Complications, Volume 1, Issue 3 (December 2024) – 6 articles

This retrospective study compares the clinical outcomes of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) and intramedullary nailing (IMN) in treating isolated surgical neck fractures of the humerus. A total of 42 patients were included, with 18 treated using MIROS and 24 with IMN. The primary outcomes assessed were the complication rates, functional recovery (DASH score), pain levels (VAS), and radiological healing. The MIROS group exhibited a higher complication rate (22.2% vs. 8.8%), with K-wire migration and superficial infections being the most frequent. Patients treated with MIROS reported lower postoperative pain (VAS 45 ± 25.7) compared to the IMN group (VAS 58.1 ± 12.5). Both groups demonstrated radiological healing within three months, but one MIROS patient required reoperation due to hardware failure. No significant differences were observed in the DASH scores between the groups. Our findings suggest that IMN is a preferable treatment option for younger patients with good bone quality, while MIROS may still be beneficial for elderly patients with significant comorbidities, albeit with a higher risk of complications. Future prospective studies are recommended to confirm these findings. Full article

Chylothorax is a rare complication occurring after cardio-thoracic surgical procedures. This condition presents challenges for diagnosis and treatment. Operative ductal ligation is the method of choice for relapsing or refractory cases, and it can be performed through the aid of IGC injection for the identification of chylous leakage. Our report presents the use of ICG fluorescence during VATS to successfully identify and treat a left-sided post-surgical chylothorax. The patient underwent a pulmonary wedge resection for a suspect malignant lesion and developed chylous leakage in the early postoperative period. On postoperative day 7, the patient underwent a revision thoracoscopy for hemostasis and thoracic duct ligation. ICG injections were performed through bilateral inguinal lymph nodes and approximately 15 min after we performed the re-thoracoscopy with effective identification and ligation of the chyle leakage. ICG fluorescence-guided VATS is a valuable and effective method for managing postoperative chylothorax, especially for left-sided leaks. Full article

(1) Background: The optimal management approach for adults with traumatic pneumothorax without haemothorax remains an area of debate. Specifically, there is lack of consensus as to whether insertion of a pigtail catheter is superior to a formal intercostal catheter in improving complication rates. (2) Methods: Medline, EMBASE, Cochrane Central, and the World Health Organisation International Clinical Trials Registry Platform databases were systematically searched for studies evaluating pigtail catheters compared to formal intercostal catheters for the management of traumatic pneumothorax. Investigative outcomes of interest included pain, duration management, failure, need for formal thoracoscopic surgery, need for supplemental oxygen, length of stay, infection and overall total complications. (3) Results: Three studies evaluating 280 patients were included in this analysis. There was no significant difference in total complications, rates of failure, length of stay or duration of management between pigtail catheters and formal intercostal catheters. This evidence was based on studies of low to moderate risk of bias with poor control for confounding factors. (4) Conclusions: This systematic review and meta-analysis demonstrates lack of evidence to suggest pigtail catheters are superior to formal intercostal catheter for traumatic pneumothorax. These findings may reflect a true absence of effect between either approach for this patient cohort or non-committal findings in light of limitations of the underlying evidence. Further prospective trials with larger sample sizes and control for confounders are required to validate the outcomes between these two modalities of treatment. Full article

Gastric leak represents one of the most common, serious and challenging complications in bariatric procedures, and it is caused by both ischemic and mechanical failure. The management of these leaks remains controversial. In this clinical case, we describe the occurrence of a gastric leak after a gastric sleeve, which was successfully treated by gastric bypass using a laparoscopic technique. Full article

Title: The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications. Introduction: Social media significantly impacts public perception of healthcare, leading to increased litigation for complications after hernia surgery. Our research focused on terms like ‘inguinal hernia repair,’ ‘medico-legal,’ ‘informed consent,’ ‘litigation,’ ‘malpractice,’ ‘social media’, ‘mesh’, ‘Leistenbruch’, and OLG in Pubmed, Google Scholar, and Google. Results showed chronic postoperative pain as a common cause of malpractice claims, with ultrasound being a valuable diagnostic tool. Urological injuries account for a significant portion of complications after surgery. Mesh infection leads to hospital readmission, increased healthcare costs, and lawsuits. The quality of the consent process is crucial, and patient perceptions of mesh use influence their decision-making. Healthcare professionals must understand the impact of social media on public perception and provide comprehensive patient information for informed consent and satisfaction. Full article

Foreign body intestinal perforation is a critical and potentially life-threatening condition that presents significant diagnostic challenges, especially in rural populations who are often distant from healthcare facilities and lack access to necessary resources. In these settings, the surgical approach is further complicated by prolonged diagnostic times and delayed access to appropriate care. This article presents a series of cases involving patients with foreign body intestinal perforation of both vegetable and animal origin. Among these cases, one patient died due to delayed voluntary treatment, and another presented without leukocytosis, further complicating the diagnosis. Socioeconomic barriers made follow-up challenging in most cases, negatively impacting patient outcomes. This study details patient characteristics, surgical approaches, and outcomes. Community education, improved infrastructure, and greater awareness among healthcare providers are essential to improving outcomes, particularly in rural areas where healthcare delivery is more challenging and intensified efforts are required to enhance patient care and quality of life. Full article