal wall and those who did not receive XRT. Propensity score match-paired and multivariate analyses were performed. A total of 511 patients (130 [25.4 %] with prior XRT; 381 [74.6 %] without prior XRT) underwent AWR with ADM for repair of a complex hernia or oncologic resection defect. Mean follow-up was 31.4 months, mean XRT dose was 48.9 Gy, and mean time between XRT and reconstruction was ...
Synmastia is a condition of aberrant communication of the breasts. Apart from the rare congenital... more Synmastia is a condition of aberrant communication of the breasts. Apart from the rare congenital cases, this is usually a result of technical complications during breast augmentation surgery caused by an overdissection at the medial side of the pocket, over the sternum, in the subglandular plane; or overdivision of the major pectoralis muscle insertion along the sternum, in the submuscular plane. A multidatabase search about synmastia has been performed. Between November 2004 and April 2009, the senior author (G.S.) has performed 924 breast augmentations and his experience in preventing synmastia is discussed and compared with the literature. Accurate surgical plan, correct choice of implants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; size, and correct surgical technique are the most important rules to prevent synmastia. It is difficult to correct synmastia: additional reoperations expose patient to risks, cost, and dissatisfaction. On the basis of the recent literature and personal experience, we propose some classifications and guidelines to prevent synmastia.
Interactive cardiovascular and thoracic surgery, 2009
The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynami... more The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA). This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction. The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 l/min/m(2) (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke volume index was 27 ml/m(2) (23.1% vs. 62.1%, OR 5.46, 95% CI 1.90-15.70) and of...
Acute haemorrhage following pelvic reconstructive surgery is a complication that requires immedia... more Acute haemorrhage following pelvic reconstructive surgery is a complication that requires immediate evaluation and treatment. Most researchers describe the perioperative morbidity associated with complex surgery for prolapsed pelvic organs, but to date, no studies have reported on the management of acute haemorrhage during surgery. This case study describes two cases of acute bleeding during complex repair prolapsed pelvic organs and different management approaches.
Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2010
there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric... more there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience. from March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic by-pass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34-63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected. intra-operative complications occurr...
Interactive cardiovascular and thoracic surgery, 2009
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. T... more A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any benefit with the use of carbon dioxide (CO(2)) field flooding techniques in heart valve surgery, in order to reduce postoperative neurological complications. Altogether 202 articles were found using the reported search, and six of them were used to answer the clinical question. All but one trial, were prospective, randomised. Four studies reported a significantly lower intracardiac bubble count in the CO(2) group. A significant reduction of p300 peak latencies in the CO(2) group was observed in one study. Otherwise, neurocognitive test batteries did not reveal any advantages of CO(2) field flooding in two studies. Three studies reported on postoperative cerebrovascular complications and the overall rate of stroke, transient ischemic attack (TIA) or prolonged reversible ischemic neurological deficit was 1.2% in the CO(2) group and 2.5% in the...
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