Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has shown to have smaller skin incision, decreased muscular dissection, and less retraction of the thecal sac, compared to conventional open approach. However, its effects on long term functional outcome and degenerative changes of paraspinal muscles are still obscure. Materials and Methods: We studied 81 patients treated by one team of surgeons at a single institution. In the two level spinal fusion, 18 patients underwent conventional TLIF (C TLIF) and 20 patients underwent MIS TLIF. In three level spinal fusion, 23 patients were treated with C TLIF and 20 patients were treated with MIS TLIF. Clinical outcomes included mean operative times, volume of blood loss, percentage of early ambulation, visual analog scale (VAS), and oswestry disability index (ODI) were analyzed. The change of multifidus muscle was calculated from magnetic resonance imaging (MRI) taken before and 6-month after the operation. Results: Lesser blood loss was noted in the MIS TLIF group compared to the conventional group in two- or three-level circumferential spinal fusion. Early ambulation (within 3 days after operation) was found in the MIS TLIF groups. Analysis of VAS scores at leg area showed no significant differences in improvement between each group at 18 month follow up. The postoperative ODI score was significantly less in the MIS TLIF groups than in the C TLIF groups after 6 month follow up. In three segment spinal fusion, MIS TLIF minimized multifidus muscle atrophy, when compared with C TLIF. Conclusion: MIS TLIF in three level lumbar fusion not only has a better functional recovery but also ameliorates the degenerative change of multifidus muscle.

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Rosai–Dorfman disease (RDD) is a rare proliferative histiocytic disorder, often clinically present with massive lymphadenopathy, which typically involves the cervical lymph nodes and is limited to head and neck. It can also be found extranodally, and an unusual site of incidence is the breast. Although it may be a benign disease, it can mimic malignancy based on features of irregularity and lymphadenopathy; thus, the recognition of this condition before any unnecessary therapeutic management is important. A definitive diagnosis is dependent on pathologic proof. This report describes a 26-year-old Asian female with a recurrent RDD, who presents with a firm and visible nodule in the breast and is treated relatively conservatively by local surgery.

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In this modern era, refinement of operative procedures and advanced instrumentation have made total thyroidectomy for benign and malignant diseases of the thyroid gland a safe procedure. Delayed tracheal perforation after thyroidectomy is a rare complication with very few cases reported. We present a case of a 47-year-old female with a delayed perforation in the trachea following thyroidectomy. Computerized tomogram demonstrated the defect in the trachea. Emergency exploration and closure of the rent in the trachea with a muscle patch, along with tracheostomy was done for the condition.

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Vertebral osteomyelitis compromises approximately 1%–7% of all cases of osteomyelitis, whereas the cervical region is affected in 3%–10% of all cases. Not surprisingly, osteomyelitis at the craniocervical junction is a rare occurrence that poses certain challenge to surgeons. With the advancement of antibiotics, most patients with vertebral osteomyelitis can be successfully treated by conservative treatment. However, surgical intervention is indicated in cases presented with neurological deficits, spinal deformity, or instability. We present one case of retropharyngeal abscess involving the craniocervical junction that led to irreducible atlantoaxial rotatory dislocation and significant ventral cord compression. Staged procedures with endoscopic endonasal odontoidectomy assisted by nasoseptal flap reconstruction for decompression and posterior occipitocervical fusion were arranged in sequence. Nevertheless, postoperative magnetic resonance imaging revealed incomplete decompression at C2 level of the cervical spine. Prompt revision surgery with nasoseptal flap takedown and reuse performed uneventfully. The patient recovered well and was able to ambulate 5 weeks later. This case illustrated long-term radionecrosis complicated with osteomyelitis and craniocervical instability. An aggressive surgical decompression followed by staged spinal fusion would be beneficial in such complex osteomyelitis cases.

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Background: Study is conducted to compare surgical site infections (SSIs) at 30 days in early and delayed dressing removal in primary closure of clean and clean contaminated surgical incisions. Also to compare pain, duration of postoperative hospital stay, and cost of dressing in both groups. Study result may change the technique of dressing and reduce the cost of dressing, pain, and hospital stay for patients after surgery. Materials and Methods: This is a Single center, prospective randomized controlled study including 200 patients divided into two groups at tertiary care hospital. Study included patients aged above 15 years who need surgical intervention with abdominal incision. Study compares results of early and delayed dressing removal in laparotomy surgery with clean and clean contaminated wounds. Results: The study shows no significant difference in outcome in relationship to age of these two Groups A and B (P = 0.94). P value for superficial SSI is 0.76, which is statistically insignificant. P value for deep SSI is 0.71, which is also statistically insignificant. Fisher's exact test for SSI with burst abdomen showed P = 1.0, which is insignificant. By applying t test to data in relationship to pain, we find P < 0.001, which is highly significant. With the use of Chi square test, P value for postoperative hospital stay is 0.03, which is statistically significant. The mean cost of dressing is significantly lower in GroupA than in GroupB (P < 0.0001). Conclusion: SSI is same in both early and delayed dressing removal in primary closure of surgical incisions. There are no significant changes in terms of superficial and deep SSIs and burst abdomen, following early dressing removal. Moreover, the duration of hospital stay is significantly lower in patients with early dressing removal as compared to conventional dressing removal of incision following surgery. Postoperative pain and cost of dressing are also reduced in early dressing removal compared to delayed dressing removal of primary incision closure following surgery. As early dressing removal reduces pain and cost of dressing, it can be applied in routine clean and clean contaminated surgical incisions.

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Background: We aim to find out the risk factors of delayed postoperative hematuria and the role of preliminary antibiotic treatment in patients receiving transurethral resection of prostate or laser prostatectomy. Materials and Methods: The study consisted of 713 patients undergoing surgical intervention for benign prostatic hyperplasia at a single medical center from January 2016 to December 2016. Severe delayed postoperative hematuria was defined as hematuria requiring an emergency department visit or a surgical intervention within 30 days after operation. Variables of interest included age, body mass index, preoperative status of urinary catheter, prostate volume, preoperative diagnosis of pyuria, preliminary antibiotic treatment, duration of operation, type of operation, and use of antiplatelet agents or 5 alpha reductase inhibitors. Results: Six hundred and twenty-three of the 713 patients had available data of preoperative transrectal ultrasonography a year before their operation. Delayed postoperative hematuria occurred in 41 patients within 30 days after operation. No statistical significance was found between the different types of operation. Multivariate analysis revealed that the odds of delayed postoperative hematuria increased with preoperative serum prothrombin time (PT) (odds ratio [OR] 1.49, 1.03–1.87), serum white blood cell (WBC) count (OR 1.26 1.05–1.50), serum creatinine (OR 1.59, 1.01–2.50); decreased with preliminary antibiotic treatment (OR 0.26 0.09–0.77). Conclusion: Higher preoperative serum PT, WBC count, and creatinine were associated with higher risk of delayed postoperative hematuria, while preliminary antibiotic treatment was associated with lower risk of delayed postoperative hematuria.

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Background: Mechanical bowel preparation (MBP) includes cleansing of intestine from its contents by giving oral preparations before surgery to clear fecal material from bowel lumen. It had many proposed advantages that lacked evidence. Recently, due to many notable side effects, the use of MBP had been questioned. This study was performed to compare the surgical outcome with MBP and without MBP in ileostomy closure surgeries. Materials and Methods: The study was conducted on 80 patients who had ileostomy for more than 3 months. They were randomly divided into two groups of 40, each using computer-generated randomization. Group A patients received MBP on the evening before elective ileostomy closure while Group B patients did not receive any MBP. Postoperatively, patients were kept in the ward and monitored for any complications and total duration of stay in hospital. Results: The mean postoperative duration of paralytic ileus after ileostomy closure surgery with bowel preparation is 4.1 ± 1.4 days. Without bowel preparation, it is 3.9 ± 1.5 days (P > 0.05). The number of patients with anastomotic leak is 3 (7.5%) in the bowel preparation group and 3 (7.5%) in the group without bowel preparation (P > 0.05). Wound infection is present in 7 (17.5%) patients in the bowel preparation group and 10 (25%) patients in the group without bowel preparation. The number of patients needing surgical intervention in the course of management is 2 (5%) in Group A (with MBP) and 3 (7.5%) in Group B (without MBP). The mean duration of hospital stay with bowel preparation is 10.6 ± 3.6 days and without bowel preparation is 10.8 ± 3.5 days (P > 0.05). Conclusion: The above study concludes that there is no influence of MBP on surgical anastomosis in ileostomy closure surgeries.

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Background: Red blood cell distribution width (RDW) is considered a marker of chronic inflammation and a predictor of poor outcome in seriously ill patients. This study is aimed to recognize RDW as a marker of inflammatory pathology and as a predictor of various postoperative complications and outcomes in terms of mortality. Materials and Methods: This was a retrospective study of all surgical patients retrieved from our prospectively collected database. RDW was studied as a marker of inflammatory pathology and as a predictor of various postoperative complications and outcomes in terms of mortality. Results: We analyzed 146 (99 males and 47 females) patients who were managed surgically for their presenting diseases. The mean age of presentation was 42.7 + 17.9 years. RDW was considered high when it was above 16%. RDW was observed to be high in 57 of 146 patients (39%). A significant correlation was found between elevated RDW and underlying inflammatory pathology (P < 0.001), development of postoperative complications (P < 0.001), and 30-days mortality (P = 0.0023, Negative Predictive Value = 93.3%). High RDW and preexisting inflammatory pathology were found in strong association with postoperative complications. Conclusion: RDW was analyzed as a marker of inflammation and for its predictive accuracy of postoperative complications and mortality. We found statistically significant correlation between elevated RDW (>16%) and postoperative complications and 30-day mortality. Strong correlation was also found between increased RDW and existing inflammatory pathology. RDW could be a useful indicator of chronic health state and practical addition to existing risk stratification strategy and decision-making process.

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