International Journal of Surgery Open最新文献

Introduction and importance

Single-port video-assisted thoracoscopic surgery is a less invasive approach for patients undergoing a bullectomy. This report demonstrates a case of post-single-port video-assisted thoracoscopic surgery of rhomboid muscle herniation into the thoracic cavity.

Case presentation

A 35-year-old lady presented with a 1-month history of dyspnea due to single large lung bullae of 13 cm × 10 cm. She underwent bullectomy using single-port video-assisted thoracoscopic surgery and recovered well thereafter. Four months later, the patient presented with pain at the site of the incision with a severe cough. During the workup, radiographic images showed herniation of the rhomboid major muscle into the thoracic cavity.

Clinical discussion

Intercostal herniation of thoracic soft tissues can be in the form of lung herniation or inverted intercostal herniation of other soft tissues. It is an extremely rare disorder and mainly occurs after an anterior thoracotomy.

Conclusion

Muscle herniation is a rare complication following video-assisted thoracoscopic surgery. Proper closure of the wound including periosteal stitches might be necessary to prevent this complication.

Introduction

Epididymal cysts usually develop in adults with rare occurrence in children. There is a shortage concerning our knowledge about this rare pathology in children. We present our experience with the presentation and management outcome of symptomatic epididymal cysts in children.

Methods

A retrospective analysis of 7 patients with symptomatic epididymal cysts during the period from October 2017 to June 2022 was conducted. Recorded data included age and mode of presentation, findings on physical examination and scrotal U/S, spontaneous resolution and its duration, indications of surgical intervention, and post management follow up. All patients underwent an initial plan of conservative management. Surgical intervention was indicated in patients with persisting symptoms and/or failure of lesion's resolution on periodic follow up of 3 months interval.

Results

The average age of patients was 7.9 years. Scrotal pain was the leading presenting symptom in 4 (57.1%) patients. The diagnosis was confirmed in all patients by scrotal ultrasonography. Spontaneous resolution was reported in 5 (71.4%) patients with an average duration of 9 months. Surgical excision was indicated in 2 (28.6%) patients. Recurrence was not recorded in all patients who developed complete lesion's resolution, and patients were symptom free for 6 months of post management follow up.

Conclusion

The majority of epididymal cysts in children can be managed conservatively. Resolution duration is directly proportional to the cyst size. Cysts larger than 10 mm less likely involute, and surgical excision may be indicated. Larger volume studies are needed to establish a more solid therapeutic regimen.

Background

During the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic.

Methods

This multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals.

Results

One hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06–9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32–0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02–1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02–1.08; p = 0.001), surgical urgency and surgical discipline.

Conclusion

A confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.

Objectives

Quality of post-operative recovery is an essential end-point for evaluating anesthesia and surgery. Measures must incorporate patient-reported outcomes and satisfaction in addition to physiological indicators of recovery in order to fully assess the effects of anesthesia and surgery. This study is to explore the quality of recovery using the postoperative quality of recovery scale (PQRS) in patients undergoing laparoscopic cholecystectomy.

Methods

This is a single-center, prospective cohort pilot study. Patients undergoing laparoscopic cholecystectomy were divided into two groups: Group D with deep neuromuscular blockade and Group M with moderate neuromuscular blockade. After surgery, patients were assessed by using Post-operative Quality Recovery Scale (PQRS).

Results

60 patients in group D and 60 patients in group M were analyzed. The proportion of patients with excellent surgical conditions in group D was higher than in group M. In the recovery room, at 15 min and 40 min after endotracheal extubation, the recovery of the physiological domain in group D was significantly higher than in group M. In postoperative day 1, the overall recovery percentage was 78.3% in group D and 76.7% in group M.

Conclusion

This is a pilot study showing that it is feasible and appropriate to use the postoperative quality of recovery scale (PQRS) in postoperative recovery assessment. Preliminary assessment of this result shows that anesthesia strategy with deep rocuronium-induced neuromuscular blockade-sugammadex reversal improved postoperative recovery versus the routine care with moderate neuromuscular block-neostigmine.

The highly contagious Omicron variant of SARS-CoV-2 is a recent cause of concern during the COVID-19 pandemic. The World Health Organization (WHO) has classified SARS-CoV-2 variants into variants of concern (VOCs), variants of interest (VOIs), and variants under monitoring (VUMs). VOCs were categorized as Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2). Omicron (B.1.1.529) was a further modified strain that has a short incubation period; it was called VOC by the WHO, and it became fifth on the list of variants. Omicron has spread faster than any other variant since its emergence in late 2021. Omicron is currently the only circulating VOC. The various subvariants of Omicron are BA.1 (B.1.1.529.1), BA.2 (B.1.1.529.2), BA.3 (B.1.1.529.3), BA.4, BA.5, and descendent lineages. More recently, identified Omicron subvariants and sublineages BQ.1, BQ.1.1, BA.4.6, BF.7, BA.2.75.2, XBB.1, and BF.7 have also attracted global attention. The BA.5 strain of Omicron is the most contagious and dominant subvariant globally. Recent spikes in cases in China are due to the BF.7 subvariant. With the large increase in the number of cases, there has been an increase in hospitalisations in countries worldwide. In many countries, the lifting of infection prevention protocols, such as the use of masks and physical distancing, contributes to the spread of the virus. This article highlights the potential impacts of SARS-CoV-2 variants and subvariants, which have made the pandemic far from over. Effective vaccination remains the safest option to kerb transmission of these variants. Therefore, people must be vaccinated, wear masks, perform regular hand hygiene, and observe social distancing. Additionally, genome sequencing of positive samples can help detect various virus variants; thus, mapping cases in a particular area can be performed.

Objectives

To predict the aggressive behavior of the bladder tumor as well as the poor prognosis of the disease, the use of some biomarkers including β-catenin and E-cadherin related to the detachment of tumoral cells from its primary lesion can be very beneficial. We intended to evaluate the incidence of β-catenin and E-cadherin expression and their association with tumor biological behavior in patients suffering bladder neoplasms.

Methods

This cross-sectional study was done on 30 established bladder neoplasms on tissue assessment with evidence of malignancy on cystoscopic examination. Hematoxylin and Eosin stains were planned for pathological evaluation in terms of tumor biological behavior. Immunohistochemistry staining for two markers E-cadherin and β-catenin was done to evaluate gene expression.

Results

Overall, β-catenin biomarker was expressed in nuclear in only one patient (3.3%), while abnormal E-Cadherin staining was revealed in none of the patients. The expression of these biomarkers was independent of tumor characteristics including vascular invasion, tumor size, tumor grade, and tumor stage (P-value>0.05).

Conclusion

The change in β-catenin and E-cadherin expression probably has a weak prognostic role in the prediction of the biological behavior in bladder neoplasms as well as the clinical outcomes of patients in our society.