Minimally invasive plate osteosynthesis using posterolateral approach for distal tibial and tibial shaft fractures

ObjectiveThe objective of the study was to evaluate the effectiveness of the posterolateral minimally invasive plate osteosynthesis (MIPO) method for managing distal tibial or tibial shaft fractures with severe anterior and medial soft tissue injuries.Materials and methodsFive consecutive patients with three distal tibial and two tibial shaft fractures (three open fractures) at a level-1 trauma and tertiary referral center were retrospectively reviewed. All patients were definitively treated and followed to bone union. Main outcome was measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, complications, and bone union on radiographs.ResultsThe average follow-up period was 15.8 months (range, 12–24 months). The average AOFAS score was 88.2 (range, 81–90). There were no complications, such as incision breakdown, deep infection, or impingement of the flexor hallucis longus tendon. Bone union was achieved in all cases.ConclusionsPosterolateral MIPO is a feasible option when treating these fractures, especially in cases with severe anterior and medial soft tissue injuries.     

腹腔镜与开腹胃癌根治术后早期并发急性胰腺炎的临床回顾性分析

目的本研究分析腹腔镜手术和开腹手术在胃癌治疗中伴发急性胰腺炎(post--gastrectomy acute pancreatitis,PGAP)的优劣性。方法收集2011年6月至2015年9月施行胃癌根治术的病人1050例。分别统计腹腔镜组和开腹组术后PGAP病例,并做回顾性分析对比研究。结果1050例胃癌根治术中并发PGAP的16例,发生率为1.52%,腹腔镜组432例,PGAP 7例,发生率为1.62%;开腹组618例,PGAP 9例,发生率为1.46%。腹腔镜组与开腹组术后PGAP发生率比较差异无统计学意义(x~2=0.046,P0.05)。腹腔镜组中远端胃251例,PGAP 1例(0.40%);近端胃78例,PGAP 1例(1.28%);全胃83例,PGAP 2例(2.41%);联合脏器切除20例,PGAP 3例(15.00%)。远端胃、近端胃和全胃切除术后PGAP发生率比较差异无统计学意义(P0.05),但三者与联合脏器切除术后PGAP发生率比较差异有统计学意义(P0.05)。开腹组中远端胃213例,PGAP 3例(1.41%);近端胃182例,PGAP 1例(0.55%);全胃174例,PGAP 2例(1.15%);联合脏器切除49例,PGAP 3例(6.12%)。结果类似腹腔镜组,远端胃、近端胃和全胃切除术后PGAP发生率比较差异无统计学意义(P0.05),但三者与联合脏器切除术后PGAP发生率比较差异有统计学意义(.P0.05)。腹腔镜组与开腹组分别对远端胃、近端胃、全胃和联合脏器切除后PGAP的发生率比较,差异均无统计学意义(P0.05)。结论腹腔镜与传统开腹胃癌根治术对于PGAP具有同样安全性。     

Knowledge,attitudes, and behaviors of women during pregnancy after bariatric surgery

BackgroundWomen of childbearing age constitute a substantial proportion of the patients who undergo weight loss procedures. However, little is known regarding attitudes and behaviors of women during pregnancy after bariatric surgery (BS).ObjectivesWe explored women’s experience and behavior during pregnancy after BS.SettingUniversity hospital.MethodsA cross-sectional survey study was performed among women who underwent sleeve gastrectomy and delivered at our center.ResultsOverall, 111 women completed the questionnaire (response rate 88.1%). The median surgery-to-conception interval was 34 (25–50) months. For 28 (25.2%) women, future pregnancy was a motivation for undergoing the weight loss procedure. Only 10 (9.0%) received contraceptive advice perioperatively. Oral contraception was the most commonly used method after surgery (n = 47, 42.3%). Pregnancy was reported as unintended by 37 (33.3%) women. Only 14 (12.6%) women stated receiving an explanation regarding the implications of BS on pregnancy outcomes. Rates of follow-up with maternal-fetal medicine specialists, bariatric surgeons, and dieticians during pregnancy were 36.0%, 9.0%, and 23.4%, respectively. Forty-four women (39.6%) felt follow-up throughout gestation was inadequate. Satisfaction from BS improved after pregnancy in 23 (20.7%) women, and 75 (67.6%) stated that they would recommend BS to a friend with obesity who plans to conceive in the future.ConclusionsWomen reported insufficient knowledge regarding the expected outcomes of pregnancy after surgery, with low rates of medical and nutritional follow-up. Only a minority of respondents received contraceptive advice after surgery, and unintended pregnancies were common. These observations represent areas of improvement for following women of childbearing age who undergo weight loss procedures.     

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass in patients with gastroesophageal reflux disease: results of a multicenter study

BackgroundThe main side effect of long-term laparoscopic sleeve gastrectomy is the onset of severe gastroesophageal reflux disease (GERD).ObjectivesThe aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling postsleeve GERD.SettingUniversity Hospital and Private Hospital, France and Private Hospital, Italy.MethodsThis retrospective multicenter study included patients who underwent laparoscopic sleeve gastrectomy and suffered from postoperative GERD, who did not respond to medical treatment and were converted to laparoscopic Roux-en-Y gastric bypass. The study involved 2 French university hospitals, 4 French private centers, and an Italian public hospital.ResultsA total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during laparoscopic sleeve gastrectomy in 3 patients, while 19 patients were operated for hiatal hernia during conversion to bypass (P = .0004). Six months after surgery, 23 of 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pump inhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared with patients with no history of gastric banding (n = 4, P = .02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass because of intractable GERD was 3 times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio = 3.69).ConclusionThe results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding.     

Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis

AimThis network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over.MethodsWe searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes.ResultsFourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups.ConclusionEvidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.     

羟考酮注射液对腹腔镜袖状胃切除术患者血流动力学及镇痛效果的影响

目的探讨羟考酮注射液对腹腔镜袖状胃切除术(LSG)患者血流动力学及镇痛效果的影响。方法随机将2017年10月至2019年10月在我院进行LSG的180例患者分为观察组(n=90,羟考酮)与对照组(n=90,芬太尼)。比较两组血流动力学指标、血糖、Cor及E水平及镇痛效果。结果T0、T1、T2时,观察组的MAP、HR均低于对照组(P<0.05)。术后12 h,两组患者血糖、Cor及E水平均较术前升高,但观察组低于对照组(P<0.05)。术后6、12 h,观察组的VAS评分低于对照组(P<0.05)。结论羟考酮应用于LSG患者镇痛效果好,可减轻应激反应,促进患者血流动力学稳定。     

Metabolic Surgery: Weight Loss,Diabetes, and Beyond

The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity. Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further examines their potential effects on cardiovascular outcomes and mortality and discusses future perspectives.     

The role of post-operative radiographs in predicting risk of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures – A case control study

Background and aimVolar plating of distal radius fractures is one of the common procedures performed in trauma surgery. Flexor pollicis longus (FPL) rupture has been described as complication following volar plating of distal radius fractures.The aim of our study was to investigate the possible relation between parameters measured on post-operative radiographs and the occurrence of FPL ruptures.Materials and methodsThis was a case control study. The post-operative radiographs of 11 FPL rupture, and 22 non-FPL rupture patients were reviewed with respect to fracture reduction and plate position and the various parameters were calculated by five independent people.Logistic regression was used to examine the importance of the variables.ResultsWe identified two significant factors to predict FPL rupture after volar plating of distal radial fractures. These were radial tilt and plate distance from the joint line. The odds ratio of ruptures was 0.74 (95% CI 0.57–0.95) for every degree of radial tilt <25° and 0.50 (95% CI 0.28–0.88) for every millimetre that the distal end of the plate was away from the volar lip of the distal radius at the wrist joint.ConclusionPost-operative radiographs could help us predict FPL rupture after distal radius volar plating. The findings also highlight the need for good fracture reduction and thoughtful placement of the volar plate intraoperatively to minimise the risk of FPL tendon rupture.