OBJECTIVE: To investigate the incidence and potential influence factors that contribute to chronic post-surgical pain (CPSP) in elderly patients with urinary tract tumors who underwent laparoscopic procedures. METHODS: A retrospective study was conducted to collect the clinical data of 182 elderly patients with urinary tract tumors who were ≥65 years and underwent laparoscopic surgery from October 2021 to March 2022 in Peking University Third Hospital. The patients'demographic information, medical history and the severity of postoperative pain were collected. Telephone follow-ups were made 6 months after surgery, and the patients' CPSP conditions were recorded. The diagnostic criteria of CPSP were referred to the definition made by the International Association for the Study of Pain (IASP): (1) Pain that developed or increased in intensity after surgical procedure and persisted for at least 3 months after surgery; (2) Pain that localized to the surgical field or projected to the innervation territory of a nerve situated around the surgical area; (3) Pain due to pre-existing pain conditions or infections and malignancy was excluded. The patients were divided into two groups based on CPSP diagnosis. Risk factors that predisposed the patients to CPSP were identified using univariate analysis. A multivariate Logistic regression model using back-forward method was designed, including both variables that significantly associated with CPSP in the univariate analysis (P < 0.1), and the variables that were considered to have significant clinical impact on the outcome. RESULTS: Two hundred and sixteen patients with urinary tract tumors who had undergone laparoscopic surgery were included, of whom, 34 (15.7%) were excluded from the study. For the remaining 182 patients, the average age was (72.6±5.2) years, with 146 males and 36 females. The incidence of CPSP at the end of 6 months was 31.9% (58/182). Multiva-riate regression analysis revealed that age ≥75 years (OR=0.29, 95% CI: 0.12-0.73, P=0.008) was the protecting factors for postoperative chronic pain in the elderly patients with urinary tract tumors undergoing surgical treatment, while renal cancer (compared with other types of urinary tract tumors) (OR=3.68, 95% CI: 1.58-8.58, P=0.003), and the 24 h postoperative moderate to severe pain (OR=2.57, 95% CI: 1.14-5.83, P=0.024) were the independent risk factors affecting CPSP. CONCLUSION Age < 75 years, renal cancer and the 24 h postoperative moderate to severe pain are influence factors of the occurrence of CPSP after laparoscopic surgery in elderly patients with urinary tract tumors. Optimum postoperative multimodal analgesia strategies are suggested to prevent the occurrence of CPSP.
Male ; Female ; Humans ; Aged ; Retrospective Studies ; Chronic Pain/diagnosis* ; Laparoscopy/adverse effects* ; Pain, Postoperative/etiology* ; Kidney Neoplasms/complications* ; Carcinoma, Renal Cell/complications* ; Risk Factors

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

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

Incidental durotomies are a frequent complication during spinal surgery. Cerebrospinal fluid (CSF) leakage from a dural tear may be visually apparent intraoperatively, but occasionally, a tear may not be recognized during the procedure. We report our experience in 2 cases of postoperative incarceration of nerve root as a cause of sciatica, without CSF leakage intraoperatively. When durotomy attributable to surgical manipulation does occur, intraoperative identification is mandated. If a patient develops unexplainable postoperative pain and neurological deficits after lumbar discectomy, incarceration of nerve root should be considered in the differential diagnosis.
Cerebrospinal Fluid ; Cerebrospinal Fluid Leak ; Diagnosis, Differential ; Diskectomy ; Humans ; Pain, Postoperative ; Sciatica* ; Spinal Nerve Roots* ; Spinal Nerves* ; Tears

Postoperative internal hernia is a rare clinical complication which often occurs after digestive tract reconstruction. Roux-en-Y anastomosis is a common type of digestive tract reconstruction. Internal hernia after Roux-en-Y reconstruction, which occurs mainly in the mesenteric defect caused by incomplete closure of mesenteric gaps in the process of digestive tract reconstruction, is systematically called, in our research, as mesenteric internal hernia after Roux-en-Y reconstruction. Such internal hernia can be divided, according to the different structures of mesentric defect, into 3 types: the type of mesenteric defect at the jejunojejunostomy (J type), the type of Petersen's defect (P type), and the type of mesenteric defect in the transverse mesocolon (M type). Because of huge differences in the number of cases and follow-up time among existing research reports, the morbidity of internal hernia after LRYGB fluctuates wildly between 0.2% and 9.0%. Delayed diagnosis and treatment of mesenteric internal hernia after Roux- en-Y reconstruction may result in disastrous consequences such as intestinal necrosis. Clinical manifestations of internal hernia vary from person to person: some, in mild cases, may have no symptoms at all while others in severe cases may experience acute intestinal obstruction. Despite the difference, one common manifestation of internal hernia is abdominal pain. Surgical treatment should be recommended for those diagnosed as internal hernia. A safer and more feasible way to conduct the manual reduction of the incarcerated hernia is to start from the distal normal empty bowel and trace back to the hernia ring mouth, enabling a faster identification of hernia ring and its track. The prevention of mesenteric internal hernia after Roux-en-Y reconstruction is related to the initial surgical approach and the technique of mesenteric closure. Significant controversy remains on whether or not the mesenteric defect should be closed in laparoscopic Roux-en-Y anastomosis. This article is to review the reports and researches on internal hernia resulting from the mesenteric defect after Roux-en-Y digestive tract reconstruction in recent years, so as to promote understanding and attention on this disease. And more active preventive measures are strongly suggested to be taken in operations where digestive tract reconstruction is involved.
Abdominal Pain ; diagnosis ; Anastomosis, Roux-en-Y ; adverse effects ; methods ; Gastric Bypass ; adverse effects ; methods ; Hernia, Abdominal ; diagnosis ; etiology ; prevention & control ; surgery ; Humans ; Intestinal Obstruction ; etiology ; Intestine, Small ; pathology ; surgery ; Laparoscopy ; adverse effects ; methods ; Mesentery ; pathology ; surgery ; Mesocolon ; pathology ; surgery ; Postoperative Complications ; prevention & control ; surgery ; Reconstructive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies

INTRODUCTIONA subungual exostosis (SE) is a bony overgrowth that is permanently attached to the tip of the distal phalanx. Its pathology differs from osteocartilaginous exostoses in that it mainly involves the overgrowth of normal bone, which may present beneath the toenail or on the sides of the toe. This retrospective study aimed to report the results of surgical treatment when the diagnosis of SE was delayed; the condition was initially considered to be another pathology affecting a different nail or the terminal toe.

METHODSA total of 17 patients (12 female, five male) were included in the study. All surgical resections were performed by the same surgeon using the same surgical technique, with the patient under digital anaesthesia. The patients were evaluated pre- and postoperatively (on Weeks 1 and 6, the first year, and the last follow-up visit) using the American Orthopaedic Foot and Ankle Society questionnaire and the Visual Analogue Scale score.

RESULTSThe patients underwent surgery for SE removal between December 2009 and October 2012. Their mean age was 21.3 ± 4.4 (range 14-29) years and the mean follow-up period was 27.1 ± 7.8 (range 18-45) months. Clinical or radiological recurrence was not observed in any of the patients during the follow-up period. Four patients had superficial infections, which were treated using appropriate antibiotic therapies.

CONCLUSIONAs SE is an uncommon benign lesion, its diagnosis may be delayed. Radiography may be useful in obtaining a differential diagnosis.

Adolescent ; Adult ; Bone Neoplasms ; diagnostic imaging ; surgery ; Cartilage ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Exostoses ; diagnostic imaging ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nail Diseases ; diagnostic imaging ; surgery ; Nails ; surgery ; Orthopedics ; methods ; Pain Measurement ; Postoperative Period ; Recurrence ; Retrospective Studies ; Surveys and Questionnaires ; Young Adult

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

OBJECTIVEPrevention of the misdiagnosis of acute appendicitis when it first manifested as acute intestinal obstruction, and to search proper way of diagnosis and treatment for such event to provide the reference.

METHODSClinical data of 33 acute appendicitis cases presented with acute intestinal obstruction in Beijing Tong Ren Hospital during January 2000 and December 2015 were analyzed retrospectively.

RESULTSAll 33 patients were admitted to the Emergency Department with symptoms of various degrees abdominal pain and abdominal distension. There was no passage of gas and feces. The mean time of onset was (62.2±25.0) hours. The imaging examination showedthat all patients had complete bowel obstruction. Twenty one patients(63.6%) had peritonitis, three of whom developed with septic shock. Abdominal CT was performed in 17 patients preoperatively, which showed retention of gas and fluid in the small intestine in all the patients and 13 were suggestive of acute appendicitis. All of these patients received surgical treatment, 12 patients underwent laparoscopic exploration, and the remaining 21 patients received exploratory laparotomy during which acute appendicitis was confirmed to be the cause of intestinal obstruction, of whom 14(42.4%) was identified as mechanical intestinal obstruction. Nine patients underwent appendectomy and lysis of adhesion, five appendectomy and partial excision of the greateromentum. Nineteenpatients(57.6%) were identified as paralytic ileus and underwent appendectomy only. Twelve patients required respiratory and circulatory support and were admitted to ICU postoperatively. The mean duration time in ICU was(8.8±5.2) days. Postoperative pathology showedgangrene accompanied with perforation in the appendix. All patients were discharged without any complication. The length of hospital stay was (15.4±4.6) days. All patients were followed up for 3 ~ 12 months. One patient with chronic obstructive pulmonary disease developed repeated pulmonary infection and died of respiratory failure at 185 days postoperatively. The remaining patients were followed up and there were no patients developed intra-abdominalsepsis, intestinal obstruction, surgery-related complications, or death.

CONCLUSIONPatients with acute appendicitis presenting with acute intestinal obstruction are mostly in severe condition. Clinical diagnosis for this patients is difficult and surgery should be performed as soon as possible.

Abdominal Pain ; Acute Disease ; Appendectomy ; Appendicitis ; diagnosis ; pathology ; surgery ; Diagnostic Errors ; Humans ; Intestinal Obstruction ; diagnosis ; Intestine, Small ; Laparoscopy ; Laparotomy ; Length of Stay ; Physical Examination ; Postoperative Period ; Retrospective Studies

STUDY DESIGN: The prevalence of disc herniation is estimated to be about 100,000 new cases per year in France and disc herniation accounts for 25% to 30% of surgical activity in Departments of Neurosurgery. Classically, sciatica is expected to follow its specific dermatome-L5 or S1-. In clinical practice, we regularly encounter patients showing discrepancy between clinical sciatica and imaging findings. PURPOSE: The aim of this paper is to review the medical concept and management of sciatica pain in patients showing this discrepancy. OVERVIEW OF LITERATURE: To the best of our knowledge, this subject has not yet been discussed in the medical literature. METHODS: The medical records of 241 patients who were operated on for L5 or S1 sciatica caused by disc herniation were reviewed. RESULTS: We found an apparent clinicoradiological discrepancy between sciatica described by patients on one side and magnetic resonance imaging (MRI) finding on the other side in 27 (11.20%) patients. We did not find any other abnormalities in the preoperative and postoperative period. All of these patients underwent lumbar discectomy via posterior interlaminar approach. Three months after surgery, 25 patients (92.59%) had been totally relieved of sciatica pain. Two patients (7.41%) continued to experience sciatica in spite of the surgery. CONCLUSIONS: The discrepancy between clinical sciatica and disc herniation level on MRI is not rare. Management of this discrepancy requires further investigation in order to avoid missing the diagnosis and treatment failure.
Decision Making* ; Diagnosis ; Diagnostic Imaging* ; Diskectomy ; France ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Magnetic Resonance Imaging ; Medical Records ; Neurosurgery ; Postoperative Period ; Prevalence ; Radiculopathy ; Sciatic Nerve* ; Sciatica ; Treatment Failure

Hernias through the broad ligament are rare with a reported incidence of only 4-7% of cases of internal hernias. Here, we report on a rare case of incarcerated internal hernia through a spontaneous defect in the broad ligament which was repaired using a laparoscopic technique. A 41-year-old female was admitted with colic abdominal pain. Laparoscopic exploration was performed for the diagnosis of intestinal obstruction. Laparoscopic examination confirmed an approximately 10-cm-long ileal loop herniated in the anterior to posterior direction through a left broad ligament defect. A large defect in the broad ligament was closed by an intracorporeal continuous running suture. The patient was highly satisfied with the cosmetic result. In conclusion, laparoscopy could be particularly helpful during pelvic surgery, which usually requires large skin incisions to ensure a good field of view. This approach was cosmetically effective, decreased the postoperative complications, and promoted early recovery to usual activity.
Abdominal Pain ; Adult ; Broad Ligament* ; Colic ; Diagnosis ; Female ; Hernia* ; Humans ; Incidence ; Intestinal Obstruction ; Laparoscopy* ; Postoperative Complications ; Running ; Skin ; Sutures