Complications

Penile cancer is a rare malignancy, with approximately 2100 cases diagnosed annually in the United States. The 5-year overall survival rate varies significantly depending on the node involvement status, at 79% in node-negative disease versus 51% for patients with inguinal metastasis. Inguinal lymph nodes are involved in micrometastatic disease in up to one out of four patients. Early inguinal lymph node dissection (ILND) has been shown to provide a survival advantage, which is why many patients undergo inguinal lymph node dissection for diagnostic and therapeutic purposes. Unfortunately, ILND is associated with high morbidity rates, which have led to potential overtreatment and decreased quality of life in the penile cancer population. Several advancements have been made to mitigate these challenges, such as dynamic sentinel node dissection, modifications to the technique or surgical templates, the introduction of minimally invasive procedures, and changes to the postoperative pathway. This manuscript examines the evolution in managing the inguinal lymph nodes in penile cancer, its associated complications, and effective strategies for their prevention and management. Full article

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches. Full article

Laparoscopic urological surgery has become a cornerstone in the management of diverse urological pathologies, offering substantial advantages over traditional open approaches. These benefits include minimized incisions, reduced tissue trauma, decreased intraoperative blood loss, lower postoperative pain, shorter hospital stays, superior cosmesis, and accelerated recovery. Despite these advantages, laparoscopic surgery carries inherent risks, with major vascular injury (MVI) representing one of the most severe and potentially life-threatening complications. This review examines the incidence, etiologies, and management strategies for MVI in laparoscopic urological surgery, emphasizing the critical role of early recognition, standardized protocols, and surgical expertise in optimizing patient outcomes. Full article

Endodontic perforations are serious complications encountered in the dental setting. Early detection, diagnosis, and proper management of perforations are crucial for a favorable prognosis. However, there are a limited number of studies that provide an overview of perforations, emphasizing these three strategies: prevention, diagnostic challenges, and management. The objective of this narrative review is to highlight the multifaceted components of endodontic perforations while also identifying the most effective methods used in their detection, diagnosis, and management. An electronic literature search was conducted using various databases and applying keywords for articles published in English. Eligible papers were reviewed further to gather relevant information. The results of the literature search found that, although perforations are relatively uncommon occurrences in the clinical setting, they still need to be understood for the prevention and treatment of these iatrogenic complications. The combination of case complexity and limited operator experience often determines the likelihood of endodontic perforation occurrence. Accurate diagnosis and identification of perforations rely heavily on the combination of clinical examination and advanced imaging technologies. In recent times, new technologies have emerged and hope to contribute to a decreased occurrence of endodontic perforations and increased prognosis in cases that do arise. Full article

Background/Objectives: This study aimed to evaluate the prognostic significance of preoperative inflammatory biomarkers—C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)—in predicting early postoperative complications (within 30 days) in patients undergoing percutaneous endoscopic gastrostomy (PEG). Methods: Data from 184 patients who underwent PEG placement at our institution between January 2021 and May 2022 were retrospectively analyzed. Demographic characteristics, PEG indications, and preoperative laboratory parameters (CRP, albumin, neutrophils, lymphocytes, and platelets) were recorded. CAR was calculated as the ratio of CRP (mg/L) to albumin (g/dL). Complications occurring within 30 days post-procedure were defined as early postoperative complications. Patients with and without complications were compared, and logistic regression analysis was used to identify potential risk factors. Results: The mean age of the patients was 71.5 ± 5.9 years, and 58.7% were male. PEG indications included neurological dysphagia (54.3%), head and neck malignancies (21.7%), and other causes (23.9%). At least one early complication occurred in 26 patients (14.1%). There were no significant differences in age, sex, body mass index, or Charlson Comorbidity Index between patients with and without complications (p > 0.05). Logistic regression revealed that elevated CAR was an independent predictor of postoperative complications (OR = 2.88; 95% CI: 1.62–5.13; p < 0.001). Although NLR (OR = 1.34) and PLR (OR = 1.02) were also associated with increased risk, they were less predictive than CAR in multivariate analysis. Conclusions: Preoperative CAR, NLR, and PLR levels are valuable biomarkers for predicting early complications following PEG. Notably, higher CAR levels are significantly associated with increased complication risk. Incorporating these indicators into clinical decision-making could facilitate early identification of high-risk patients and implementation of preventive strategies. Full article

Background: People with spinal cord injury/disorder are at a high risk of pressure injury formation, and, in advanced cases, surgery is mandatory. These patients present specific clinical aspects to consider in order to reduce the risk of complications. This paper is a narrative review and expert opinion based on the authors’ institutional experience of over 10 years in a spinal unit. The specific protocols of treatment based on a multidisciplinary approach, protocols of flap selection, and strategies to prevent and manage complications are reviewed. The specific clinical aspects of each patient that should be considered during treatment to optimize the results and to reduce complication rates are reviewed. Conclusions: A multidisciplinary team approach and specific protocols for patient management allow for a reduction in complication rates in the surgical treatment of pressure injuries in spinal cord injury patients and implement an overall success rate. Complications management protocols should be developed and investigated to further improve the overall success rate. Full article

Transseptal puncture (TSP) is an essential step for left heart procedures that allows access to the left atrium (LA) through the fossa ovalis (FO) of the interatrial septum (IS). Initially developed for diagnostic purposes, today, it is performed for procedures that require large-bore device delivery systems and complex three-dimensional navigation in the left atrium. TSP supports various interventions, including atrial fibrillation ablation, left atrial appendage closure, and transcatheter mitral valve repair and replacement. While traditionally performed with Brockenbrough needles under fluoroscopic guidance, the integration of transesophageal and intracardiac echocardiography (TEE/ICE) has significantly improved its safety and precision. Despite its generally high success rate, TSP poses challenges in complex anatomies or for less experienced operators, with complications such as cardiac tamponade, aortic root puncture, and embolic events. Anatomical variations, such as thickened or floppy septa, further complicate the procedure. Technological advancements, including radiofrequency-based systems and specialized guidewires, have enhanced safety in difficult cases. Effective training, including echocardiography and complication management, is vital for operator proficiency. This review outlines the procedural steps for safe TSP, emphasizing proper equipment selection, anatomical considerations, and vascular access techniques. Common complications are discussed alongside management strategies. Advanced tools and techniques for addressing challenging scenarios are highlighted. Full article

Background: Surgical complications are devastating both for patients and treating surgeons. When complications occur after bariatric procedures, due to specific characteristics of this population, management, although multidisciplinary, should always be led by a surgical team. Methods: We present major complications treated at our general surgery service over a seven-year period. Case series: We present five cases that were treated at our service after a bariatric procedure was performed. Two patients were operated on in another country and two more at another service. Three patients showed perforation and leak-related complications. One patient died due to refeeding syndrome complications after revisional surgery. Conclusions: Optimal preoperative evaluations and surgical planning are mandatory for any type of surgery including bariatric procedures, and attempting adequate and well-established surgical techniques extensively described in the medical literature is associated with better outcomes. It is also our understanding that easy channels of communication between patients and treating surgeons could avoid delays in detecting and treating life-threatening conditions. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction is considered the gold standard for autologous breast reconstruction due to its favorable aesthetic results and low donor site morbidity. Nevertheless, it remains associated with potentially life-threatening complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). This report aims to describe a complex clinical case in which severe thromboembolic and ischemic complications occurred despite adherence to standard prophylactic protocols. Methods: We present the case of a 65-year-old female with multiple thromboembolic risk factors—including obesity, a history of heavy smoking, hormone therapy, and prior COVID-19 infection—who underwent immediate bilateral breast reconstruction with DIEP flaps following mastectomy. Results: Within the first 24 h postoperatively, the patient developed a massive pulmonary embolism requiring intensive care management. Despite appropriate anticoagulation and supportive measures, she subsequently experienced full-thickness necrosis of the central portion of the abdominal flap. Thrombophilia screening and diagnostic imaging did not reveal peripheral venous thrombosis, raising the hypothesis of a hypercoagulable state potentially related to prior SARS-CoV-2 infection. Conclusions: This case underscores the importance of individualized risk stratification and suggests that current prophylaxis protocols may be insufficient for patients with overlapping thrombotic risk factors. The findings advocate for further investigation into the long-term vascular effects of COVID-19 and support reconsidering extended or intensified prophylaxis in high-risk populations undergoing complex microsurgical procedures. Full article

Pelvic organ prolapse (POP) is a prevalent condition worldwide with detrimental effects on patients’ quality of life. Laparoscopic sacrocolpopexy (LSC) has emerged as the gold standard for managing complex and high-grade POP. While anatomical and subjective outcomes have been extensively documented, the management of its associated complications, particularly urinary incontinence, remains challenging. This study evaluates the strategies implemented to address complications arising from LSC, focusing on urinary incontinence. A retrospective multicenter study analyzed 325 patients who underwent LSC using lightweight macroporous Surelift Uplift mesh between 2011 and 2019. Data on perioperative and long-term complications, with emphasis on urinary incontinence management, were extracted from participating centers. Among them, the incidence of new-onset stress urinary incontinence (SUI) postoperatively was 12.9%. A total of 21 patients required further treatment for urinary symptoms, including mid-urethral sling (MUS) procedures in 5.5% and botulinum toxin injections for overactive bladder (OAB) in 0.9%. The findings underscore the importance of proactive and tailored management strategies for urinary incontinence following LSC. While the procedure demonstrates low complication rates and high anatomical success, urinary symptoms require vigilant monitoring and intervention in a two-step procedure for stress incontinence, if needed. Full article

A periprocedural prosthetic valve leak (PVL) after transcatheter aortic valve implantation (TAVI), a minimally invasive treatment modality for patients with severe, symptomatic aortic stenosis, may entail serious morbidity. Cohorts hospitalized for TAVI from a national database (2016–2020) were stratified on the presence of PVL post-TAVI. TAVI patients with and without PVL were selected for propensity score matching. Pearson’s x² test was used to compare outcomes. Among 319,448 TAVI patients over five years, 2043 had periprocedural PVL identified at index hospitalization, acute heart failure (49.61% vs. 41.15%, p < 0.001), acute kidney injury (20.40% vs. 11.77%, p < 0.001), cardiac tamponade (1.31% vs. 0.52%, p < 0.05), higher inpatient mortality (3.05% vs. 1.05%, p < 0.001), postprocedural bleeding (3.5% vs. 1.48%, p < 0.001), sudden cardiac arrest (15.34% vs. 8.54%, p < 0.001), and vascular complications (4.10% vs. 1.57%, p < 0.001). TAVI with PVL was associated with a significantly longer length of stay (p < 0.05) and total cost of hospitalization (p < 0.05). The 30-day (15.2% vs. 12%, p = 0.02), 90-day (24.4% vs. 19.9%, p < 0.01), and 180-day (34.7% vs. 24.8%, p < 0.01) readmission rates were significantly higher in the TAVI cohort with PVL. PVL in patients post-TAVI is associated with greater mortality and morbidity during index hospitalization, higher readmission rates, and increased burden on healthcare costs and infrastructure. Full article

This review explores current strategies aimed at reducing complications in gynecologic surgery, focusing on innovations in laparoscopic entry techniques, extraperitoneal lymphadenectomy, and alternative approaches such as gasless laparoscopy. We conducted a comprehensive literature review, including studies and technical descriptions relevant to improved surgical access, lymph node dissection, and overall risk mitigation. Key findings indicate that the individualized selection of entry points—ranging from Palmer’s point in the left upper quadrant to the recently described Jain point—can minimize vascular and bowel injuries, especially in patients with prior abdominal surgeries. Furthermore, extraperitoneal lymphadenectomy appears to lower adhesion formation and bowel handling, potentially decreasing postoperative morbidity in oncologic cases. Gasless laparoscopy may offer comparable surgical outcomes with improved cardiorespiratory stability in high-risk patients, although visualization challenges remain. Overall, the evidence suggests that advanced minimally invasive methods and tailored procedural planning can effectively enhance patient safety and reduce postoperative complications. These approaches, however, demand a high level of surgical expertise, thorough preoperative imaging, and an institutional framework that supports training and ongoing quality monitoring. Continued investigations, including prospective trials and larger sample sizes, are required to validate these findings and further refine protocols aimed at optimizing outcomes in gynecologic surgery. Full article

Introduction: Uterine transplantation is currently the only treatment that allows women with absolute uterine factor infertility (AUFI) to gestate and give birth. Objective: This systematic review aims to analyze the available evidence on uterine transplantation, focusing on the medical process, associated complications, ethical dilemmas, and the psychological and social impact on recipients. Methods: A systematic review of PubMed, Medline, MedNar, and Cinahl databases was conducted. The inclusion criteria included articles related to uterine transplantation published in English or Spanish between 2019 and 2024, excluding animal studies or other uterine procedures. Results: A total of 46 articles were analyzed. The review describes ethical considerations and recipients’ perceptions, two variables that have received limited attention in recent studies. Additionally, the transplant and gestation processes, along with associated complications, were detailed. Discussion: The limited availability of studies on ethical aspects and recipient perceptions presented challenges in the research. Moreover, the role of nurses and midwives, despite their importance in the process, is scarcely discussed in the literature. Conclusions: Although uterine transplantation remains an emerging treatment, its development suggests that the benefits may outweigh the risks, offering new hope for women with AUFI. Full article

Fat embolism syndrome (FES) is a rare multisystem disorder caused by the dispersion of fat emboli in the systemic circulation. FES typically occurs after orthopedic trauma and classically manifests as a triad of respiratory failure, neurologic impairment, and petechial rash. Ophthalmic involvement is uncommon in the absence of cardiac or pulmonary arteriovenous shunts and presents with diffuse retinal hemorrhages and accompanying visual disturbances. We report a case of FES and Purtscher-like retinopathy following the surgical repair of a comminuted femur fracture in a previously healthy 19-year-old male without a known predisposing cause and document the course of successful recovery. Full article

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

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

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

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