Sanamed

RISK FACTOR STRATIFICATION AND EARLY DETECTION OF INCISIONAL HERNIAS AFTER CESAREAN AND OPEN GYNECOLOGIC PROCEDURES: A PROSPECTIVE OBSERVATIONAL STUDY

2025-10-31T11:46:25+01:00

Background: Incisional hernia is a major complication of abdominal surgery, leading to pain, functional impairment, and increased healthcare costs. This study aimed to identify and rank risk factors for incisional hernia in patients undergoing Cesarean section or open gynecologic surgery, and to evaluate strategies for early detection.

Methods: From January 2023 to June 2025, a prospective observational study enrolled 200 women, each followed for 12 months. Half of the women underwent Cesarean section (n=100) and the other half underwent open gynecologic surgery (n=100). Data were collected on patient demographics, body mass index, comorbidities, surgical details, and complications. The primary outcome was the incidence of incisional hernia within one year, assessed by clinical examinations at 6 weeks, 6 months, and 12 months.

Results: The overall incidence of incisional hernia was 8.0% (16/200), with 6.0% (6/100) after Cesarean section and 10.0% (10/100) after open gynecologic procedures. Multivariable analysis identified independent risk factors: higher body mass index (adjusted odds ratio 1.12 per unit, 95% confidence interval 1.05–1.19, p<0.001), vertical incision (odds ratio 4.10, 95% CI 1.75–9.60, p=0.001), postoperative wound infection (odds ratio 5.22, 95% CI 2.15–12.67, p<0.001), and history of two or more prior Cesarean sections (odds ratio 3.85, 95% CI 1.42–10.45, p=0.008). Continuous fascial closure was protective (odds ratio 0.42, 95% CI 0.20–0.88, p=0.022). Early patient-reported symptoms preceding diagnosis included a palpable bulge (75%), persistent pain (62.5%), and discomfort during activity (50%).

Conclusion: Higher body mass index, vertical incisions, wound infection, and multiple prior Cesarean sections are significant risk factors for incisional hernia. Using transverse incisions and continuous fascial closure, when possible, together with vigilant wound care and patient education on self-examination for early symptoms, can help reduce risk and enable early detection in high-risk patients.

AVULSION FRACTURES OF THE ANTERIOR ILIAC SPINE IN CHILDREN AND ADOLESCENTS: CLINICAL OUTCOMES OF NON-OPERATIVE TREATMENT

2025-11-24T11:23:16+01:00

Objective: Avulsion fractures of the anterior iliac spine are injuries typically seen in physically active children and adolescents. There is no clear consensus regarding the optimal treatment, particularly concerning the degree of fragment displacement that warrants surgical intervention.

Aim: The aim of this study was to analyze the clinical outcomes of non-operative treatment of pelvic avulsion fractures in adolescents and to examine the relationship between patient age and rehabilitation duration.

Patients and Methods: A retrospective study was conducted on 12 adolescent patients with radiographically confirmed pelvic avulsion fractures. Data on age, fracture location, injury mechanism, treatment, and rehabilitation duration were collected and analyzed. All patients underwent non-operative management consisting of rest, analgesics, and crutch-assisted ambulation, followed by physical therapy.

Results: All patients were male, with a mean age of 12 years. The most common fracture site was the anterior inferior iliac spine (66.6%). All fractures healed without complications. Rehabilitation duration tended to be shorter in younger patients. Functional outcomes were excellent, with all patients returning to their pre-injury activity levels.

Conclusion: Non-operative treatment is an effective and safe approach for managing pelvic avulsion fractures in adolescents, even in cases with fragment displacement up to 15 mm. It provides excellent functional recovery without complications, supporting its use as the first-line treatment in this population.

EVALUATION OF HEMODYNAMIC AND BIOMARKER CHANGES IN PATIENTS UNDERGOING SURGICAL AORTIC VALVE REPLACEMENT

2025-11-24T11:24:34+01:00

Background: Aortic stenosis (AS) is a systemic disease characterized by valvular obstruction, ventricular remodeling, and perioperative vulnerability to oxygen supply–demand imbalance. This study evaluated perioperative metabolic and biomarker dynamics and early postoperative outcomes in patients undergoing surgical aortic valve replacement (AVR).

Patients and Methods: A prospective observational study was conducted on 60 consecutive adults with severe AS who underwent surgical AVR at a single center. Demographics, anthropometric data, intraoperative variables, complications, and pre- and postoperative hemodynamic and laboratory parameters were evaluated. Postoperatively, the following were assessed at 6 and 24 hours: mean arterial pressure (MAP), arterial oxygen saturation (SaO₂), partial pressure of oxygen (PaO₂), pH, partial pressure of carbon dioxide (PaCO₂), hemoglobin (Hb), lactate, and creatine kinase–MB isoenzyme (CK-MB). Continuous data are presented as mean ± standard deviation (SD) or median (interquartile range, IQR). Paired t-tests were used to compare values between 6 and 24 hours.

Results: The mean age was 69.9 ± 7.3 years; 58.3% were male. Mean anesthesia and operation times were 151.5 ± 21.8 and 126.8 ± 20.6 minutes, respectively; mean cardiopulmonary bypass (CPB) and cross-clamp times were 78.3 ± 17.6 and 58.5 ± 16.7 minutes. Nearly half of the patients (46.7%) had no postoperative complications; others experienced bleeding (16.7%), arrhythmias requiring therapy (6.7%), permanent pacemaker implantation (8.3%), re-exploration (6.7%), infection (8.3%), respiratory failure (3.3%), or renal failure (3.3%). From 6 to 24 hours postoperatively, lactate decreased (2.34 ± 0.96 →1.87 ± 0.98 mmol/L; p = 0.006) and CK-MB declined (52.5 ± 34.2 →39.0 ± 30.8 U/L; p = 0.001), while Hb increased (103.5 ± 10.1 →120.1 ± 22.9 g/L; p < 0.001). pH decreased modestly (7.396 ± 0.057 →7.365 ± 0.065; p = 0.015). MAP, SaO₂, PaO₂, and PaCO₂ showed no significant changes. The median hospital stay was 7 days (IQR 6–8).

Conclusions: In patients undergoing surgical AVR for AS, early postoperative trends demonstrated an improving metabolic profile (lower lactate) and biomarker normalization (CK-MB) with stable oxygenation, alongside low-to-moderate complication rates and a consistent 7-day median stay. Integrating perioperative oxygen-balance markers and cardiac biomarkers with imaging and left ventricular hypertrophy (LVH) assessment may refine timing and risk stratification for intervention. Prospective studies with standardized imaging and longer follow-up are warranted to link early metabolic recovery with ventricular remodeling and clinical outcomes.

AORTIC AND SUPERIOR MESENTERIC ARTERY THROMBOSIS IN ANTITHROMBIN III DEFICIENCY-DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN CONSERVATIVE MANAGEMENT

2025-11-30T18:52:44+01:00

Introduction: Thrombosis of large arterial vessels, such as the abdominal aorta and superior mesenteric artery, is a rare but serious condition that requires timely diagnosis and appropriate management. One of the risk factors is antithrombin III (AT III) deficiency, a rare coagulation disorder that increases the likelihood of thrombosis. While arterial thromboses are less common than venous ones, they can have significant clinical consequences.

Case report: We present the case of a 39-year-old woman hospitalized due to sudden abdominal pain. Diagnostic imaging, including a contrast-enhanced CT scan of the abdomen and pelvis and CT angiography, revealed thrombosis of the distal abdominal aorta and superior mesenteric artery. Laboratory testing confirmed low AT III levels, while tests for hereditary thrombophilias were negative, suggesting a likely acquired deficiency.

The patient was treated conservatively with AT III concentrate, low-molecular-weight heparin, and oral anticoagulation, alongside regular INR monitoring. Therapy was complemented with cardioprotective and gastroprotective medications, as well as physical rehabilitation. During hospitalization, the patient remained hemodynamically stable, and symptoms gradually resolved. Follow-up imaging after several months demonstrated complete recanalization of the affected vessels. Long-term monitoring over two years confirmed stable clinical status and absence of recurrent thrombosis.

Conclusion: This case highlights the importance of early diagnosis, identification of the underlying cause, and carefully implemented conservative management in patients with AT III deficiency. It demonstrates that even in extensive arterial thrombosis, conservative management can preserve organ function and achieve a favorable outcome without the need for surgical intervention.

ANTIMICROBIAL STEWARDSHIP ACROSS THE SURGICAL PATHWAY

2025-10-31T11:47:22+01:00

Antimicrobial stewardship programs (ASPs) help ensure antibiotics are used effectively to treat infections, reduce side effects, and slow the spread of antibiotic resistance. Improving collaboration among healthcare professionals is the most important way to strengthen ASPs in hospitals.

So far, most ASPs have focused on medical specialities and applied the same approach to all hospital settings. In surgery, it is essential to understand the local cultural and contextual factors that shape prescribing habits so targeted strategies can be developed. Antibiotic stewardship in surgery must be integrated with strict infection prevention and source control, as all three work together to improve patient care.

Effective ASPs usually combine persuasive strategies, which educate and influence prescribers, with restrictive ones, which limit certain practices. While clinical guidelines turn evidence into practice and improve the quality of care, they do not always fit local realities. Adapting them into locally relevant tools, such as protocols, bundles, checklists, and posters, can boost acceptance and adherence. Actively involving prescribers in developing these tools increases the likelihood of meaningful change. Clearly defining responsibilities for specific actions within these protocols helps ensure they are followed.

THE LIFE AND LEGACY OF ERNEST AMORY CODMAN: A PIONEER OF OUTCOMES AND A FORERUNNER OF MODERN QUALITY MEASUREMENT SYSTEMS IN HEALTHCARE

2025-11-25T13:58:55+01:00

Ernest Amory Codman (1869–1940) was an American surgeon, reformer, and visionary whose work marked the beginnings of systematic quality measurement in medicine. The first part of this paper traces his life and career: his education at Harvard Medical School, his work at Massachusetts General Hospital, his conflicts with colleagues over his insistence on public reporting of outcomes, his founding of a private hospital, and the establishment of the Bone Sarcoma Registry—one of the first disease-specific registries in history.

The second part of the paper analyzes his philosophy of the “End Result System” through a comparative table in which its core principles—patient monitoring, complication tracking, transparency, continuous improvement, and accountability—are compared with their modern equivalents, such as outcome indicators, national registries, public reporting systems, quality improvement (QI) methodologies, and health information systems.

The paper concludes that Codman’s work represents both the biographical story of a persistent reformer and a conceptual foundation for modern quality measurement systems in healthcare.