Surgery Commons^™

Multilevel Anterior Lumbar Interbody Fusion Combined With Posterior Stabilization In Lumbar Disc Disease-Prospective Analysis Of Clinical And Functional Outcomes., Diogo Lino Moura, David Lawrence, Josué Pereira Gabriel

Surgery Articles

Objective This was a prospective controlled study with lumbar degenerative disc disease patients submitted to instrumented anterior lumbar interbody fusion (ALIF) combined with posterior stabilization. Methods A sample with 64 consecutive patients was operated by the same surgeons over 4 years. Half of the ALIFs occurred at 2 levels, 43.8% at 3 levels, and 6.25% at 1 level. Interbody cages with integrated screws, filled with bone matrix and bone morphogenetic protein 2, were used. Results Half of the patients had undergone previous lumbar spine surgeries, 75% presented with associated degenerative listhesis, and 62.5% had posterior lumbar compression disease. Approximately 56% …

Foam Sclerotherapy Augmented Phlebectomy (Sap) Procedure For Varicose Veins: Report Of A Novel Technique., Raghu Kolluri, Katherine U Hays, Manjit S Gohel

Surgery Articles

INTRODUCTION: While traditional ambulatory phlebectomy (AP) is a safe and effective procedure, few adverse effects such as hematoma, bleeding, bruising and nerve injury have been reported. To improve AP and to reduce some of these adverse events, herein we report a novel technique - Foam Sclerotherapy Assisted Phlebectomy (SAP).

REPORT: The details of the above technique, along with the potential advantages and limitations will be discussed.

DISCUSSION: Foam sclerotherapy and DUS act as valuable adjuncts to traditional AP. SAP increases precision and creates additional venospasm leading to reduced bruising, reduced nerve injury and sclerosis of residual vein segments.

The Impact Of Depression On Patient Outcomes In Hip Arthroscopic Surgery., Robroy L Martin, John J Christoforetti, Ryan Mcgovern, Benjamin R Kivlan, Andrew B Wolff, Shane J Nho, John P Salvo, Thomas J Ellis, Geoff Van Thiel, Dean Matsuda, Dominic S Carreira

Surgery Articles

BACKGROUND: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement.

HYPOTHESIS: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and …

Twenty-Four Month Results From A Randomized Trial Of Cyanoacrylate Closure Versus Radiofrequency Ablation For The Treatment Of Incompetent Great Saphenous Veins., Kathleen Gibson, Nick Morrison, Raghu Kolluri, Michael Vasquez, Robert Weiss, Daniel Cher, Monte Madsen, Andrew Jones

Surgery Articles

OBJECTIVE: We previously reported 3-month and 12-month occlusion rates after treatment of clinically symptomatic saphenous vein reflux with either cyanoacrylate closure (CAC) using the VenaSeal Closure System (Medtronic, Dublin, Ireland) or radiofrequency ablation (RFA) in a randomized, multicenter, clinical trial, VenaSeal Sapheon Closure System vs Radiofrequency Ablation for Incompetent Great Saphenous Veins (VeClose). Herein we report the 24-month follow-up results of the VeClose trial.

METHODS: There were 222 patients with symptomatic great saphenous vein (GSV) incompetence who were randomly assigned to receive either CAC (n = 108) or RFA (n = 114). Patients were not allowed to receive adjunctive treatment …

Restoration Of External Rotation Following Reverse Shoulder Arthroplasty Without Latissimus Dorsi Transfer., Derek D Berglund, Samuel Rosas, Jacob J Triplet, Jennifer Kurowicki, Brandon Horn, Jonathan C Levy

Surgery Articles

BACKGROUND: Latissimus dorsi transfers have been considered necessary to restore active external rotation following reverse shoulder arthroplasty (RSA). The purpose of this study was to assess the effectiveness of an RSA system that lateralizes the center of rotation in restoring active external rotation without a latissimus dorsi transfer in patients with a preoperative external rotation deficit (external rotation of < 0°).

METHODS: We retrospectively reviewed the records of patients who had undergone RSA with a lateralized center of rotation without a latissimus dorsi transfer. All patients had had a preoperative external rotation deficit (active external rotation of < 0°), and all were followed for a minimum of 2 years. Patients were stratified into 2 groups on the basis of the preoperative diagnosis: (1) those with a combined loss of active elevation and external rotation as a result of rotator cuff tear arthropathy (CLEER group) and (2) those with a combined loss of active elevation and external rotation as a result of other posttraumatic etiologies (non-CLEER group). The mean improvement of external rotation was analyzed. Subgroup analysis was performed on the basis of the Goutallier classification, glenosphere lateralization, and total prosthetic lateralization.

RESULTS: Thirty-three patients (24 in …

Incidence Of Dysphagia After Odontoid Screw Fixation Of Type Ii Odontoid Fracture In The Elderly., Rudy D Marciano, Brian Seaman, Saurabh Sharma, Teresa Wood, Chris Karas, Kailash Narayan

Surgery Articles

BACKGROUND: Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication.

METHODS: We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative dysphagia. The severity of dysphagia was determined based on the requirements for modified diets, PEG tubes, and prolonged length of stay (LOS), while costs were based upon discharge disposition (e.g. home vs. rehabilitation facilities) and total hospital costs.

RESULTS: The incidence of postoperative dysphagia was 80%; …

Comparative Outcomes Between The First And Second Operated Shoulders In Bilateral Shoulder Arthroplasty., Derek D Berglund, Jennifer Kurowicki, Jacob J Triplet, Samuel Rosas, Molly Moor, Brandon Horn, Jonathan C Levy

Surgery Articles

INTRODUCTION: Studies that report outcomes after staged bilateral shoulder arthroplasty (BSA) are limited. This study compared the overall improvement between the first and second operated shoulders after BSA.

METHODS: Preoperative and postoperative motion and patient-reported outcomes for function, pain, and general health were assessed for patients who underwent BSA with a 2-year follow-up. Ultimate outcomes and the efficacy of treatment were compared between the first and second operated shoulders.

RESULTS: Seventy-three patients met the inclusion criteria (mean follow-up, 51.4 months). There were no notable differences between the first and second operated shoulders for all preoperative and postoperative variables except for …

Transanal Drainage Of Coloanal Anastomotic Leaks., Bradley Sherman, Mark Arnold, Syed Husain

Surgery Articles

The conventional operative intervention for leaks following coloanal anastomoses has been proximal fecal diversion with or without take-down of anastomosis. A few of these cases are also amenable to percutaneous drainage. Ostomies created in this situation are often permanent, specifically in cases where coloanal anastomoses are taken down at the time of reoperation. We present two patients who developed perianastomotic pelvic abscesses that were treated with transanal large bore catheter drainage resulting in successful salvage of coloanal anastomoses without the need for a laparotomy or ostomy creation. We propose this to be an effective therapeutic approach to leaks involving low …

Trends In Management Of Radial Head And Olecranon Fractures., Matthew Motisi, Jennifer Kurowicki, Derek D Berglund, Jacob J Triplet, Shanell Disla, Timothy Niedzielak, Jonathan C Levy

Surgery Articles

BACKGROUND: Advancement in surgical techniques and implants has improved the ability to manage radial head and olecranon fractures. However, trends in management of these fractures are largely unstudied.

OBJECTIVE: This purpose of this study is to evaluate management trends for these common fractures.

METHODS: A retrospective review of a comprehensive Humana database was performed using Pearl Diver supercomputer (Warsaw, IN, USA) for radial head and neck (RHNF) and olecranon fractures (OF) between 2007 and 2014. Treatment methods including open reduction internal fixation (ORIF), radial head arthroplasty (RHA), and non-operative treatment were reviewed. Total reported incidence of office visits and utilization …

A Case Of Spontaneous Transdiaphragmatic Intercostal Hernia With Contralateral Injury, And Review Of The Literature., Alexander A Chapman, Steven B Duff

Surgery Articles

This case report discusses the diagnosis and management of a 67-year-old male presenting with a spontaneous transdiaphragmatic intercostal hernia with contralateral intercostal hernia. The patient had a history of chronic obstructive pulmonary disease (COPD) exacerbations requiring multiple prolonged courses of steroids. The patient was ultimately diagnosed with computed tomography (CT) and underwent surgical repair via thoracotomy with primary repair of the diaphragmatic defect. The patient's postoperative course was uncomplicated. A review of the literature since the first similar case in 1977 recognizes the propensity of this injury to be found in patients with COPD and chronic steroid usage, as well …