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Showing 33 results for Surgical
Ali Mohammad Mosadeghrad , Fatemeh Khalaj ,
Volume 74, Issue 5 (8-2016)
Volume 74, Issue 5 (8-2016)
Abstract
Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.
Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.
Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.
Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.
Soheila Aminimoghaddam, Sara Norouzi, Elham Nasrolahi, Narmin Karisani,
Volume 74, Issue 6 (9-2016)
Volume 74, Issue 6 (9-2016)
Abstract
Background: Cervical cancer is the third most common gynecologic cancer in women worldwide. Cervical cancer has lower incidence and mortality rates than uterine corpus and ovarian cancer, as well as many other cancer sites. Unfortunately, in countries that do not have access to cervical cancer screening and prevention programs, cervical cancer remains the second most common type of cancer. Staging of the disease is made clinically. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) for diagnosing the invasion of cancer to organs and staging of cervical cancer and the relationship between clinical and pathological findings and the sensitivity and specificity of the assay in cervical cancer.
Methods: The study included records of 40 patients with cervical cancer that undergo surgery or Chemoradiation in Firoozgar University Hospital. In this study that made retrospectively, non-randomized, the MRI reports and clinical findings records and pathology results was discussed. The sensitivity and specificity of MRI for diagnosing the invasion to parameters, bladder, rectum, vagina, pelvic wall and it’s accuracy to determine tumor stage has been set.
Results: A total of 40 patients with pathology information of cervical cancer was retrospectively reviewed in the study. The patients were 28-83 years old by mean age of 49.3 Pathology of cervical cancer in 80% of cases was SCC, 15% adenocarcinoma and 5% melanoma. The sensitivity and specificity of MRI for diagnosing invasion of parameter was 76% and 88%. The sensitivity of MRI in the detection of bladder invasion was 100% and specificity of 100%. The sensitivity of MRI in the diagnosis of rectal invasion was 50% and specificity of 100%. The sensitivity of MRI in the diagnosis of pelvic wall invasion was 100% and specificity of 86%. Sensitivity in detecting invasion into the upper third of the vagina was 100%.
Conclusion: Overall, this study showed a good sensitivity and specificity for detecting invasion into the bladder, vagina, pelvic wall and parameters and good specificity for the diagnosis of rectal invasion and acceptable accuracy at 67.5% for detection of tumor stage by MRI show.
Khosro Barkhordari , Samaneh Yaghooti , Sepideh Nikkhah , Afsaneh Aein , Arash Jalali , Akbar Shafiee ,
Volume 74, Issue 9 (12-2016)
Volume 74, Issue 9 (12-2016)
Abstract
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Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable. Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95) and the control group (n= 161). The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr)> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG) characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups. Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively). There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005) and also the euroSCORE was higher (P< 0.002). There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both) as well as lower HCO3 and pH (P< 0.001 for both) were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both). The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups. |
Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.
Abbas Kazemi Ashtiani , Peyman Khoshnood , Mohammad Javad Fatemi , Seyed Jaber Mousavi , Seyed Aboozar Hoseini ,
Volume 74, Issue 10 (1-2017)
Volume 74, Issue 10 (1-2017)
Abstract
Background: The use of random flaps is one of the most common methods of reconstructive surgery because they are easy to use and quick to do. However, the absence of axial vessels especially in the distal areas can cause ischemia and loss of total or part of the flap. Different methods and systemic and topical medications have been recommended to prevent ischemia in random flaps. The aim of this study was to evaluate the effect of stem cells derived from umbilical cord blood in random flap survival in rats.
Methods: This experimental study was conducted in Animal Laboratory of Hazrat Fatemeh Hospital in 2012. In this study twenty Sprague-Dawley male rats weighing approximately 300 to 350 g were selected and divided randomly into two groups. In both groups after anesthesia, a flap was created in the posterior part of each rat with a size of 2 x 6 cm. In the intervention group we injected stem cells derived from umbilical cord blood into the flap, and after eight days the effects on the survival of flaps were examined by digital photography and then pathological examination was performed.
Results: The mean of viable flap in the stem cell group was 6.57 cm2 and in control group 4.71 cm2. The minimum and maximum flap survival in the intervention group were 4.71 and 8.75, and the minimum and maximum flap survived in control group were 1.86 and 7.77. This difference was significant and showed that the viable parts of flap were more in the intervention group (P=0.49). In pathologic examinations epidermal and muscle necrosis of the skin were reported in 3 cases in the intervention group and 5 cases in control group.
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Conclusion: This study showed that cord blood stem cells can be effective somehow in reducing ischemia and increasing random flap survival. However, similar studies are recommended in order to compare the results of this drug and placebo or other proven effective drugs. |
Yousef Shafaee , Vahid Sadeghifard , Bita Shahbazzadegan ,
Volume 74, Issue 12 (3-2017)
Volume 74, Issue 12 (3-2017)
Abstract
Background: Even though replantation surgery has now become a routine procedure, it remains delicate and demanding surgery, requiring adequate training and expertise in microsurgical techniques. Functional outcomes following replantation vary with the level of injury. Replants of the fingers distal to the flexor superficial are insertion, the hand at the wrist, and the upper extremity at the distal forearm can achieve good function. With the advent of refined microscopes, sutures, and needles, along with specialized surgical training, replantation has become a routine part of hand-surgery practice in centers all over the world. Clearly, survival does not equate with function. Amputations constitute multisystem injury, with disruption of skeletal support (bone), motor function (muscle), sensibility (nerve), circulation (blood vessel), and soft-tissue coverage (skin). A lot of News work-related accidents published daily. Complete amputation of the palm with sharp objects electric disrupts quality of life and irreversible effects on their life. Replantation or repair the damaged organ can improve their quality of life, functional body.
Case presentation: The case is a man with complete amputation of the palm while working with an electrical machine, at the same time as damage and severe crush was also the distal phalanx of the first finger of the right hand. Patient was admitted to the emergency unit at Fatemi Hospital of Ardabil city in January 2014, Iran, and underwent to surgery for replantation.
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Conclusion: Complete amputation of palm and its successful replantation are among rarely occurred and reportable cases. Complete amputation of palm and successful replantation and the 10-month follow-up indicated that the patient had a successful operation. No abnormalities were found in the blood circulation, and finger grasping was acceptable. Nerve development was acceptable. |
Alireza Tavassoli , Sadjad Noorshafiee , Ahmadreza Tavassoli , Saeedeh Hajebi Khaniki ,
Volume 75, Issue 12 (3-2018)
Volume 75, Issue 12 (3-2018)
Abstract
Background: The benefits of aspirin have been proven by repeated examinations, especially in secondary prevention in cardiac infarction, stroke, and after interventional angiography and stent insertion.
Methods: This is a retrospective study on all patients who underwent non-cardiac surgeries between June 2005 and March 2013 in Ghaem hospital in Mashhad and aspirin continued due to many reasons. Most frequent surgeries included laparoscopic appendectomy and cholecystectomy. Information such as bleeding and its amount both during surgery and post-operative, hematoma after surgery, requiring re-operation due to bleeding and cardiovascular events in hospital were recorded and analyzed. Moreover, all patients were followed within one month after discharge from hospital to check whether any cardiovascular events had been happened. Furthermore, bruising in the skin, and bleeding after discharge were evaluated. Data were analyzed using SPSS Version 16 (SPSS, Chicago, IL, USA).
Results: One hundred seventy patients enrolled in the study and all of them underwent general anesthesia. Of all patients 37.06% were male and 62.94% were female. The mean age was 52.78±5.01 years. Majority of operations included laparoscopic cholecystectomy (41.62%). Also in most of the patients (58.38%) surgery were emergency and discontinuation of aspirin were impossible. 91.37% of patients were taking less than 80 mg aspirin per day. Mean bleeding amount during surgery was 100 ml. 13 patients (6.59%) who undergo laparoscopic cholecystectomy and one patients in appendectomy group had bleeding more than 110 ml due to inadequate artery ligation and they underwent conversion to open surgery and bleeding were controlled successfully. Other eight patients (4.06%) treated conservatively without need to conversion to open surgery. In 7.61% of patients, ecchymosis happened which were healed within one month. No patient underwent reoperation due to post-operative hemorrhage. No vascular event and hematoma had been reported during one month follow up after surgery.
Conclusion: Continuing aspirin in perioperative period of non-cardiac surgeries were without additional risk of bleeding and it also helped to reduce risk of vascular evets post-operatively.
Methods: This is a retrospective study on all patients who underwent non-cardiac surgeries between June 2005 and March 2013 in Ghaem hospital in Mashhad and aspirin continued due to many reasons. Most frequent surgeries included laparoscopic appendectomy and cholecystectomy. Information such as bleeding and its amount both during surgery and post-operative, hematoma after surgery, requiring re-operation due to bleeding and cardiovascular events in hospital were recorded and analyzed. Moreover, all patients were followed within one month after discharge from hospital to check whether any cardiovascular events had been happened. Furthermore, bruising in the skin, and bleeding after discharge were evaluated. Data were analyzed using SPSS Version 16 (SPSS, Chicago, IL, USA).
Results: One hundred seventy patients enrolled in the study and all of them underwent general anesthesia. Of all patients 37.06% were male and 62.94% were female. The mean age was 52.78±5.01 years. Majority of operations included laparoscopic cholecystectomy (41.62%). Also in most of the patients (58.38%) surgery were emergency and discontinuation of aspirin were impossible. 91.37% of patients were taking less than 80 mg aspirin per day. Mean bleeding amount during surgery was 100 ml. 13 patients (6.59%) who undergo laparoscopic cholecystectomy and one patients in appendectomy group had bleeding more than 110 ml due to inadequate artery ligation and they underwent conversion to open surgery and bleeding were controlled successfully. Other eight patients (4.06%) treated conservatively without need to conversion to open surgery. In 7.61% of patients, ecchymosis happened which were healed within one month. No patient underwent reoperation due to post-operative hemorrhage. No vascular event and hematoma had been reported during one month follow up after surgery.
Conclusion: Continuing aspirin in perioperative period of non-cardiac surgeries were without additional risk of bleeding and it also helped to reduce risk of vascular evets post-operatively.
Azadeh Zahedi, Seyed Mokhtar Esmaeilnejadganji , Sekineh Kamali Ahangar , Rahmatollah Jokar,
Volume 77, Issue 1 (4-2019)
Volume 77, Issue 1 (4-2019)
Abstract
Background: Diabetes Mellitus is a prevalent disease worldwide and foot ulcer is one of the serious complications of chronic uncontrolled diabetes which could lead to various complications such as amputation of the extremity if left untreated. Total contact casting (TCC) is the gold standard in treatment of neuropathic and neuro ischemic diabetic foot ulcers (DFU) on which less emphasize is seen on routine medical practice. The aim of this study was to emphasize on healing effect of this off-loading method and to study the possible influence of variants on the healing rate of this technique.
Methods: In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week.
Results: 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate.
Conclusion: The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.
Methods: In this cohort study, 92 diabetic patients with complaint of plantar foot ulcer grade 0, 1 and 2 according to Wagner classification had participated in Shahid Beheshti Hospital, Babol City, Iran, from March 2014 to February 2016. The demographic and biochemical information along with dimensions of foot ulcers were carefully recorded. After the primary cleansing, surgical debridement and dressing, TCC was applied on foot by the specialist and they were requested to return weekly for changing the TCC and re-evaluation of ulcers. The healing rate was calculated as decline in ulcer surface area per week.
Results: 92 patients of study sample with mean age of 63.9±10.56 year consisted of 76 patients with DM type 2 with BMI of 31.16±3.8 kg/m² and 58 male patients. The average healing rate of ulcers treated with TCC was 0.406 ±0.168 cm²/week. The duration of diabetes on average was 17.23±6.93 years. Most of the patients (n=45) had an ulcer on the forefoot and the healing rate of midfoot ulcers was slower. The average amount of baseline HbA1c was 8.2±0.19%. There was no relation between smoking history (P=0.94) and anti-diabetic regimen used by patients (P=0.754) with the healing rate.
Conclusion: The healing rate is slower in elderly patients and those with longer duration of diabetes. So in these two groups, TCC is to be applied for a longer duration in order to achieve complete healing.
Sepehr Eslami , Seyed Hamid Mousavi, Keyvan Ghadimi ,
Volume 77, Issue 9 (12-2019)
Volume 77, Issue 9 (12-2019)
Abstract
Background: Recently, the surgical methods are used in patients with anterior cruciate ligament rupture and have been associated with successful results. There are different results in the term of using of the surgical methods for anterior cruciate ligament that often is associated with some complications such as infection, static laxity, remaining the pain, need to recurrence surgery, and limitation in the range of motion. Therefore, in this study, we aimed to compare outcomes of anterior cruciate ligament reconstruction with the fixed loop and the adjustable loop.
Methods: This cross-sectional study was done on 60 patients undergoing anterior cruciate ligament reconstruction referred to Kashani Hospital of Isfahan, Iran, from March 2017 to February 2019. Also, this study was approved in the Isfahan University of Medical Sciences, Isfahan, Iran. 30 patients were assigned to a fixed loop and 30 patients under the adjustable loop method. Postoperative outcomes were compared with the fixed loop group and the adjustable loop group.
Results: The frequency of static laxity below 8 mm in the fixed loop group was 83.3% and the frequency of static laxity below 8 mm in the adjustable loop was 76.7%. There was no significant difference between the fixed loop group and the adjustable loop group based on static laxity. Also, no infection was seen in the fixed loop group and the adjustable loop group. There was no significant difference between the fixed loop group and the adjustable loop group in terms of range of motion and knee score before and after surgery. After surgery, 96.7% of the fixed loop group and 86.7% of the adjustable loop group returned to normal activity. There was no significant difference between the fixed loop group and the adjustable loop group in terms of return to normal activity and satisfaction.
Conclusion: Using the fixed loop is effective, useful, and with low-complication for the patients with anterior cruciate ligament and also using the adjustable loop grafts is effective, useful, and with low-complication for the patients with the anterior cruciate ligament rupture.
Methods: This cross-sectional study was done on 60 patients undergoing anterior cruciate ligament reconstruction referred to Kashani Hospital of Isfahan, Iran, from March 2017 to February 2019. Also, this study was approved in the Isfahan University of Medical Sciences, Isfahan, Iran. 30 patients were assigned to a fixed loop and 30 patients under the adjustable loop method. Postoperative outcomes were compared with the fixed loop group and the adjustable loop group.
Results: The frequency of static laxity below 8 mm in the fixed loop group was 83.3% and the frequency of static laxity below 8 mm in the adjustable loop was 76.7%. There was no significant difference between the fixed loop group and the adjustable loop group based on static laxity. Also, no infection was seen in the fixed loop group and the adjustable loop group. There was no significant difference between the fixed loop group and the adjustable loop group in terms of range of motion and knee score before and after surgery. After surgery, 96.7% of the fixed loop group and 86.7% of the adjustable loop group returned to normal activity. There was no significant difference between the fixed loop group and the adjustable loop group in terms of return to normal activity and satisfaction.
Conclusion: Using the fixed loop is effective, useful, and with low-complication for the patients with anterior cruciate ligament and also using the adjustable loop grafts is effective, useful, and with low-complication for the patients with the anterior cruciate ligament rupture.
Mehdi Sanatkar , Mehrdad Goudarzi , Ebrahim Espahbodi , Alireza Takzare ,
Volume 77, Issue 11 (2-2020)
Volume 77, Issue 11 (2-2020)
Abstract
Background: Nausea and vomiting is one of the most common complications after the strabismus surgery. In this study, we evaluated the efficacy of atropine versus ondansetron administration on the incidence of postoperative nausea and vomiting and duration of recovery stay in patients undergoing this procedure.
Methods: In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.
Results: There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.
Conclusion: It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.
Methods: In this case-control study, 90 patients between 3 to 30 years old who were candidates for elective strabismus surgery in Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran, from February to April 2019, were randomly divided into three groups (placebo, ondansetron and atropine group). Patients who had taken hypnotic drugs while entering the operating room were excluded. In all patients, after arriving into the operating room and installation of standard monitoring equipment and peripheral vein implantation, anesthesia was induced by receiving 0.05 mg/kg midazolam, fentanyl 1 μg/kg and propofol 2.5 mg/kg. After induction of anesthesia, placebo group was compared with ondansetron group and atropine group that received 0.1 mg/kg ondansetron and 30 µg/kg atropine, respectively. The rate of postoperative nausea and vomiting, duration of recovery stay and satisfaction of recovery nurses were recorded and compared between groups.
Results: There was no statistically significant difference between the three groups in terms of mean age, weight, and gender. It seems that group matching is appropriate and there are no confounding factors for demographic variables. Administration of atropine and ondansetron significantly reduces the incidence of nausea and vomiting postoperatively and in recovery. There was no significant difference in the incidence of nausea and vomiting between the atropine and ondansetron groups. Duration of recovery stay was decreased after ondansetron and atropine administration versus control group. Postoperative laryngospasm and bronchospasm were not observed in any of the three groups after surgery and at the time of recovery. The satisfaction of recovery nurses in both atropine and ondansetron groups were higher than control group.
Conclusion: It seems that the administration of atropine as much as ondansetron can be effective in reducing the incidence of postoperative nausea and vomiting and the length of recovery stay in patients who undergoing strabismus surgery.
Fahimeh Ghotbizadeh Vahdani , Zahra Panahi , Maryam Tahani , Roya Ghiaghi ,
Volume 77, Issue 11 (2-2020)
Volume 77, Issue 11 (2-2020)
Abstract
Background: Cervix insufficiency is diagnosed based on a previous history of pregnancy loss in the second trimester, followed by painless cervical dilatation or premature rupture of the fetal membranes. Abnormal cervical tissue structural appears to be the cause of this complication. There are no diagnostic methods for cervical insufficiency before pregnancy, but magnetic resonance imaging (MRI), hysterosalpingography, and ultrasound can detect uterine anomalies that are risk factors for cervical insufficiency. Cerclage is known as a common procedure for prevention of the preterm labor, caused by cervix insufficiency. This study aimed to evaluate the prevalence of cerclage and it’s complications and prognosis based on the patient’s age, history of cervical insufficiency, history of preterm labor, history of miscarriage, curettage, and cervical and vaginal abnormalities.
Methods: A retrospective cohort study was conducted, including 65 patients, from March 2012 to March 2018, in Valiasr Hospital, Tehran, Iran. Data including the age, history of cervical insufficiency, history of abortion, history of cervix surgery and curettage, gestational age, presence of vaginal and cervical anomaly as well as complications such as bleeding and severe cervical pain and prognosis of cerclage were extracted.
Results: In our study, 65 women who undergone cerclage were evaluated, the mean age of the participants was 28.4 years. Abortion was present in 27.7% of cases, 16.9% once, 7.7% twice and 3.1% three times. In 21.5% of cases, there was a history of curettage and 66.2% had a history of preterm labor. For 4.6% of the subjects, the length of cervix was under 10 mm. Gestational age at the end of cerclage was under 26 weeks in 5.8% of patients. The termination of pregnancy was higher in patients with lower gravida, and the termination of pregnancy was significantly higher in those who were not curetted (P= 0.001). There were no complications, and the prognosis is considered good, in case the termination is above 32 weeks. The birth weight mean was 3041.5 grams. According to our study, the failure of the cerclage is associated with previous history of dilation and curettage (D&C) and higher gravidity.
Conclusion: Putting all the results together, 80% of the cerclage, performed in our institution were successful, without any complications.
Methods: A retrospective cohort study was conducted, including 65 patients, from March 2012 to March 2018, in Valiasr Hospital, Tehran, Iran. Data including the age, history of cervical insufficiency, history of abortion, history of cervix surgery and curettage, gestational age, presence of vaginal and cervical anomaly as well as complications such as bleeding and severe cervical pain and prognosis of cerclage were extracted.
Results: In our study, 65 women who undergone cerclage were evaluated, the mean age of the participants was 28.4 years. Abortion was present in 27.7% of cases, 16.9% once, 7.7% twice and 3.1% three times. In 21.5% of cases, there was a history of curettage and 66.2% had a history of preterm labor. For 4.6% of the subjects, the length of cervix was under 10 mm. Gestational age at the end of cerclage was under 26 weeks in 5.8% of patients. The termination of pregnancy was higher in patients with lower gravida, and the termination of pregnancy was significantly higher in those who were not curetted (P= 0.001). There were no complications, and the prognosis is considered good, in case the termination is above 32 weeks. The birth weight mean was 3041.5 grams. According to our study, the failure of the cerclage is associated with previous history of dilation and curettage (D&C) and higher gravidity.
Conclusion: Putting all the results together, 80% of the cerclage, performed in our institution were successful, without any complications.
Mohsen Sheykhhasan, Hossein Bakhtiari Pak , Mohammad Bakhtiari Pak , Naser Kalhor ,
Volume 77, Issue 12 (3-2020)
Volume 77, Issue 12 (3-2020)
Abstract
Background: One of the most significant factors in the success of dental implant procedures, can be mentioned by the quality and quantity of jaw bone. The occurrence of some problems such as trauma, infection, pathological lesions and the long-term absence of teeth in patients, it causes irregularities in the jaw bone and can get bone resorption. Sever defects after trauma or tumor resection needs bone reconstruction. Sticky bone is a new biological agent that provides stabilization of bone graft in the defect, and therefore, ameliorates tissue repairing and decreases bone loss during healing period. In this study, the evaluation of sticky bone performance to reconstruction of defects in two patients jaw's bone was considered.
Case Presentation: Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.
Conclusion: The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.
Case Presentation: Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.
Conclusion: The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.
Ezzatollah Rezaei, Mahmoud Reza Kalantari , Sahar Fereydouni, Kamrooz Pouryousef,
Volume 79, Issue 8 (11-2021)
Volume 79, Issue 8 (11-2021)
Abstract
Background: Surgical margin determination in malignant lesions is essential and has a direct impact on the choice of postoperative treatments and patient follow-up. Therefore, the processes affecting this variable are worth exploring. This study aimed to evaluate the difference in surgical margin values in excisional skin samples during surgery and after formalin fixation.
Methods: A cross-sectional study was performed on forty randomly selected patients with benign and malignant skin lesions who were referred to the plastic surgery ward of Ghaem Hospital in Mashhad from November 2018 to January 2019. Malignant and benign skin lesions were excised with a healthy margin, then the specimens were sent to the pathologist in a formalin-containing container. The amount of tissue shrinkage and the factors affecting them were compared.
Methods: A cross-sectional study was performed on forty randomly selected patients with benign and malignant skin lesions who were referred to the plastic surgery ward of Ghaem Hospital in Mashhad from November 2018 to January 2019. Malignant and benign skin lesions were excised with a healthy margin, then the specimens were sent to the pathologist in a formalin-containing container. The amount of tissue shrinkage and the factors affecting them were compared.
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Results: Among all 40 participants about 57.5% of the them were male and 42.5% were female. The mean age of the patients was 66.55±14.53 years. Surgical margin was evaluated in three patterns: before surgical incision and after surgical incision (P<0.001), before surgical incision and after formalin fixation (P<0.001), after surgical incision and after formalin fixation (P=0.02). In this study, the relationship between the age and initial length of the skin lesion with sample shrinkage was not statistically significant.
Conclusion: The results of this study showed that tissue shrinkage occurs both after incision and after formalin fixation. The highest rate of shrinkage was seen after surgical excision, which was due to the elasticity of the tissue itself. Increasing age and initial length of skin lesion did not affect this shrinkage. Also tumoral tissue contracted less than healthy tissue due to flexibility of fatty tissue and water and lipid content. |
Leila Sadati, Peigham Heidarpoor, Babak Sabet , Shahram Yazdani ,
Volume 80, Issue 5 (8-2022)
Volume 80, Issue 5 (8-2022)
Abstract
Background: The training and education of competent and qualified surgeons have been one of the challenges of the surgical profession. The concept of surgical competence has been affected widely due to a series of developments in the new disease emergence, various surgical techniques and the introduction of advanced tools and equipment into the operating. The development of surgical competence and achieving this goal requires accurate identification and analysis of the dimensions of competence. This study was done to explain the concept of surgical competence using the 8-step Walker and Avant approach.
Methods: This study is a qualitative study that was conducted from May- October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eight-step approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it.
Methods: This study is a qualitative study that was conducted from May- October 2016 at Shahid Beheshti University of Medical Sciences. The present study is a qualitative and conceptual analysis study, which is done with Walker&Avant's eight-step approach to determine the defining characteristics of the concept of surgical competence. A systematic search was conducted between 1990 and 2020 by keywords search such as surgery, surgical, operation OR laparoscopy AND competence competency development competency proficient, proficiency, expertise, clinical, in the database like Google Scholar, PubMed, SID, Magiran, Scopus, Web of Science. Twenty articles were included in the study based on inclusion and exclusion criteria. Moreover, the defining features of the concept were extracted from it.
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Results: Based on the results of this study, the concept of surgical competence was defined and the four dimensions of elements, goals, components and the process of developing surgical competence were identified. Then, by clarifying the characteristics of surgical competence, a model of surgical competence development was drawn. Surgical competence development depends on the acquisition of specialized knowledge and numerous skills that are acquired through experience and deliberated practice under the supervision of others in the surgical community of practice and over time.
Conclusion: Surgical competence is a set of observable and measurable skills that allows a surgeon to manage the surgical process independently pbt while maintaining the patient's safety. It includes specialized knowledge, communication skills, cognitive and technical skills, and basic surgical skills. |
Vahid Malekzadeh, Shadi Sheikhizadeh , Mohadeseh Taklo, Hossein Jamalifar, Younes Ghaseminezhad Koshali , Hassan Khorramian, Hossein Naseri ,
Volume 82, Issue 2 (5-2024)
Volume 82, Issue 2 (5-2024)
Abstract
Background: Considering the emergence of new diseases, increased prevalence of nosocomial infections, and microbial resistance in recent years, it is necessary to disinfect the hands with a suitable hand sanitizer, as instructed by the Center for Disease Control (CDC). This is because hand hygiene is the most important way to control infections. Surgical hand antisepsis protocols emphasize the importance of both mechanical cleaning and antimicrobial action to effectively eliminate microbial contamination. Recommendations from organizations such as the Association of Perioperative Registered Nurses (AORN), the World Health Organization (WHO), and the Association for Professionals in Infection Control and Epidemiology (APIC) underscore this principle. While routine handwashing removes visible debris and transient microbes, surgical hand antisepsis requires additional steps and the use of antimicrobial agents. This may involve a surgical scrub with an antimicrobial soap or the application of an alcohol-based hand rub (ABHR). The latter approach has demonstrated greater efficacy in reducing microbial contamination compared to soap and water alone. Since a few compressive studies in Iran have dealt with global standards for disinfectants, this study investigated the effects of surgical scrub based on the European standards with TGSept AL Plus, produced by the research team of Tajhiz Gostar Sharif , on normal flora of hands in a group of the operating room medical staff in Hazrat Fatemeh Plastic Surgery and Repair Hospital of Tehran, in 2023.
Methods: This study evaluated the short-term durability and effectiveness of this solution according to the EN12791 standard on microorganisms and microbial contamination reduction. To this end, 30 members of the surgical team were randomly selected. The bacterial sampling was performed three times: after washing the hands with common detergents, after hand scrubbing with the studied disinfectant (about 90 seconds), and three hours after surgery. The samples were immediately transferred to a laboratory for swap culture and pour plate test.
| Results: Then bacterial colonies were counted, contamination reduction was measured, and the shelf life of the solution was determined according to the standards. Results showed that a 60-to-90-second scrub with an alcohol-based disinfectant is the best way to reduce hand contamination and, thereby, nosocomial infections. Conclusion: Based on the study findings, alcohol-based solutions can be recommended for surgical scrubs, according to WHO guidelines. |
Reihane Chegini , Seyed Hasan Seyed Sharifi , Rasul Nikdel ,
Volume 82, Issue 5 (8-2024)
Volume 82, Issue 5 (8-2024)
Abstract
Background: Benign tumors of the gastrointestinal tract with a muscular origin are typically found in the esophagus, stomach, or small intestine, and rarely in the large intestine. Approximately 3% of all gastrointestinal leiomyomas occur in the large intestine, primarily in the descending colon and sigmoid colon. These lesions are usually asymptomatic and are often discovered during endoscopic procedures.
Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.
Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.
Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma.
Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications.
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Iraj Nazari, Seyed Masood Mousavi, Ali Asghar Dastyar , Shaghayegh Sherafatmand , Ali Saeidi,
Volume 82, Issue 8 (11-2024)
Volume 82, Issue 8 (11-2024)
Abstract
Background: Vascular trauma is a life-threatening emergency and the third leading cause of death worldwide. Due to the frequency and importance of distal lower extremity artery injury in lower extremity trauma, the present study aimed to investigate the outcomes of vascular surgical interventions in patients with non-penetrating arterial trauma of the distal lower extremity (sub-trifurcation).
Methods: In this retrospective study, trauma patients with suspected non-penetrating injuries of the lower extremity arteries (sub-trifurcation) who referred to the Vascular Surgery Center of Golestan Hospital, Ahvaz, between September 2021 to September 2023 were evaluated. Data included demographic information, duration of surgery, length of hospitalization, and side effects of surgery.
| Results: Of the total of 86 patients, 76 patients (88.4%) were treated with open surgery. 83.7% of patients (72) were male and in the age range of 30-35 years. The most common surgical method used was bi-artery repair (92.3%). The most complications were in the bi-artery bypass repair method, but only the results of nerve involvement and limb preservation in the Ligation repair or bypass two artery intervention showed a statistically significant difference in the first week after surgery (P=0.05). Among patients, only two cases of mortality were observed one week after surgery, which was in the bi-artery repair group. (5.1%). The bi-artery repair intervention method was the best and least complicated surgical method among patients with vascular injury under blunt trauma. Conclusion: According to the results of this study, the bi-artery repair intervention method had the lowest rate of other complications and was the best and least complicated surgical method among patients with vascular injury under blunt trauma. |
Nazila Farnosh, Abdolreza Roueintan, Seyd Ebrahim Hejazian, Khadijeh Ezoji , Fatemeh Abdullah Gorji , Sadrollah Motamed,
Volume 82, Issue 9 (12-2024)
Volume 82, Issue 9 (12-2024)
Abstract
Background: Introduction & Objective: Reductive mammoplasty, which is performed for medical or cosmetic reasons, can be carried out with different techniques. In this study, we compare the results obtained from vertical mammoplasty surgery with reverse T method and purse method in patients.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Ramyar Rahimi Darehbagh , Ebrahim Khajeh, Daem Roshani , Farhang Safarnejhad,
Volume 82, Issue 12 (3-2025)
Volume 82, Issue 12 (3-2025)
Abstract
Background: Surgical site infections (SSIs) represent one of the most common and significant complications following surgical interventions. These infections not only prolong hospital stay and recovery but also impose a considerable economic burden on healthcare systems and patients. Reducing the risk of SSIs is therefore a major focus of perioperative care, and several strategies have been proposed to minimize their occurrence. One of the most widely practiced preventive measures is preoperative skin antisepsis, aimed at lowering the microbial load at the surgical site. Among available antiseptics, chlorhexidine has been shown to have broad-spectrum antimicrobial activity and sustained effectiveness. This study was designed to evaluate the effect of preoperative chlorhexidine showers on the incidence of SSIs in patients undergoing elective inguinal hernia surgery.
Methods: A randomized clinical trial was carried out in 2019 at Kowsar Hospital, Sanandaj. A total of 300 patients scheduled for elective inguinal hernia repair were enrolled and randomly assigned into three groups of 100 participants each. The intervention group was instructed to take a shower with 4% chlorhexidine solution on the night before surgery. Control group 1 took a routine bath using regular detergents, while control group 2 did not bathe prior to the operation. All patients were monitored for the occurrence of superficial SSIs for up to 30 days postoperatively.
Results: Among the 300 patients included in the study, 12 cases (4%) of superficial SSIs were documented. The distribution of infections varied significantly across the groups: one case in the chlorhexidine group, three cases in the regular detergent group, and eight cases in the group that did not shower. Statistical analysis confirmed that the difference in infection rates among the groups was significant (P=0.034).
Conclusion: The findings of this clinical trial demonstrate that preoperative showers with 4% chlorhexidine solution are effective in reducing the incidence of SSIs in patients undergoing elective inguinal hernia surgery. Implementing this simple, low-cost intervention may therefore be a valuable strategy in routine surgical practice to enhance patient outcomes and reduce postoperative complications.
Seyed Mohammad Hosseini , Saba Mohammadalizadeh , Sanaz Arvin,
Volume 83, Issue 2 (5-2025)
Volume 83, Issue 2 (5-2025)
Abstract
Background: Adenoid cystic carcinoma (ACC) is a rare neoplasm of the major salivary glands, characterized by a slow-growing tumor, wide local infiltration, perineural spread, a propensity to local recurrence and distant metastasis, and has a poor prognosis. Although surgery and radiotherapy are considered standard treatments, the role of systemic therapy in advanced and metastatic stages remains unclear and rarely results in complete remission. Due to the rarity and limited number of reported cases, here, we report a complete response with systemic treatment in a case of metastatic ACC of the salivary gland.
Case Presentation: The patient is a 50-year-old woman with a history of ACC of the submandibular salivary gland at 20 years old. No recurrence of the disease was observed until, at 47 years old, when metastatic adenocarcinoma with salivary gland origin was diagnosed. From the age of 47 to 50 years, multiple cervical lymph node involvement, multiple masses in the parotid gland and thyroid tissue, as well as distant metastasis to the breast, ovary, and lungs were observed. The patient underwent cervical lymphadenectomy, total parotidectomy, and several courses of radiotherapy and chemotherapy. After six cycles of the Bevacizumab + Adriamycin + Cisplatin regimen, radiologic evaluation confirmed a complete response to the treatment with the disappearance of pulmonary nodules and parotid lesions. The patient is currently under follow-up.
Conclusion: Our reported case shows the aggressive nature of recurrent metastatic ACC of the salivary gland and the positive effect and importance of systemic treatment in these patients. Because the metastasis can appear very slowly, early diagnosis is essential for a better prognosis. These rare malignant lesions should be followed up for a long time after initial treatment due to slow growth, frequent recurrence and late and distant metastasis possibility. This case highlights the potential of systemic therapy to induce complete response even in extensively metastatic disease, suggesting that further clinical trials may be warranted.
Case Presentation: The patient is a 50-year-old woman with a history of ACC of the submandibular salivary gland at 20 years old. No recurrence of the disease was observed until, at 47 years old, when metastatic adenocarcinoma with salivary gland origin was diagnosed. From the age of 47 to 50 years, multiple cervical lymph node involvement, multiple masses in the parotid gland and thyroid tissue, as well as distant metastasis to the breast, ovary, and lungs were observed. The patient underwent cervical lymphadenectomy, total parotidectomy, and several courses of radiotherapy and chemotherapy. After six cycles of the Bevacizumab + Adriamycin + Cisplatin regimen, radiologic evaluation confirmed a complete response to the treatment with the disappearance of pulmonary nodules and parotid lesions. The patient is currently under follow-up.
Conclusion: Our reported case shows the aggressive nature of recurrent metastatic ACC of the salivary gland and the positive effect and importance of systemic treatment in these patients. Because the metastasis can appear very slowly, early diagnosis is essential for a better prognosis. These rare malignant lesions should be followed up for a long time after initial treatment due to slow growth, frequent recurrence and late and distant metastasis possibility. This case highlights the potential of systemic therapy to induce complete response even in extensively metastatic disease, suggesting that further clinical trials may be warranted.
Reza Saeidi , Mahboobe Gholami,
Volume 83, Issue 4 (7-2025)
Volume 83, Issue 4 (7-2025)
Abstract
Background: Neonatal circumcision is one of the most common surgical procedures worldwide, performed for cultural, religious, and health-related reasons. The two primary methods for neonatal circumcision are the classic surgical method (using sutures or clamps such as Gomco or Mogen) and the plastic ring method (e.g., Plastibell). This systematic review and meta-analysis aimed to compare the benefits and complications of these two methods in neonates.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases for articles published between 2000 and 2024. Inclusion and exclusion criteria: Included studies included randomized controlled trials (RCTs), cohort studies, and cross-sectional studies that compared the benefits and harms of classical surgery and plastic ring in infants (<28 days). Studies without a comparison group, studies conducted in older children or adults, and articles that did not provide sufficient data were excluded. Keywords included "neonatal circumcision", "plastic ring", "Plastibell", "classical surgery", "Gomco clamp", "Mogen clamp", "benefits", "complications" and their English equivalents.
Studies comparing the benefits and complications of the classic surgical method and the plastic ring method in neonates were included. Data were meta-analyzed using a random-effects model, and risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results: From a total of 12 included studies (involving 5,342 neonates), the plastic ring method was associated with a significant reduction in bleeding (RR: 0.45; 95% CI: 0.32-0.64) and healing time (mean difference: -2.3 days; 95% CI: -3.1 to -1.5) compared to the classic surgical method. However, the risk of skin adhesion was higher with the plastic ring method (RR: 1.32; 95% CI: 1.05-1.66). Serious complications, such as urethral injury, were rare in both methods (less than 0.2%).
Conclusion: The plastic ring method is a suitable option for neonatal circumcision due to its ease of use, reduced bleeding, and faster healing time. However, careful post-procedural care is essential to minimize the risk of skin adhesion. The choice of method should consider the operator’s expertise and parental preferences.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases for articles published between 2000 and 2024. Inclusion and exclusion criteria: Included studies included randomized controlled trials (RCTs), cohort studies, and cross-sectional studies that compared the benefits and harms of classical surgery and plastic ring in infants (<28 days). Studies without a comparison group, studies conducted in older children or adults, and articles that did not provide sufficient data were excluded. Keywords included "neonatal circumcision", "plastic ring", "Plastibell", "classical surgery", "Gomco clamp", "Mogen clamp", "benefits", "complications" and their English equivalents.
Studies comparing the benefits and complications of the classic surgical method and the plastic ring method in neonates were included. Data were meta-analyzed using a random-effects model, and risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results: From a total of 12 included studies (involving 5,342 neonates), the plastic ring method was associated with a significant reduction in bleeding (RR: 0.45; 95% CI: 0.32-0.64) and healing time (mean difference: -2.3 days; 95% CI: -3.1 to -1.5) compared to the classic surgical method. However, the risk of skin adhesion was higher with the plastic ring method (RR: 1.32; 95% CI: 1.05-1.66). Serious complications, such as urethral injury, were rare in both methods (less than 0.2%).
Conclusion: The plastic ring method is a suitable option for neonatal circumcision due to its ease of use, reduced bleeding, and faster healing time. However, careful post-procedural care is essential to minimize the risk of skin adhesion. The choice of method should consider the operator’s expertise and parental preferences.
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