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Complications, Volume 2, Issue 1 (March 2025) – 5 articles

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11 pages, 237 KiB  
Review
Complications in Percutaneous Nephrolithotomy
by Rebeca Escobar Monroy, Silvia Proietti, Federico De Leonardis, Stefano Gisone, Riccardo Scalia, Luca Mongelli, Franco Gaboardi and Guido Giusti
Complications 2025, 2(1), 5; https://doi.org/10.3390/complications2010005 - 10 Feb 2025
Abstract
Purpose: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal calculi. Despite its efficacy, complications can occur. This narrative review aims to classify, manage, and prevent PCNL complications, emphasizing risk factors and strategies to optimize outcomes. Findings: PCNL is a safe and [...] Read more.
Purpose: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal calculi. Despite its efficacy, complications can occur. This narrative review aims to classify, manage, and prevent PCNL complications, emphasizing risk factors and strategies to optimize outcomes. Findings: PCNL is a safe and highly effective procedure for the management of renal stones. Risk factors include patient comorbidities, stone complexity, prolonged surgical time, and improper access. Proactive measures, such as accurate imaging, antibiotic prophylaxis, and careful surgical techniques, reduce complication rates. Although certain complications may affect surgical outcomes, most are effectively managed through conservative or minimally invasive approaches. Proficiency in the technique is essential for reducing the risk of complications. Conclusions: Understanding the classification, risk factors, and management of PCNL complications is essential for optimizing patient outcomes. Comprehensive preoperative planning, meticulous surgical technique, and tailored postoperative care are critical for minimizing risks and improving procedural safety. Full article
12 pages, 6582 KiB  
Case Report
Multidisciplinary Management of Non-Healing Umbilical Ulcer in an Infant: A Case Report
by Stefano L’Erario, Marena Francesco, Franco Bassetto and Antonio Amabile
Complications 2025, 2(1), 4; https://doi.org/10.3390/complications2010004 - 10 Feb 2025
Abstract
This case report outlines the intricate clinical management of a 5-month-old infant with recurrent bacterial infections and a non-healing umbilical ulcer following the surgical excision of a urachal remnant. The infant’s medical history was significant for delayed umbilical cord detachment and multiple surgical [...] Read more.
This case report outlines the intricate clinical management of a 5-month-old infant with recurrent bacterial infections and a non-healing umbilical ulcer following the surgical excision of a urachal remnant. The infant’s medical history was significant for delayed umbilical cord detachment and multiple surgical site infections. The initial surgical approach included the excision of the residual urachus, wound debridement, and abdominal wall reinforcement using a collagen matrix combined with local flap closure. Despite an apparently uneventful postoperative course, the wound experienced dehiscence and failed to heal. As part of the diagnostic workup, genetic testing was conducted, revealing an autosomal dominant mutation in the RAC2 gene, which impairs neutrophil function. Given the urgent need for wound closure prior to hematopoietic stem cell transplantation (HSCT), further debridement and sessions of negative pressure therapy were performed, alongside attempted repair with acellular dermal regeneration matrices, which ultimately proved to be ineffective. Ultimately, HSCT was undertaken despite the infectious associated risks, resulting in spontaneous wound healing without requiring further surgical interventions. This case highlights the challenges of coordinating medical, surgical, and hematological treatments in such complex cases, necessitating effective communication and collaboration among multidisciplinary teams to optimize patient outcomes. Full article
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6 pages, 1036 KiB  
Case Report
Arteriovenous Fistula with Pseudoaneurysm and Facial Palsy Following Bilateral Sagittal Split Osteotomy: A Case Report
by Michala Ivanic-Sefcikova, Vasco Starke, Lukas Groessing, Michael Augustin, Michael Schwaiger and Wolfgang Zemann
Complications 2025, 2(1), 3; https://doi.org/10.3390/complications2010003 - 8 Feb 2025
Abstract
Bilateral sagittal split osteotomy is a commonly used, standard procedure in orthognathic surgery to correct malocclusion and jaw misalignment. Postoperative vascular complications are extremely rare and under-reported in the literature. This contribution presents the case of a 48-year-old male patient who underwent bilateral [...] Read more.
Bilateral sagittal split osteotomy is a commonly used, standard procedure in orthognathic surgery to correct malocclusion and jaw misalignment. Postoperative vascular complications are extremely rare and under-reported in the literature. This contribution presents the case of a 48-year-old male patient who underwent bilateral sagittal split osteotomy due to class II skeletal malocclusion. There were no abnormalities during the surgery. However, the patient developed facial palsy and experienced a pulse-synchronised murmur. Computed tomographic angiography (CTA) revealed an arteriovenous fistula between the right external carotid artery and the pterygoid plexus with pseudoaneurysm. Following the diagnosis, the patient was successfully treated with an intervention involving coiling and sealing with histoacrylic glue. It is crucial to be aware of serious vascular complications following orthognathic surgery, as a delay in diagnosis and treatment can lead to life-threatening bleeding or long-term damage. CTA is the most rapid and accurate method of confirming the diagnosis. If there is clinical suspicion, this examination should not be delayed, and the therapeutic approach should be determined on an interdisciplinary basis. Full article
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10 pages, 203 KiB  
Article
Thirty-Day Complications Following Anterior Lumbar Interbody Fusion Versus Lumbar Disc Arthroplasty: A Propensity Score Matched Analysis
by Phillip B. Wyatt, Charles R. Reiter, James R. Satalich, Conor N. O’Neill, Anirugh K. Gowd, Dantae King, Albert Anastasio, John Cyrus, Samuel Adams and Prakasam Kalluri
Complications 2025, 2(1), 2; https://doi.org/10.3390/complications2010002 - 9 Jan 2025
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Abstract
The anterior lumbar interbody fusion (ALIF) and lumbar disc arthroplasty (LDA) procedures are both commonly performed to improve the quality of life and pain in people with lower back pain. However, few recent studies have compared 30-day complications on a large scale. The [...] Read more.
The anterior lumbar interbody fusion (ALIF) and lumbar disc arthroplasty (LDA) procedures are both commonly performed to improve the quality of life and pain in people with lower back pain. However, few recent studies have compared 30-day complications on a large scale. The objectives of this study were to compare the 30-day complications seen after ALIF and LDA and identify risk factors for these complications. The National Surgical Quality Improvement Program (NSQIP) database was queried between the years 2012–2021 (10 years in total) for records of patients who underwent either ALIF or LDA as a primary procedure. Patients in each group underwent a 1:1 propensity match for age, gender, BMI, ASA status, diabetes mellitus (DM), hypertension requiring medication, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), inpatient/outpatient status, smoking status, and bleeding disorders. Bivariate and multivariate analyses were performed to determine significant differences in complications and risk factors between these cohorts. A total of 1218 propensity-matched subjects, with 609 receiving ALIF and 609 receiving LDA, were included in the analyses of this study. The incidence of extended length of stay (LOS) (>4 days) was higher in the ALIF cohort compared to the LDA cohort (14.6% vs. 4.76%, p < 0.001). Multivariate analysis demonstrated that subjects who underwent LDA had lower odds (Odds Ratio [OR]: 0.457; 95% Confidence Interval [CI]: 0.283–0.738, p = 0.001) of experiencing extended LOS compared to the ALIF cohort. Longer operative times increased the odds of prolonged LOS in both cohorts. The results of this study suggest that ALIF is associated with longer LOS than LDA when baseline demographic data are controlled. Further, longer operative times increase the odds that subjects receiving either ALIF or LDA will experience a prolonged LOS. Besides extended LOS, ALIF and LDA produce a relatively similar 30-day complication profile. Full article
10 pages, 1465 KiB  
Case Report
Posterior Dislocation of Descemet Stripping Automated Endothelial Keratoplasty—A Case Report and Review
by Valentino de Ruvo, Alfonso Strianese, Lily Chacra, Luca Rossetti, Fabio Patelli and Paolo Fogagnolo
Complications 2025, 2(1), 1; https://doi.org/10.3390/complications2010001 - 3 Jan 2025
Viewed by 283
Abstract
In this study, we describe a case of graft dislocation into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK), and review the risk factors and complications of posterior dislocation. A 70-year-old female with disruption of the iris–lens diaphragm experienced DSAEK graft [...] Read more.
In this study, we describe a case of graft dislocation into the vitreous cavity after Descemet stripping automated endothelial keratoplasty (DSAEK), and review the risk factors and complications of posterior dislocation. A 70-year-old female with disruption of the iris–lens diaphragm experienced DSAEK graft dislocation into the vitreous cavity during air re-bubbling at 1 week postoperatively. The corneal opacity hindered adequate visualization of the vitreous cavity for the immediate retrieval of the graft. Five days after re-bubbling, vitrectomy and corneal tissue removal was performed using a temporary Eckardt keratoprosthesis, and penetrating keratoplasty was subsequently performed. Two weeks after graft removal, a retinal detachment occurred. Silicon oil was used as a tamponade to reattach the retina. Three months after the last procedure, the retina was attached, and the cornea was clear. Posterior dislocation of DSAEK graft is a rare complication. A disrupted iris–lens diaphragm and previous vitrectomy are the main risk factors. Severe vision loss is more likely to occur when corneal tissue removal is delayed. In cases of delayed removal, it is advisable to take precautions to prevent possible retinal detachment. Full article
(This article belongs to the Special Issue Complications in Ophthalmology)
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