MyMedR

Fulltext Iatrogenic ureter injuries: eleven years experience in a tertiary hospital

Mahendran HA, Singam P, Ho C, Goh EH, Tan GH, Zuklifli MZ

Med J Malaysia, 2012 Apr;67(2):169-72.

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis

Matched MeSH terms: Intraoperative Complications/etiology*

A case of supercarbia following pneumoperitoneum in an infant

Lew YS, Thambi Dorai CR, Phyu PT

Paediatr Anaesth, 2005 Apr;15(4):346-9.

PMID: 15787930

A 4-month-old healthy male infant underwent left herniotomy under general anesthesia with caudal block. Carbon dioxide (CO2) pneumoperitoneum was created through the left hernial sac for inspection of the right processus vaginalis. Episodes of desaturation associated with significant reduction in chest compliance were noted intraoperatively. This was overcome by increasing the inspired oxygen concentration (FiO2). The infant failed to regain consciousness and spontaneous respiration at the end of surgery. The chest compliance deteriorated further and clinically a CO2 pneumothorax (capnothorax) was suspected. The endtidal carbon dioxide (P(E)CO2) was initially low in the immediate postoperative period. Subsequent to the readministration of sevoflurane and manual ventilation with a Jackson Rees circuit, a sudden surge in P(E)CO2 with improvement of chest compliance was observed. At that time arterial blood gas (ABG) analysis revealed a PCO2 of 17.5 kPa (134 mmHg) and pH of 6.9. The causes of severe hypercarbia and the physiological changes observed in this infant are discussed.

Matched MeSH terms: Intraoperative Complications/etiology*

Intravesical explosion during transurethral resection of the prostate

Dublin N, Razack AH, Loh CS

ANZ J Surg, 2001 Jun;71(6):384-5.

PMID: 11409027

Matched MeSH terms: Intraoperative Complications/etiology*

Fulltext Repair of thoracic oesophageal perforation with latissimus dorsi flap

Yap CM

Med J Malaysia, 1994 Mar;49(1):100-1.

PMID: 8057981

Thoracic oesophageal perforation, a life-threatening condition, is a therapeutic challenge. A 20 year old male developed a lower oesophageal perforation following an abdominal cardiomyotomy for achalasia of the lower oesophagus. The resulting suppurative mediastinitis and left empyema thoracis were treated by decortication. The oesophageal perforation was closed using a transposition pedicle left latissimus dorsi muscle flap.

Matched MeSH terms: Intraoperative Complications/etiology

Fulltext [Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema]

Foo LL, Chaw SH, Chan L, Ganesan D, Karuppiah R

Rev Bras Anestesiol, 2016 09 28;67(6):655-658.

PMID: 27692367 DOI: 10.1016/j.bjan.2015.09.006

Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Matched MeSH terms: Intraoperative Complications/etiology*

Fulltext Retrospective study of transobturator polypropylene mesh kit for the management of pelvic organ prolapse

Vaiyapuri GR, Han HC, Lee LC, Tseng AL, Wong HF

Singapore Med J, 2012 Oct;53(10):664-70.

PMID: 23112018

This retrospective study assessed the surgical outcomes of patients for whom the transobturator polypropylene mesh kit was used for the management of pelvic organ prolapse (Gynecare Prolift) in a tertiary urogynaecological centre in Singapore from January 1, 2006 to December 31, 2007.

Matched MeSH terms: Intraoperative Complications/etiology

Preventing a surgical complication during cesarean delivery in a morbidly obese patient: a simple apparatus to retract the abdominal panniculus

Viegas CM, Viegas OA

MedGenMed, 2006 Feb 21;8(1):52.

PMID: 16915182

Obesity is no longer just a "Western" problem, as evidenced by an increase in prevalence of up to 75% in parts of the developing world. It is important to transfer experience from the developed world to developing countries in an attempt to prepare for the inevitable health and economic problems. This case report highlights an unusual intraoperative complication that has medical and medico-legal implications. A simple apparatus designed to retract the panniculus of an obese patient might reduce complications when performing abdominal surgery in such cases.

Matched MeSH terms: Intraoperative Complications/etiology*

Fulltext Hemorrhagic cardiac tamponade: rare complication of radiofrequency ablation of hepatocellular carcinoma

Loh KB, Bux SI, Abdullah BJ, Raja Mokhtar RA, Mohamed R

Korean J Radiol, 2012 Sep-Oct;13(5):643-7.

PMID: 22977334 DOI: 10.3348/kjr.2012.13.5.643

Local treatment for hepatocellular carcinoma (HCC) has been widely used in clinical practice due to its minimal invasiveness and high rate of cure. Percutaneous radiofrequency ablation (RFA) is widely used because its treatment effectiveness. However, some serious complications can arise from percutaneous RFA. We present here a rare case of hemorrhagic cardiac tamponade secondary to an anterior cardiac vein (right marginal vein) injury during RFA for treatment of HCC.

Matched MeSH terms: Intraoperative Complications/etiology*

Retained Endoscope: An Unexpected but Serious Complication of Hemospray®

Yii RSL, Chuah KH, Poh KS, Lau PC, Ng KL, Ho SH, et al.

Dig Dis Sci, 2022 01;67(1):344-347.

PMID: 33491164 DOI: 10.1007/s10620-021-06835-4

Matched MeSH terms: Intraoperative Complications/etiology

Fulltext Posterior Capsule Rupture With/Without Vitreous Loss During Phacoemulsification in a Hospital in Malaysia

Thanigasalam T, Sahoo S, Ali MM

Asia Pac J Ophthalmol (Phila), 2015;4(3):166-70.

PMID: 26065504 DOI: 10.1097/APO.0000000000000056

PURPOSE: This study was undertaken to determine the risk factors and the point at which posterior capsule rupture (PCR) with/without vitreous loss occurred after cataract surgery and the precautions to be taken to avoid it in the future.

DESIGN: A retrospective study.

METHODS: Patients who underwent cataract surgery from January 2011 to December 2012 in a hospital in Malaysia were studied. The data were obtained from the National Eye Database of Malaysia.

RESULTS: Of 80.4% eyes (2519) that had undergone phacoemulsification, it was found that 3.06% (77) of the cases had PCR as one of the complications. The largest number of PCRs happened during cortical removal (35.2%), followed by segment removal (25.4%), cracking (8.5%), and aspiration of the oculoviscodevice (8.5%). It has been found that the rupture most often occurred during cortex removal by consultants, whereas most PCRs occurred during segment removal by specialists.

CONCLUSIONS: This study reveals that around 3% of patients had PCR during phacoemulsification. It is important to recognize PCR and presence of vitreous loss intraoperatively to prevent further complications of cystoid macular edema and endophthalmitis.

Matched MeSH terms: Intraoperative Complications/etiology

Predicting safe tonsillectomy for ambulatory surgery

Ahmad R, Abdullah K, Amin Z, Rahman JA

Auris Nasus Larynx, 2010 Apr;37(2):185-9.

PMID: 19720483 DOI: 10.1016/j.anl.2009.06.010

To assess the safety of tonsillectomy procedure in local setting.

Matched MeSH terms: Intraoperative Complications/etiology*

External laryngeal nerve in thyroid surgery: recognition and surgical implications

Aina EN, Hisham AN

ANZ J Surg, 2001 Apr;71(4):212-4.

PMID: 11355727

Injury to the external laryngeal branch of the superior laryngeal nerve during thyroid surgery is not uncommon. Most surgeons tend to avoid rather than expose and identify the external laryngeal nerve (ELN). The aim of the present study was to analyse the frequency and types of ELN crossing the avascular space in relationship to the structures to the upper pole of the thyroid and related thyroid pathology.

Matched MeSH terms: Intraoperative Complications/etiology*

Sengstaken-Blakemore tube malposition with esophageal rupture

Chuah YY, Lee YY, Chen WC, Kao SS

Acta Gastroenterol Belg, 2018 10 24;81(3):447-448.

PMID: 30350541

Matched MeSH terms: Intraoperative Complications/etiology*

Fulltext Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear

Mohd Esa NY, Faisal M, Vengadesa Pilla S, Abdul Rahaman JA

BMJ Case Rep, 2020 Dec 22;13(12).

PMID: 33370965 DOI: 10.1136/bcr-2020-236414

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.

Matched MeSH terms: Intraoperative Complications/etiology

Fulltext Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers

Siow SL, Mahendran HA, Najmi WD, Lim SY, Hashimah AR, Voon K, et al.

Asian J Surg, 2021 Jan;44(1):158-163.

PMID: 32423838 DOI: 10.1016/j.asjsur.2020.04.007

BACKGROUND: To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.

METHODS: Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed.

RESULTS: The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person.

CONCLUSIONS: Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.

Matched MeSH terms: Intraoperative Complications/etiology

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