Surg. Tech. Dev., Volume 12, Issue 3 (September 2023) – 6 articles

Anesthetic management for pregnant patients suffering from airway pathology poses unique challenges. The presence of a bilateral vocal cord granuloma adds further complexity to anesthetic management as it can potentially cause a compromised airway and respiratory distress. This case presents a pregnant patient with a bilateral vocal cord granuloma who underwent anesthesia using high-flow nasal cannula (HFNC) oxygenation and oxygen reserve index (ORi) monitoring. A 33-year-old pregnant woman, who underwent intubation six months ago, experienced hoarseness and was ultimately diagnosed with a bilateral granuloma. Due to the significant airway obstruction, neither intubation nor ventilation was feasible, thereby requiring a surgical intervention. Before the surgical removal, the patient’s oxygenation was ensured using HFNC oxygenation. After confirming the sufficient oxygenation of the patient with an ORi of 0.38, the operation commenced, and as it lasted approximately 3 min, the patient was able to tolerate the brief period without additional oxygen supply. Post-surgical excision, mask bagging, and HFNC oxygenation was resumed, driving the ORi to 0.39; then, the operation was resumed. Throughout the procedure, the SpO₂ remained above 98. The combination of HFNC and ORi ensured adequate oxygenation and allowed for the early detection of hypoxemia during the procedure. This approach may be a good option for managing granulomas. Full article

Objectives: This study was designed to determine objective surgical indications of correcting caudal end deviation of the nasal septum. Methods: We employed quantitative computed tomographic (CT) analysis and assessed the validity by comparing this with anterior rhinoscopic findings (AR findings). The study population consisted of 300 patients. The archived CT data were transferred to a workstation, and 3D CT volume-rendered images were generated using computer graphics tools. In the plane of the nostril entrance, we calculated ratios of the cross-sectional area of the convex side (narrower side) and the concave side (wider side), which is abbreviated as the N/W ratio. We also examined the presence of laterality between the right and the left cross-sectional area of the nasal valve based on the AR findings. Surgical procedures for whether to expose the caudal end were planned based on the AR findings and the N/W ratio. Results: A significant correlation was found between the AR findings and the N/W ratio. After surgery, the average N/W ratio improved from 0.53 ± 0.15 to 0.81 ± 0.15, and the average values of VAS scaling for nasal obstruction improved from 8.1 ± 0.2 to 1.0 ± 0.1. Conclusions: The quantitative CT analysis proposed in the study is a useful modality to objectively determine the surgical indications of managing the caudal end of the nasal septum. Full article

Purpose: Although open reduction and internal fixation (ORIF) by plating are the treatment of choice for diaphyseal fractures of the forearm, delayed union and non-union remain as existing complications. This study aimed to analyze predictive factors for the union time in diaphyseal fractures of the forearm. Methods: A retrospective study was conducted on all adult patients with diaphyseal forearm fractures who underwent surgical treatment with plate fixation between 2007 and 2016 at a tertiary care referral center. The patients were divided into two groups based on their union times: ≤3 months or >3 months. They were then compared for demographics, fracture pattern and characteristics, associated injuries, type of fixation, and quality of postoperative reduction. Results: Eighty-six diaphyseal forearm bone fractures (radius, ulna, or both) were observed in 55 adults. Out of these fractures, 55 (65.1%) achieved union within ≤3 months, 26 (30.3%) took more than 3 months to achieve union, and 4 (4.6%) resulted in nonunion. The use of a locking plate in open reduction and internal fixation of diaphyseal forearm fractures significantly increased the likelihood of union within ≤3 months (p = 0.043). The parameter of gap width at the fracture site, as observed on postoperative X-rays, showed a qualitative and quantitative correlation with union time (p = 0.028). Conclusion: The use of a locking plate, combined with reducing the gap width at the fracture site after reduction during open reduction and internal fixation (ORIF) of diaphyseal forearm fractures, is significantly correlated with an increased likelihood of achieving bone union within 3 months. Full article

Since its inception in the early 1970s, bariatric surgery has experienced remarkable advancements, leading to improved patient outcomes. However, amidst these developments, the once-popular ileojejunal bypass procedure has faded into obscurity, along with its associated risks and complications. In this particular case, we present the medical history of a 68-year-old male who endured prolonged hospitalization due to a myriad of health issues, including malnutrition, kidney stones, chronic kidney disease, and persistent diarrhea following an ileojejunal bypass performed back in 1973. Troublingly, his symptoms were erroneously attributed to other causes for an extended period, overlooking the potential long-term effects of his prior surgery. This case emphasizes the importance of recognizing and monitoring the lasting impacts of historical surgical interventions, as well as the need for heightened vigilance in postoperative care. Full article

Introduction: Achalasia is a pathology with an incidence of 1 in 100,000 inhabitants per year. There are very limited data on achalasia in the obese population, especially in those undergoing bariatric surgery. The approach of choice for cases of achalasia is the procedure partial fundoplication to correct the reflux; however, lacking a fundus due to a previous gastrectomy, an alternative that offers optimal results should be chosen. Here, we present the surgical approach in a case of esophageal achalasia and a history of vertical sleeve gastrectomy, where we performed a simultaneous Heller’s cardiomyotomy and laparoscopic Roux-en-Y gastric bypass, as well as the results obtained. Case Presentation: A 44-year-old woman with no chronic degenerative diseases, who had a vertical sleeve gastrectomy carried out 5 years ago. Her first symptoms manifested 17 months before, and they were dysphagia to liquids and then to solids, in addition to weight loss of 10 kg in 4 months. Her body mass index before the vertical sleeve gastrectomy was 32 kg/m²; her body mass index at the time of admission was 20 kg/m²; she also presented regurgitation and generalized weakness. After analyzing the surgical options, it was decided to perform a Heller cardiomyotomy and a Roux-en-Y gastric bypass. Discussion and Conclusions: The procedure turned out to be safe and successful in treating achalasia symptomatology, in addition to completely resolving the reflux symptoms. Full article

Background: Supracondylar humeral fracture is probably the most common elbow fracture in children requiring surgical intervention. We observed a subtype of pediatric supracondylar humeral fracture with a sideward translation, without substantial displacement in the sagittal plane on initial radiographs. The purpose of this study was to calculate the incidence of this fracture subtype and suggest a modification to the standard operative technique, to achieve the desired fracture alignment and fixation. Methods: We reviewed the clinical records and radiographs of all pediatric patients with supracondylar humeral fractures surgically treated in our institution between the years 2006 and 2014. The fracture types, fixation configuration and any complications were recorded. Results: Overall, 263 consecutive patients were included. The incidence of supracondylar fracture of the humerus with solely sideward displacement was 6%. The fracture was characterized clinically and radiographically. We proposed a modification to the standard operative technique for this fracture subtype for successful closed reduction and percutaneous pinning. Conclusions: Special attention to this fracture subtype, including appropriate operating room setup and the application of a suitable reduction and pinning technique, has the potential to achieve successful results and avoid the need for open reduction. Full article