Surgical Operation and Preoperative and Postoperative Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Perioperative Care".

Deadline for manuscript submissions: closed (1 December 2023) | Viewed by 16578

Special Issue Editor

Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
Interests: medicine and surgery; digestive surgery; surgical digestive endoscopy; molecular imaging; general surgery

Special Issue Information

Dear Colleagues,

In the fields of Surgical Operation and Preoperative and Postoperative Care, many researchers have come across cases that deviate from the textbook descriptions, their training, and their clinical experience. This Special Issue will focus on the latest updates on the prevention, diagnosis, and treatment of Preoperative and Postoperative complication, aiming mainly to investigate how all these new developments are adjusted in clinical practice. I welcome abnormal cases with the aim of illuminating the variability of clinical outcomes in order to improve our understanding of this area. The purpose of this Special Issue is to collect and present data on the latest developments in the surgical field. We look forward to receiving reviews and research articles, case reports, protocols, short communications, and interesting images. I propose for the purpose of the scientific debate to also send comments or responses on interesting observations published in Healthcare between  2021 and2023, or on articles published in Special Issues, sent within 60 days of the online publication of the article of interest from this Special Issue.

In this Special Issue, experts in this field will highlight current approaches in the management of fragile and non-fragile surgical patients (transplanted, immunosuppressed, oncological, hematological, etc.) to improve our knowledge. 

Dr. Armando Calogero
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • immunosuppressed patients
  • immunosuppressive therapies
  • surgery and COVID-19
  • cancer
  • transplant surgery
  • abdominal surgery
  • plastic and aesthetic surgery
  • the use of radiologically guided interventions
  • innovative surgical methods
  • medical devices
  • advanced surgery
  • minimally invasive surgery
  • robotic surgery
  • microsurgical procedures

Published Papers (9 papers)

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14 pages, 1572 KiB  
Article
Treatment of Esophago–Airway Fistula after Esophageal Resection
by Janusz Włodarczyk, Tomasz Smęder, Piotr Obarski and Mirosław Ziętkiewicz
Healthcare 2023, 11(24), 3165; https://doi.org/10.3390/healthcare11243165 - 14 Dec 2023
Viewed by 616
Abstract
(1) Background: Esophago–airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material [...] Read more.
(1) Background: Esophago–airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material and Methods: We present a retrospective analysis of a group of 22 patients treated for an esophago–airway fistula between 2012 and 2022, with 21 cases after esophageal resection and one during the course of Hodgkin’s disease. (3) Results: Twenty-two patients were treated for an esophago–airway fistula. Among them, a tracheobronchial fistula occurred in 21 (95.4%) patients during the postoperative period, while 1 (4.5%) was treated for Hodgkin’s disease. Of these cases, 17 (70.7%) patients underwent esophageal diversion with various treatments, including intercostal flap in most cases, greater omentum in one (4.5%), latissimus dorsi muscle in two (9%), and greater pectoral muscle in one (4.5%). Esophageal stenting was performed in two patients (9.0%), and one (4.5%) was treated conservatively. Unfortunately, one patient (4.5%) died after being treated with bronchial stenting, and two (9.5%) experienced a recurrence of the fistula. (4) Conclusions: The occurrence of an esophago–airway fistula after esophagectomy is a rare but life-threatening complication with an uncertain prognosis that results in several serious perioperative sequelae. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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33 pages, 387 KiB  
Article
Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework
by William Olin Blair, Mary Allison Ellis, Maria Fada, Austin Allen Wiggins, Rachel C. Wolfe, Gourang P. Patel, Kara K. Brockhaus, Molly Droege, Laura M. Ebbitt, Brian Kramer, Eric Likar, Kerilyn Petrucci, Sapna Shah, Jerusha Taylor, Paula Bingham, Samuel Krabacher, Jin Hyung Moon, Monica Rogoz, Edson Jean-Jacques, Robert K. Cleary, Ransome Eke, Rachelle Findley and Richard H. Parrish IIadd Show full author list remove Hide full author list
Healthcare 2023, 11(23), 3060; https://doi.org/10.3390/healthcare11233060 - 28 Nov 2023
Cited by 1 | Viewed by 1239
Abstract
Background: The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. Methods and Materials: Records of 476 randomly selected adult patients [...] Read more.
Background: The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. Methods and Materials: Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. Results: POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. Conclusions: Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
13 pages, 4877 KiB  
Article
Periodontal Healing after Lower Third Molars Extraction: A Clinical Evaluation of Different Flap Designs
by Valentina Castagna, Alessia Pardo, Luca Lanaro, Annarita Signoriello and Massimo Albanese
Healthcare 2022, 10(8), 1587; https://doi.org/10.3390/healthcare10081587 - 21 Aug 2022
Cited by 6 | Viewed by 3360
Abstract
Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, [...] Read more.
Periodontal healing after third molars extraction seems to be influenced by the choice of different flap techniques. The purpose of the present study was to assess the clinical condition of adjacent first and second molar sites, after the extraction of lower third molars, performed through different flap designs. Eighty patients, aged between 14 and 30 years, were analyzed for periodontal parameters of VPI, PPD, and CAL, pre-operatively (T0), after 15 days (T1), after 1 month (T2), and after 2 months (T3) from extraction. Techniques performed were trapezoidal flap (TRAP), marginal flap (MARG), flap with papilla detachment (DETP), and flap with papilla decapitation (DEC). No significant differences were found between the four flaps at each observation time and considering the interval between T0 and T3, for VPI, PPD at first molar site, PPD at second molar site, and CAL at second molar site. Significant variations for CAL were registered, for each flap, between T0 and T3, in all cases for buccal site, in three cases for buccal-distal site. After 2 months of follow-up, no strong evidence can be assumed for or against the use of a particular flap design for the extraction of lower third molars. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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9 pages, 13954 KiB  
Article
Cranioplasty after Two Giant Intraosseous Angiolipomas of the Cranium: Case Report and Literature Review
by Aurel George Mohan, Alexandru Vlad Ciurea, Iulian Antoniac, Veronica Manescu (Paltanea), Alin Bodog, Octavian Maghiar, Lavinia Marcut, Adrian Ghiurau and Florian Bodog
Healthcare 2022, 10(4), 655; https://doi.org/10.3390/healthcare10040655 - 31 Mar 2022
Cited by 9 | Viewed by 1548
Abstract
Angiolipomas are rare, benign tumors resulting from the proliferation of adipose tissue and blood vessels, most frequently encountered subcutaneously at the upper limbs and trunk level. Due to their rarity, few cases of intraosseous angiolipomas are presented in the literature. The paper reports [...] Read more.
Angiolipomas are rare, benign tumors resulting from the proliferation of adipose tissue and blood vessels, most frequently encountered subcutaneously at the upper limbs and trunk level. Due to their rarity, few cases of intraosseous angiolipomas are presented in the literature. The paper reports a 50-year-old female case with intracranial hypertension syndrome, frontal and parietal headache, nausea, and vomiting symptoms increasing in intensity. A CT exam revealed two hypodense expansive intraosseous formations/lesions. The first one was located in the projection of the frontal bone and the second one was placed on the left parietal bone. After further investigations, a two-stage procedure was considered. A frontal craniotomy with excision of the intraosseous tumor was performed in the first stage. In the second stage, a left parietal craniotomy was done with excision of the intraosseous tumor combined with a cranioplasty procedure. The patient had a favorable postoperative evolution with no symptoms or neurological deficits. This is among the few reported cases of intraosseous angiolipoma located at the cranium level and the first case report of two intraosseous angiolipomas situated on the same site. The medical recommendation was a complete surgical excision of the lesion followed by cranioplasty. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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9 pages, 1691 KiB  
Article
True Brachial Artery Aneurysm in Patients with Previous Arterio-Venous Fistula Ligation and Immunosuppressant Therapy for Renal Transplantation: Case Report and Literature Review
by Sorin Barac, Andreea Luciana Rata, Alexandra Ioana Popescu, Roxana Ramona Onofrei and Sorin Dan Chiriac
Healthcare 2022, 10(3), 470; https://doi.org/10.3390/healthcare10030470 - 03 Mar 2022
Cited by 4 | Viewed by 1725
Abstract
Background/Objective: Brachial artery aneurysm (BAA) is a serious complication in patients with previous arterio-venous fistula (AVF), renal transplantation (RT), and immunosuppressive regimens. Until now, there has been no standard of care for these patients, especially for patients undergoing chronic dialysis and immunosuppressive treatment. [...] Read more.
Background/Objective: Brachial artery aneurysm (BAA) is a serious complication in patients with previous arterio-venous fistula (AVF), renal transplantation (RT), and immunosuppressive regimens. Until now, there has been no standard of care for these patients, especially for patients undergoing chronic dialysis and immunosuppressive treatment. The aim of this study was to investigate data from the literature regarding these patients and to suggest recommendations for the best approach to their treatment. Methods: A review of the literature was performed by searching the PubMed database in the English language. The review was accompanied by two case reports. A total of 24 articles with different variables—demographics, renal transplantation, aneurysm size, and type of surgery—were subjected to the review. In addition, two cases are reported. Conclusion: This review suggests that the best treatment for these patients is open surgery, with aneurysmectomy and graft interposition. Results: All patients had RT. The age of patients ranged from 26–77 yo, with a male predominance. The majority had an AVF ligated after RT. The main clinical symptoms were pain, swelling, and pulsatile mass (66%). All patients, except one, were treated through open surgery. The first option for treatment was reversed saphenous vein graft interposition (36%), followed by ePTFE graft (16%). Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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9 pages, 1756 KiB  
Case Report
A Case Series on Pain Accompanying Photoimmunotherapy for Head and Neck Cancer
by Yuma Shibutani, Haruna Sato, Shinya Suzuki, Takeshi Shinozaki, Hayato Kamata, Kazuki Sugisaki, Atushi Kawanobe, Shinya Uozumi, Toshikatsu Kawasaki and Ryuichi Hayashi
Healthcare 2023, 11(6), 924; https://doi.org/10.3390/healthcare11060924 - 22 Mar 2023
Cited by 3 | Viewed by 1445
Abstract
One of the most severe side effects of photoimmunotherapy (PIT) for head and neck cancer is pain. As there are presently no detailed reports on pain and pain management in PIT, we conducted a retrospective case series study. We conducted a retrospective study [...] Read more.
One of the most severe side effects of photoimmunotherapy (PIT) for head and neck cancer is pain. As there are presently no detailed reports on pain and pain management in PIT, we conducted a retrospective case series study. We conducted a retrospective study of five patients who had received PIT at the National Cancer Center Hospital East between January 2021 and June 2022 using medical chart data. All patients experienced pain, evidenced by an increased numerical rating scale (NRS) after PIT, regardless of the illumination method. The daily change in mean NRS rating shows that the pain was highest on the day of PIT, with ratings of 6.8 and 7.8 for the frontal and cylindrical diffuser methods, respectively; it dropped the following day quickly. Four of the five patients received fentanyl injections for postoperative pain management beginning on postoperative day (POD) 0. All patients who underwent therapy using a cylindrical diffuser required postoperative pain management with opioid drugs. Pain after PIT tended to be most intense immediately after or one hour after illumination and declined the following day, suggesting the need to have a pain relief plan in place in advance. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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11 pages, 559 KiB  
Systematic Review
Occupational Exposure to Inhalational Anesthetics and Teratogenic Effects: A Systematic Review
by José Manuel García-Álvarez, Guillermo Escribano-Sánchez, Eduardo Osuna, Alonso Molina-Rodríguez, José Luis Díaz-Agea and Alfonso García-Sánchez
Healthcare 2023, 11(6), 883; https://doi.org/10.3390/healthcare11060883 - 17 Mar 2023
Cited by 2 | Viewed by 2065
Abstract
(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to [...] Read more.
(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to analyze the teratogenic effects of inhalational anesthetics in conditions of actual use, determining any association with spontaneous abortion or congenital malformations. (2) Methods: A systematic review was carried out according to the PRISMA statement based on PICO (problem of interest–intervention to be considered–intervention compared–outcome) (Do inhalational anesthetics have teratogenic effects in current clinical practice?). The level of evidence of the selected articles was evaluated using the SIGN scale. The databases used were PubMed, Embase, Scopus, Web of Science, Google academic and Opengrey. Primary studies conducted in professionals exposed to inhalational anesthetics that evaluate spontaneous abortions or congenital malformations, conducted in any country and language and published within the last ten years were selected. (3) Results: Of the 541 studies identified, 6 met all inclusion criteria in answering the research question. Since many methodological differences were found in estimating exposure to inhalational anesthetics, a qualitative systematic review was performed. The selected studies have a retrospective cohort design and mostly present a low level of evidence and a low grade of recommendation. Studies with the highest level of evidence do not find an association between the use of inhalational anesthetics and the occurrence of miscarriage or congenital malformations. (4) Conclusions: The administration of inhalational anesthetics, especially with gas extraction systems (scavenging systems) and the adequate ventilation of operating rooms, is not associated with the occurrence of spontaneous abortions or congenital malformations. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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9 pages, 866 KiB  
Case Report
Effect of Three Weeks of High-Intensity, Long-Term Preoperative Rehabilitation for Esophageal Cancer Patients with Stroke Sequelae Who Were Considered Unfit for Surgery Due to Low Activity: A Case Report
by Tokio Kinoshita, Yukihide Nishimura, Rikito Zaiki, Yoshinori Yasuoka, Yasunori Umemoto, Yumi Koike, Makoto Kawanishi and Fumihiro Tajima
Healthcare 2023, 11(5), 665; https://doi.org/10.3390/healthcare11050665 - 24 Feb 2023
Viewed by 1605
Abstract
Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient’s ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a [...] Read more.
Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient’s ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient’s condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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6 pages, 1427 KiB  
Case Report
Promoting Laparoscopic Anterior Approach for a Very Low Presacral Primary Neuroendocrine Tumor Arising in a Tailgut Cyst
by Maria Michela Di Nuzzo, Carlo De Werra, Mirella Pace, Raduan Ahmed Franca, Maria D’Armiento, Umberto Bracale, Ruggero Lionetti, Michele D’Ambra and Armando Calogero
Healthcare 2022, 10(5), 805; https://doi.org/10.3390/healthcare10050805 - 26 Apr 2022
Cited by 1 | Viewed by 1915
Abstract
Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is [...] Read more.
Background: Tailgut cysts are rare congenital lesions that develop in the presacral space. As they can potentially conceal primary neuroendocrine tumors, surgical excision is suggested as the treatment of choice. However, specific management guidelines have yet to be developed. A posterior approach is usually preferred for cysts extending to the third sacral vertebral body. Conversely, a transabdominal approach is preferred for lesions extending upward to achieve an optimal view of the surgical field and avoid injuries. Case report: Here, we report a case of a 48-year-old man suffering from perianal pain and constipation. Digital rectal examination and magnetic resonance imaging revealed a presacral mass below the third sacral vertebral body. A laparoscopic transabdominal presacral tumor excision was performed. The final histological diagnosis was a rare primary neuroendocrine tumor arising from a tailgut cyst. The postoperative course was uneventful, and no signs of recurrence were observed at the six-month follow-up. Conclusions: This study may help establish more well-grounded recommendations for the surgical management of rectal tumors, demonstrating that the laparoscopic transabdominal technique is safe and feasible, even for lesions below the third sacral vertebral body. This approach provided an adequate view of the presacral space, facilitating the preservation of cyst integrity, which is essential in cases of malignant pathologies. Full article
(This article belongs to the Special Issue Surgical Operation and Preoperative and Postoperative Care)
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