PURPOSE: By comparing the outcomes of total hip arthroplasty with hemiarthroplasty in elderly patients with a femoral neck fracture to investigate the one-year mortality, dislocation, infection, reoperation rate, and thromboembolic event. METHODS: The PubMed, EMBASE databases, and Cochrane library were systematically searched from the inception dates to April 1, 2020 for relevant randomized controlled trials in English language using the keywords: "total hip arthroplasty", "hemiarthroplasty" and "femoral neck fracture" to identify systematic reviews and meta-analyses. Two reviewers independently selected articles, extracted data, assessed the quality evidence and risk bias of included trials using the Cochrane Collaboration' stools, and discussed any disagreements. The third reviewer was consulted for any doubts or uncertainty. We derived risk ratios and 95% confidence intervals. Mortality was defined as the primary outcome. Secondary outcomes were other complications, dislocation, infection, reoperation rate, and thromboembolic event. RESULTS: This meta-analysis included 10 studies with 1419 patients, which indicated that there were no significant differences between hemiarthroplasty and total hip arthroplasty in reoperation, infection rate, and thromboembolic event. However, there was a lower mortality and dislocation rate association with total hip arthroplasty at the one-year follow-up. CONCLUSION Based on our results, we found that total hip arthroplasty was better than hemiarthroplasty for a hip fracture at one-year follow-up.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods* ; Female ; Femoral Neck Fractures/surgery* ; Follow-Up Studies ; Hemiarthroplasty/methods* ; Humans ; Male ; Postoperative Complications/epidemiology* ; Reoperation/statistics & numerical data* ; Surgical Wound Infection/epidemiology* ; Thromboembolism/epidemiology* ; Time Factors ; Treatment Outcome

With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.
Diabetes Complications/surgery* ; Diabetes Mellitus/epidemiology* ; Erectile Dysfunction/surgery* ; Humans ; Hypertension ; Impotence, Vasculogenic/surgery* ; Male ; Pelvic Bones/injuries* ; Penile Implantation/statistics & numerical data* ; Penile Induration/surgery* ; Penile Prosthesis ; Penis/injuries* ; Prostatectomy/adverse effects* ; Prostatic Neoplasms/surgery* ; Radiation Injuries/surgery* ; Radiotherapy/adverse effects* ; Reoperation ; Spinal Cord Injuries/epidemiology* ; Vascular Diseases/epidemiology* ; Wounds and Injuries/epidemiology*

The emerging endoscopic technologies are proved to be effective treatments for obesity in selected patients and to offer the potential advantages of reduced invasiveness, reversibility and repeatability. From the view of operation principle, endoscopic technologies can be classified as restrictive procedure, malabsorption procedure and endoscopic revision of gastric bypass. Restrictive procedures include intragastric balloon, aspiration therapy, endoscopic sleeve gastroplasty (ESG) and transoral gastroplasty. Intragastric balloon employs space occupying, volume restriction and satiety mechanisms, which is superior to drugs and lifestyle change, but shorter than sleeve and bypass surgery. Aspiration therapy is similar to standard percutaneous endoscopic gastrostomy, while there are no available data regarding the obesity and metabolic improvement. Compared with traditional bariatric surgery, ESG does not excise gastric tissue with less complications and without weight regain, but it can not be used as an independent operation still now. Transoral gastroplasty is rarely applied clinically whose efficacy and long-term complications need further studies. Malabsorption surgery includes endoscopic duodenojejunal bypass sleeve (EDJBS) and endoscopic gastroduodenojejunal bypass sleeve(EGDJBS). EDJBS may have the similar mechanism like bypass reducing the blood glucose. Even with obvious effect of weight loss, EDJBS has high morbidity of complications and requirements of the skilled operators. EGDJBS, which imitates bypass anatomy changes and belongs to the mixed operation, should be superior to the above procedures in reducing weight theoretically, but due to the lack of clinical data, its short-term and long-term efficacy still need further clinical observation. As compared to the complexity and risks associated with telescopic surgical revision, endoscopic suturing has been confirmed as less invasive and safer for stomal revisions, while its long-term efficacy of reducing weight and improvement of diabetes are not yet clear. Even if long-term efficacy of reducing weight and morbidity of complication in endoscopic bariatric surgery are still indefinite, and clinical trial researches of large sample and long-term follow-up are absent, with the development of endoscopic skill and the gradual clinical application, endoscopic bariatric surgery will provide a new option for the patients of obesity and metabolic diseases.
Bariatric Surgery ; adverse effects ; methods ; statistics & numerical data ; trends ; Disease Management ; Endoscopy ; adverse effects ; methods ; statistics & numerical data ; Gastric Balloon ; statistics & numerical data ; Gastric Bypass ; adverse effects ; methods ; statistics & numerical data ; Gastroplasty ; adverse effects ; methods ; statistics & numerical data ; Humans ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Reoperation ; adverse effects ; methods ; statistics & numerical data ; Surgical Stomas ; pathology ; statistics & numerical data ; Treatment Outcome ; Weight Loss

OBJECTIVETo compared the clinical efficacy of laparoscopic repair (LR) versus open repair (OR) for perforated peptic ulcers.

METHODSFrom January 2010 to June 2014, in Shanghai Tongji Hospital, 119 patients who were diagnosed as perforated peptic ulcers and planned to receive operation were prospectively enrolled. Patients were randomly divided into LR (58 patients) and OR(61 patients) group by computer. Intra-operative and postoperative parameters were compared between two groups. This study was registered as a randomized controlled trial by the China Clinical Trials Registry (registration No.ChiCTR-TRC-11001607).

RESULTSThere was no significant difference in baseline data between two groups (all P>0.05). No significant differences of operation time, morbidity of postoperative complication, mortality, reoperation probability, decompression time, fluid diet recovery time and hospitalization cost were found between two groups (all P>0.05). As compared to OR group, LR group required less postoperative fentanyl [(0.74±0.33) mg vs. (1.04±0.39) mg, t=-4.519, P=0.000] and had shorter hospital stay [median 7(5 to 9) days vs. 8(7 to 10) days, U=-2.090, P=0.001]. In LR group, 3 patients(5.2%) had leakage in perforation site after surgery. One case received laparotomy on the second day after surgery for diffuse peritonitis. The other two received conservative treatment (total parenteral nutrition and enteral nutrition). There was no recurrence of perforation in OR group. One patient of each group died of multiple organ dysfunction syndrome (MODS) 22 days after surgery.

CONCLUSIONLR may be preferable for treating perforated peptic ulcers than OR, however preventive measures during LR should be taken to avoid postopertive leak in perforation site.

China ; Comparative Effectiveness Research ; Digestive System Surgical Procedures ; adverse effects ; methods ; Enteral Nutrition ; Female ; Fentanyl ; Humans ; Laparoscopy ; adverse effects ; rehabilitation ; Laparotomy ; Length of Stay ; statistics & numerical data ; Male ; Multiple Organ Failure ; epidemiology ; Operative Time ; Pain, Postoperative ; drug therapy ; epidemiology ; Parenteral Nutrition, Total ; Peptic Ulcer Perforation ; rehabilitation ; surgery ; Peritonitis ; therapy ; Postoperative Complications ; epidemiology ; therapy ; Postoperative Period ; Prospective Studies ; Recurrence ; Reoperation ; Treatment Outcome

OBJECTIVETo analyze the change in postoperative complication rate after gastric cancer surgery registered in the Peking University Cancer Hospital in recent 11 years and the learning curve of complication registration, and to investigate how to improve the complication registration and evaluation in gastric cancer surgery.

METHODSPatients who underwent open or laparoscopic gastric cancer surgery between April 14, 2005 and February 15, 2016 in our institution were included in the study, and those without essential clinical and administrative data were excluded. Data were biennially collected, and linear regression was performed to investigate the changes of the following parameters, including overall complication rate, severe complication proportion (proportion of complications with Clavien-Dindo score ≥III(a in the total registered complications), re-operation rate and the major complication rate.

RESULTSA total of 5 666 patients were included in the analysis, with 4 111 males (72.56%) and 1 555 females (27.44%). The average age was (58.87±11.50) years and average BMI was(23.15±3.30) kg/m. There were 305 patients included in the 2005-2006 interval, 810 patients in 2007-2008, 957 patients in 2009-2010, 1 163 patients in 2011-2012, 1 421 patients in 2013-2014, and 1 010 patients in 2015-2016, respectively. The overall re-operation rate was 2.34%(133/5 666), postoperative mortality was 0.41%(23/5 666), registered complication rate was 19.66%(1 114/5 666), severe complication proportion was 32.28%(338/1 047), and the proportion of complication missing the Clavien-Dindo score was 6.01%(67/1 114). The linear regression showed the re-operation rate (r=0.13, P=0.801) and postoperative mortality (r=0.58, P=0.231) remained low (< 4% and < 1% respectively) since 2005, and showed no statistical significance. The registered complication rate showed evident increase from 3.93%(12/305) to 29.13%(414/1 421) between 2005 and 2014 (r=0.92, P=0.010), and slight decrease to 22.77%(230/1 010) in 2015-2016. The severe complication proportion significantly decreased from 6/9 in 2005-2006 to 22.73%(50/220) in 2015-2016 (r=0.90, P=0.014). The proportion of complication missing the Clavien-Dindo score significantly decreased from 25.00%(3/12) in 2005-2006 to 4.35%(10/230) in 2015-2016(r=0.82, P=0.044). The most common complications were infection (9.12%, 517 cases), effusions (6.26%, 355 patients), gastrointestinal motility disorder (4.45%, 252 cases), anastomotic leakage (3.19%, 181 cases) and bleeding (2.31%, 131 cases). The registered rates of these complications all increased since 2005, and the rates of leakage and effusions decreased since 2012 while the others decreased after 2014.

CONCLUSIONSAccording to the data from our institution in the recent 11 years, a learning curve exists in our institution for complication registration in gastric cancer surgery. The administrative data appears to be more reliable than registered complication data in quality and safety evaluation during the learning period. A detailed classification with the Clavien-Dindo score aids to the use of complication data for the quality and safety measurement.

Aged ; Anastomotic Leak ; etiology ; Data Collection ; methods ; statistics & numerical data ; Female ; Gastrectomy ; adverse effects ; mortality ; Humans ; Laparoscopy ; adverse effects ; Male ; Medical Records ; statistics & numerical data ; Middle Aged ; Postoperative Complications ; epidemiology ; Registries ; statistics & numerical data ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
Aged ; Comparative Effectiveness Research ; Fracture Healing ; Fractures, Multiple ; complications ; therapy ; Fractures, Ununited ; epidemiology ; Humans ; Humerus ; injuries ; surgery ; Orthopedic Procedures ; adverse effects ; methods ; statistics & numerical data ; Osteoarthritis ; epidemiology ; Osteonecrosis ; epidemiology ; Randomized Controlled Trials as Topic ; Reoperation ; statistics & numerical data ; Shoulder Fractures ; complications ; therapy ; Treatment Outcome

BACKGROUND: Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. METHODS: Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. RESULTS: The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up (p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II (p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively (p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. CONCLUSIONS: The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of squeaking (1 of 8 hips) was higher, as compared to the control group or previously reported values.
Adult ; *Arthroplasty, Replacement, Hip/adverse effects/methods/statistics & numerical data ; Case-Control Studies ; *Decompression, Surgical/adverse effects/methods/statistics & numerical data ; Femur Head/diagnostic imaging/surgery ; Femur Head Necrosis/diagnostic imaging/*surgery ; Humans ; Male ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Tantalum/*therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.
Adult ; Aged ; Aged, 80 and over ; Biopsy/statistics & numerical data ; Diagnostic Errors/*statistics & numerical data ; Female ; Gastroscopy/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Observer Variation ; Referral and Consultation/statistics & numerical data ; Reoperation/statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Stomach/*pathology ; Stomach Neoplasms/*pathology ; Young Adult

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis.
 Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI).
 Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation.
 Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.
Back Pain ; surgery ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrospinal Fluid Leak ; epidemiology ; Female ; Follow-Up Studies ; Fractures, Bone ; complications ; surgery ; Humans ; Hypesthesia ; etiology ; Kyphosis ; etiology ; surgery ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Operative Time ; Osteotomy ; adverse effects ; methods ; Postoperative Complications ; epidemiology ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Surgical Wound Infection ; epidemiology ; Thoracic Vertebrae ; injuries ; surgery ; Treatment Outcome ; Urinary Tract Infections ; epidemiology

OBJECTIVE: Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS: This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS: Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1+/-117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION: Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
Aged ; Carcinoma, Endometrioid/epidemiology/pathology/*surgery ; Endometrial Neoplasms/epidemiology/pathology/*surgery ; Female ; Humans ; *Hysterectomy/methods/statistics & numerical data ; Lymph Node Excision/*methods/standards/statistics & numerical data ; Middle Aged ; Morbidity ; Neoplasm Staging/standards ; Pelvis ; Postoperative Complications/epidemiology ; Prognosis ; Reoperation/statistics & numerical data ; Retrospective Studies ; *Salpingectomy/methods/statistics & numerical data