OBJECTIVETo compare the clinical effects of the circumcision stapler, circumcision cerclage, and traditional circumcision in the treatment of phimosis and redundant prepuce.

METHODSUsing the circumcision stapler (group A), foreskin cerclage (group B), and traditional circumcision (group C), we treated 276 patients with phimosis or redundant prepuce. We made comparisons among the three groups in the operation time, intraoperative blood loss, intraoperative and 24-hour postoperative pain scores, and incidence of postoperative complications. Results: The operation time, intraoperative blood loss, and intraoperative pain score were (6.52 ± 2.45) min, (1.93 ± 0.82) ml, and 1.37 ± 0.68 in group A and (7.24 ± 1.86) min, (1.51 ± 0.72) ml, and 1.20 ± 0.79 in group B, all significantly lower than (28. 36 ± 4.22) min, (9.52 ± 3.29) ml, and 3.06 ± 0.75 in group C (P <0.05). The 24-hour postoperative pain score was remarkably higher in group B than in A and C (3. 18 ± 0. 82 vs 1. 85 ± 0. 63 and 1. 82 ± 0. 75, P <0. 05). The incidence rate of postoperative complications was markedly lower in group A than in B (5. 43% vs 14. 13%, P < 0.05), but with no significant differences between either A and C or B and C (P >0.05).

CONCLUSIONThe circumcision stapler, with its advantages of simple operation, minimal invasiveness, fewer complications, and better cosmetic result, deserves a wider clinical application.

Blood Loss, Surgical ; Circumcision, Male ; adverse effects ; instrumentation ; methods ; Foreskin ; Humans ; Incidence ; Male ; Pain Measurement ; Pain, Postoperative ; diagnosis ; Penis ; abnormalities ; Phimosis ; therapy ; Postoperative Complications ; Postoperative Period

This study was performed to assess the degree of acute pain in children following eye surgery using a Face Pain Rating Scale (FPRS), with a validity and reliability test employing a Numeric/Word Graphic Rating Scale (NWGRS). The degree of pain was obtained at 2, 4, 6, 8 and 24 hours after surgery using the FPRS and NWGRS. The changes in pain intensities were analyzed using a RM-ANOVA, while the relationship between the FPRS and NWGRS was analyzed by a Pearson coefficient in SPSS/WIN. Two third of the children experienced pain equal to, or greater, than moderate to severe, and about one fifth of the subjects expressed the most severe pain at 2 hours after surgery. At 4 hours after surgery, 95.3% of the children still complained of pain, and 8 hours after surgery, 82.8% of the patients experienced 'a little bit' or 'a little more' pain or discomforts. At 1 day after surgery, only 34.4% of children were free of pain. A high correlation between the FPRS and NWGRS was identified over 5 time-points (.887 < r < .735). The gender, type of the surgery and past operation experience had no effects on the degree of pain. Our results suggest that FPRS is a reliable and valid measurement for acute pain assessment in Korean children following eye surgery, and warrants application in the integrated clinical protocol, including non-pharmacological and pharmacological management of acute pediatric pain reduction following surgery.
Analysis of Variance ; Child ; Female ; Human ; Male ; Ophthalmologic Surgical Procedures/*adverse effects ; Pain Measurement/*methods ; Pain, Postoperative/*diagnosis ; Reproducibility of Results

Failed back surgery syndrome was recently renamed, as chronic pain after spinal surgery (CPSS) by international classification of disease-11. CPSS is a challenging clinical condition. It has a variety of causes associated with preoperative, intraoperative and postoperative periods. Also, psychosocial factors should be considered. Diagnostic tools must be used differently, for each patient. Imaging and interventional nerve block for diagnosis, should be used properly. Strategy of management requires a multidisciplinary approach. The effect of conservative management (medication, interventional management) and invasive procedure (spinal cord stimulator, intrathecal drug delivery system) has been studied by many researchers. However, an evidence-based guide on management of CPSS, remains necessary, and further research is needed. This review focuses on understanding and clinical approaches for CPSS.
Chronic Pain* ; Classification ; Diagnosis ; Failed Back Surgery Syndrome ; Humans ; Nerve Block ; Pain Management ; Postoperative Period ; Psychology ; Spinal Cord Stimulation

Postoperative epidural hematoma (EDH) usually present with neurological deficit. Massive EDH presenting with only severe pain without neurological deficit are rare. Atypical presentations of postoperative EDHs may lead to delayed diagnosis and treatment. We present three such cases after posterior cervical spine surgery. Three patients presented with severe neck pain and spasms without motor deficits several days after posterior cervical decompressive procedures. Imaging studies identified compressive EDHs at the surgical site with severe compression of the spinal cord. All were treated with emergent decompression, with resulting improvement of symptoms and pain relief without further neurological sequelae. In conclusion, postoperative EDHs after posterior cervical spine surgery may result in minimal neurological deficit. Our report reminds surgeons to keep this possibility in mind when patients complain of unusually severe neck pain and spasms after posterior cervical spine surgery.
Decompression ; Delayed Diagnosis ; Hematoma* ; Humans ; Neck Pain* ; Neck* ; Postoperative Complications ; Spasm ; Spinal Cord ; Spine*

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.
Arthroscopes ; Arthroscopy ; Diagnosis ; Pain, Postoperative ; Pathology ; Shoulder Joint ; Shoulder* ; Suture Anchors

PURPOSE: Endoscopic thyroidectomy has not become a widespread procedure because of limited advantages to its use. We have performed endoscopic thyroidectomies by use of the axillary approach. The purpose of this study was to determine the efficacy of this surgical procedure. METHODS: Between June of 2002 and December of 2002, 17 patients underwent an endoscopic thyroidectomy by use of the axillary approach while 11 patients underwent a conventional thyroidectomy. Each procedure was performed by one surgeon under general anesthesia. Patients with thyroid carcinoma at the preoperative diagnosis or who received a bilateral thyroidectomy were excluded. We compared the age, size of the tumor, postoperative pain (48 hours after surgery), surgical time, cosmetic result, length of hospital stay, and paresthesia. Statistical analysis was determined by use of the Mann-Whitney test and the chi-square test using SPSS software. RESULTS: The mean age of the patients was 46.6 years who received a conventional thyroiodectomy and 32.9 years who underwent the axillary approach. The size of the tumor was 3.1 cm for patients who received conventional thyroiodectomy and 3.3 cm for patients who underwent the axillary approach. The operation time was 80.91±16.1 (65~100) minutes for the conventional thyroiodectomy and 135.3± 34.6 (80~210) minutes for the axillary approach. The difference between the two approaches in regards to parameters such as postoperative pain, parethesia, and total hospital days was negligible. The degree of satisfaction was 2.7±0.8 for the conventional thyroiodectomy and 1.1±0.3 for the axillary approach. CONCLUSION: While conventional thyroidectomy still offers an advantage in terms of surgical time, performance of endoscopic thyroidectomy by the axillary approach has an advantage in producing better cosmetic results. Although a multitude of patients will be necessary to follow in further studies, the use of endoscopic thyroidectomy by the axillary approach could become the procedure of choice by offering better cosmetic results to young patients who present with thyroid nodules.
Anesthesia, General ; Diagnosis ; Humans ; Length of Stay ; Operative Time ; Pain, Postoperative ; Paresthesia ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy*

Procedure for prolapse and hemorrhoids( PPH) is one of the important techniques developed for the treatment of hemorrhoids with severe degree in the last decade. Its principle is based on the "anal cushion" theory.Compared with traditional hemorrhoidectomy , PPH has advantages of shorter operation time , minor degree of postoperative pain , shorter hospital stay and quicker recovery.However, the occurrence of relapse and re-prolapse of hemorrhoids is high. Besides, the short-term efficacy of PPH for the constipation outlet obstruction caused by anterior rectocele is also favorable.
Anal Canal ; Hemorrhoids ; diagnosis ; Humans ; Operative Time ; Pain, Postoperative ; Prolapse ; Surgical Stapling

With the help of the evolution of endoscopic and angiographic intervention, nonsurgical techniques became the procedures of choice for the diagnosis and treatment of gastrointestinal (GI) bleeding and role of surgery have been decreased. However, surgical operations are still necessary for controlling bleeding lesions when these maneuvers fail and conventional operations continue to be life-saving in many instances. Laparoscopic surgeries have an advantage of less postoperative pain and wound problem, quicker recovery, and shorter hospital stay and been widely used for GI bleeding. An elective laparoscopic resection of the intestine for appropriate indications may be an ideal application of this technique, while emergent use should be tempered by skillful surgeons because most patients are relatively unstable and time-limited. Newly developed technologies will continue to facilitate collaboration and cooperation between gastroenterologists, radiologists, and surgeons by encouraging working in multispecialty teams. This review will address the surgical approach associated with various treatments for GI bleeding according to many kinds of GI bleeding diseases.
Cooperative Behavior ; Diagnosis ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestines ; Laparoscopy ; Length of Stay ; Pain, Postoperative ; Surgeons ; Wounds and Injuries

BACKGROUND: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients' family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. METHODS: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution's ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). RESULTS: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52+/-0.51 years and the age at the time of operation was 17.89+/-0.42 years; for PC patients, the corresponding ages were 15.23+/-0.55 years and 16.77+/-0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17+/-0.15 for PE patients and 8.37+/-0.26 for PC patients. The postoperative pain duration was 51.93+/-5.18 days for PE patients and 38.5+/-6.88 days for PC patients. CONCLUSION: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.
Congenital Abnormalities ; Diagnosis ; Ethics Committees ; Follow-Up Studies ; Funnel Chest* ; Humans ; Internet ; Kyphosis ; Male ; Pain Management ; Pain, Postoperative ; Patient Satisfaction* ; Postoperative Care ; Retrospective Studies ; Scoliosis ; Thoracic Wall

Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Diagnosis, Differential ; Epididymitis/*diagnosis/drug therapy ; Humans ; Male ; Pain/*diagnosis ; *Pain Management ; Pain, Postoperative ; Physical Examination ; *Scrotum ; Spermatic Cord Torsion/*diagnosis/surgery ; Testis/physiopathology ; Varicocele/*diagnosis/physiopathology/therapy ; Vasectomy