Y. Obadiel, Mohammed Al-Shehari, Ali Al-Shawesh, Basma Al-Huribi, Haitham Jowah
Background: Thymectomy is an option for the treatment of myasthenia gravis (MG). While the open technique was most frequently performed in the past, nowadays the endoscopic approach has gained wide acceptance. Here we assessed our early experience in thoracoscopic thymectomy (TT). Methods: This case series was retrospectively conducted at Al-Thawra Modern General Hospital and included all patients diagnosed with MG who underwent TT from January 2018 to January 2024. Results: Our case series consisted of 13 predominantly female patients (61.5%), with a median age of 39.5 years. Surgeries typically lasted 50 ± 10.41 minutes, with the majority performed using a left-sided thoracoscopic approach (n=10, 77%). Immediate extubation was achieved in 10 patients (76%). Four patients experienced early postoperative complications (31%), including dyspnoea, prolonged intubation, chest infection, confusion, tracheostomy, and re-tracheostomy. There were 2 recorded deaths due to complications. Eleven patients were followed up for an average of 16.5 months, revealing that 54.5% achieved complete stable remission, 18% showed improvement with reduced symptoms and medications, and 27% remained unchanged. Conclusion: Thoracoscopic thymectomy is feasible and effective procedure for the management of MG in Yemeni patients. The observed remission and improvement rates are promising and align with global experiences. It is recommended that with proper resources and expertise, similar minimally invasive surgical approaches can be implemented in resource-limited regions. Plain language summary: This study was conducted to evaluate the use of thoracoscopic thymectomy (TT) for the treatment of myasthenia gravis (MG) at Al-Thawra Modern General Hospital. In this study, we included 13 predominantly female patients with a median age of 39.5 years. The most common symptoms experienced by the patients were generalized weakness and ptosis (drooping of the eyelids). During the surgeries, which typically lasted around 50 minutes, we primarily used a left-sided thoracoscopic approach. We were successful in immediately removing the breathing tube in 10 out of 13 patients. However, four patients experienced early postoperative complications, including difficulties in breathing, longer intubation, chest infection, confusion, and the need for tracheostomy. Out of the 13 patients, two unfortunately passed away due to complications. We followed up with 11 patients for an average of 16.5 months and observed that 54.5% of them achieved complete stable remission, meaning they had no MG symptoms and did not require any treatment for at least one year. Additionally, 18% of the patients showed improvement with reduced symptoms and medication usage, while 27% remained unchanged. Based on our findings, we conclude that thoracoscopic thymectomy is a safe and effective procedure for managing MG in Yemeni patients. The remission and improvement rates we observed align with experiences from around the
{"title":"Thoracoscopic Thymectomy for Myasthenia Gravis: An Early Experience in Yemen","authors":"Y. Obadiel, Mohammed Al-Shehari, Ali Al-Shawesh, Basma Al-Huribi, Haitham Jowah","doi":"10.2147/oas.s463877","DOIUrl":"https://doi.org/10.2147/oas.s463877","url":null,"abstract":"Background: Thymectomy is an option for the treatment of myasthenia gravis (MG). While the open technique was most frequently performed in the past, nowadays the endoscopic approach has gained wide acceptance. Here we assessed our early experience in thoracoscopic thymectomy (TT). Methods: This case series was retrospectively conducted at Al-Thawra Modern General Hospital and included all patients diagnosed with MG who underwent TT from January 2018 to January 2024. Results: Our case series consisted of 13 predominantly female patients (61.5%), with a median age of 39.5 years. Surgeries typically lasted 50 ± 10.41 minutes, with the majority performed using a left-sided thoracoscopic approach (n=10, 77%). Immediate extubation was achieved in 10 patients (76%). Four patients experienced early postoperative complications (31%), including dyspnoea, prolonged intubation, chest infection, confusion, tracheostomy, and re-tracheostomy. There were 2 recorded deaths due to complications. Eleven patients were followed up for an average of 16.5 months, revealing that 54.5% achieved complete stable remission, 18% showed improvement with reduced symptoms and medications, and 27% remained unchanged. Conclusion: Thoracoscopic thymectomy is feasible and effective procedure for the management of MG in Yemeni patients. The observed remission and improvement rates are promising and align with global experiences. It is recommended that with proper resources and expertise, similar minimally invasive surgical approaches can be implemented in resource-limited regions. Plain language summary: This study was conducted to evaluate the use of thoracoscopic thymectomy (TT) for the treatment of myasthenia gravis (MG) at Al-Thawra Modern General Hospital. In this study, we included 13 predominantly female patients with a median age of 39.5 years. The most common symptoms experienced by the patients were generalized weakness and ptosis (drooping of the eyelids). During the surgeries, which typically lasted around 50 minutes, we primarily used a left-sided thoracoscopic approach. We were successful in immediately removing the breathing tube in 10 out of 13 patients. However, four patients experienced early postoperative complications, including difficulties in breathing, longer intubation, chest infection, confusion, and the need for tracheostomy. Out of the 13 patients, two unfortunately passed away due to complications. We followed up with 11 patients for an average of 16.5 months and observed that 54.5% of them achieved complete stable remission, meaning they had no MG symptoms and did not require any treatment for at least one year. Additionally, 18% of the patients showed improvement with reduced symptoms and medication usage, while 27% remained unchanged. Based on our findings, we conclude that thoracoscopic thymectomy is a safe and effective procedure for managing MG in Yemeni patients. The remission and improvement rates we observed align with experiences from around the","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Perioperative blood transfusions are necessary during orthopaedic surgery since it is linked with significant bleeding. Remember that receiving blood transfusions containing various blood components might lead to a number of problems. In order to draw conclusions on perioperative blood transfusion methods in orthopaedic surgery, including adjuvants, this literature analysis looks at the most recent data that are currently available. Methods: Databases and other sources were searched for pertinent literature. The following databases were searched for recent evidence: MEDLINE, EMBASE, SCOPUS, PubMed, Google Scholar, the Cochrane Library, and Science Direct. Medical heading subjects (MeSH) were merged with Boolean operators such as OR, AND, and NOT, which restrict or broaden the scope of possible supporting evidence. The weight of the evidence supporting each conclusion was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: The included literatures cover a wide range of topics, including fracture type, perioperative bleeding management techniques like adjuvant therapies used to reduce problems from blood transfusions, and hemoglobin thresholds for blood transfusion. Conclusion and Recommendations: Patients who are at danger of bleeding during surgery or who are anemic should be handled with medication, allogenic blood transfusions (restrictive type), adjuvants, and non-pharmacological methods such tourniquets and cell savers. Instead of relying just on one transfusion technique, healthcare personnel should consider the patient’s situation in depth and use a variety of transfusion tactics.
{"title":"Perioperative Blood Transfusion Strategies in Orthopaedic Surgery: A Comprehensive Review and Analysis","authors":"Debas Yaregal Melesse, B. Admass, B. Admassie","doi":"10.2147/oas.s430812","DOIUrl":"https://doi.org/10.2147/oas.s430812","url":null,"abstract":"Introduction: Perioperative blood transfusions are necessary during orthopaedic surgery since it is linked with significant bleeding. Remember that receiving blood transfusions containing various blood components might lead to a number of problems. In order to draw conclusions on perioperative blood transfusion methods in orthopaedic surgery, including adjuvants, this literature analysis looks at the most recent data that are currently available. Methods: Databases and other sources were searched for pertinent literature. The following databases were searched for recent evidence: MEDLINE, EMBASE, SCOPUS, PubMed, Google Scholar, the Cochrane Library, and Science Direct. Medical heading subjects (MeSH) were merged with Boolean operators such as OR, AND, and NOT, which restrict or broaden the scope of possible supporting evidence. The weight of the evidence supporting each conclusion was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: The included literatures cover a wide range of topics, including fracture type, perioperative bleeding management techniques like adjuvant therapies used to reduce problems from blood transfusions, and hemoglobin thresholds for blood transfusion. Conclusion and Recommendations: Patients who are at danger of bleeding during surgery or who are anemic should be handled with medication, allogenic blood transfusions (restrictive type), adjuvants, and non-pharmacological methods such tourniquets and cell savers. Instead of relying just on one transfusion technique, healthcare personnel should consider the patient’s situation in depth and use a variety of transfusion tactics.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Open Wound Reconstruction of the Thumb Tip: A Review of Current Literature and Case Reports","authors":"Ricardo Cortes, R. Datiashvili","doi":"10.2147/oas.s417999","DOIUrl":"https://doi.org/10.2147/oas.s417999","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Peri-Operative Outcomes of Patients with Inflammatory Bowel Disease After the Introduction of an ERAS Protocol – A Retrospective Cohort Review","authors":"Rebecca J Lendzion, Ankur Sidhu, Basil D’Souza","doi":"10.2147/oas.s440460","DOIUrl":"https://doi.org/10.2147/oas.s440460","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Shale, Tolasa Jirata, Mekbeb Enawgaw, Ararso Metekia, Yosef Kelecha
{"title":"Rare Classic Presentation of Primary Hyperparathyroidism: A Case Report and Literature Review","authors":"W. Shale, Tolasa Jirata, Mekbeb Enawgaw, Ararso Metekia, Yosef Kelecha","doi":"10.2147/oas.s433529","DOIUrl":"https://doi.org/10.2147/oas.s433529","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Affinity of Colonic Granular Cell Tumor Within the Right Colon: Case Report and Review of Literature","authors":"A. Aggarwal, Saakshi Joshi, J. Bhullar","doi":"10.2147/oas.s424597","DOIUrl":"https://doi.org/10.2147/oas.s424597","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Bogale, Sintayew Beyene, Dawit Desta, Eyob Tessema, Sebsbie Birhanie
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{"title":"Cecal Volvulus in Pregnancy, a Diagnostic Dilemma and Management: A Case Report and Literature Review","authors":"N. Bogale, Sintayew Beyene, Dawit Desta, Eyob Tessema, Sebsbie Birhanie","doi":"10.2147/oas.s436134","DOIUrl":"https://doi.org/10.2147/oas.s436134","url":null,"abstract":",","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Appendicitis is a common abdominal surgical emergency. However, treatment becomes more complex when the patient is pregnant. It is important to consider the diagnostic differences in pregnant and non-pregnant patients, as well as the changes to surgical and non-surgical management. Commonly, appendicitis in pregnancy is diagnosed with radiographic imaging, preferably ultrasound or MRI. Due to increased risk with delay to surgery, surgical management is recommended, as opposed to non-operative management, and ultimately a laparoscopic appendectomy is the surgery of choice. We aim to provide a comprehensive review of the best practices and clinical management of appendicitis in pregnancy.
{"title":"Appendicitis During Pregnancy: Best Surgical Practices and Clinical Management","authors":"Caroline Smolkin, Adam Kiridly, Aurora Pryor","doi":"10.2147/oas.s405514","DOIUrl":"https://doi.org/10.2147/oas.s405514","url":null,"abstract":": Appendicitis is a common abdominal surgical emergency. However, treatment becomes more complex when the patient is pregnant. It is important to consider the diagnostic differences in pregnant and non-pregnant patients, as well as the changes to surgical and non-surgical management. Commonly, appendicitis in pregnancy is diagnosed with radiographic imaging, preferably ultrasound or MRI. Due to increased risk with delay to surgery, surgical management is recommended, as opposed to non-operative management, and ultimately a laparoscopic appendectomy is the surgery of choice. We aim to provide a comprehensive review of the best practices and clinical management of appendicitis in pregnancy.","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Giant Cystic Hygroma with Complete Encasement of the Great Vessels of the Neck in an 18 Month Old Infant","authors":"Zinedin Abdulahi, Girum Meseret, Anteneh Belachew, Kalkidan Abera","doi":"10.2147/oas.s416166","DOIUrl":"https://doi.org/10.2147/oas.s416166","url":null,"abstract":"","PeriodicalId":56363,"journal":{"name":"Open Access Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135605936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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