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Fulltext An early single institutional experience in sutureless total thyroidectomy

Nani Harlina ML, Naqiyah I, Shahrun Niza AS, Jasmi AY, Rohaizak M

Med J Malaysia, 2012 Apr;67(2):177-80.
PMID: 22822639 MyJurnal
Matched MeSH terms: Postoperative Complications
Fulltext Daycare tonsillectomy: a safe outpatient procedure. Hospital Sultanah Bahiyah, Alor Setar Malaysia experience

Nurliza I, Norzi G, Azlina A, Hashimah I, Sabzah MH

Med J Malaysia, 2011 Dec;66(5):474-8.
PMID: 22390104 MyJurnal

OBJECTIVE: We present our experience with daycare tonsillectomy and evaluate patient satisfaction and the post operative complication rate.
METHODS: A prospective audit review of 38 patients from March 2009 till May 2010 was conducted in our ambulatory care center.
RESULTS: There were 38 patients involved in this review. All patients were satisfied with our Ambulatory care services. No admission was reported after daycare tonsillectomy.
CONCLUSION: Daycare tonsillectomy with or without adenoidectomy is safe. It can reduce the waiting time and also bed occupancy thus cost effective. Proper selection of patient is very important.

Matched MeSH terms: Postoperative Complications
Fulltext Safety of thoracic pedicle screw application using the funnel technique in Asians: a cadaveric evaluation

Chan CY, Kwan MK, Saw LB

Eur Spine J, 2010 Jan;19(1):78-84.
PMID: 19763636 DOI: 10.1007/s00586-009-1157-8

The objective of this cadaveric study is to determine the safety and outcome of thoracic pedicle screw placement in Asians using the funnel technique. Pedicle screws have superior biomechanical as well as clinical data when compared to other methods of instrumentation. However, misplacement in the thoracic spine can result in major neurological implications. There is great variability of the thoracic pedicle morphometry between the Western and the Asian population. The feasibility of thoracic pedicle screw insertion in Asians has not been fully elucidated yet. A pre-insertion radiograph was performed and surgeons were blinded to the morphometry of the thoracic pedicles. 240 pedicle screws were inserted in ten Asian cadavers from T1 to T12 using the funnel technique. 5.0 mm screws were used from T1 to T6 while 6.0 mm screws were used from T7 to T12. Perforations were detected by direct visualization via a wide laminectomy. The narrowest pedicles are found between T3 and T6. T5 pedicle width is smallest measuring 4.1 +/- 1.3 mm. There were 24 (10.0%) Grade 1 perforations and only 1 (0.4%) Grade 2 perforation. Grade 2 or worse perforation is considered significant perforation which would threaten the neural structures. There were twice as many lateral and inferior perforations compared to medial perforations. 48.0% of the perforations occurred at T1, T2 and T3 pedicles. Pedicle fracture occurred in 10.4% of pedicles. Intra-operatively, the absence of funnel was found in 24.5% of pedicles. In conclusion, thoracic pedicle screws using 5.0 mm at T1-T6 and 6.0 mm at T7-T12 can be inserted safely in Asian cadavers using the funnel technique despite having smaller thoracic pedicle morphometry.

Matched MeSH terms: Postoperative Complications/etiology; Postoperative Complications/physiopathology; Postoperative Complications/prevention & control*
980-nm laser therapy versus varicose vein surgery in racially diverse Penang, Malaysia

Lakhwani MN, Dadlani NI, Wong YC

ANZ J Surg, 2009 May;79(5):352-7.
PMID: 19566516 DOI: 10.1111/j.1445-2197.2009.04888.x

Chronic venous disorders are conditions of increasing prevalence in the developing world, and venous ulceration is the terminal sequel. Currently there are only limited data on all aspects of this from Southeast Asia. The aim of the present study was to assess differences in the demography and outcome between varicose vein surgery (VVS) and the relatively new endovenous laser therapy (EVT) in patients from Penang, Malaysia.

Matched MeSH terms: Postoperative Complications
Combined large radial retinotomy and circumferential retinectomy in the management of advanced proliferative vitreoretinopathy

Lim AK, Alexander SM, Lim KS

Retina, 2009 Jan;29(1):112-6.
PMID: 18784619 DOI: 10.1097/IAE.0b013e318187f14a
Matched MeSH terms: Postoperative Complications
Fulltext Parotid mass: a 5-year review of parotid surgery

Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2007 Dec;62(5):388-9.
PMID: 18705472

This study is to analyze the incidence of facial nerve paralysis after parotidectomy and the type of pathologic condition involved in Hospital Pakar Sultanah Fatimah, Muar between 2002 and 2006. There were 20 parotidectomies done on 20 patients over this period of time. Fourteen were done for tumour and six for inflammatory conditions. The pathology involved were pleomorphic adenoma 9 (45%) cases, Kimura disease 2 (10%) cases, carcinoma 5 (25%) cases and inflammatory condition 4 (20%) cases. Out of 20 parotidectomies done (13 for superficial and 7 for total), 4 (20%) patients had complication of facial nerve paralysis, 2 Malignant tumour, 1 benign tumor and 1 was inflammatory condition. In conclusion, preservation of the facial nerve and its function, wherever possible, is very important to reduce social and functional morbidity.

Matched MeSH terms: Postoperative Complications
Fulltext Dropped nucleus following phacoemulsification cataract surgery

Tajunisah I, Reddy SC

Med J Malaysia, 2007 Dec;62(5):364-7.
PMID: 18705466 MyJurnal

Twenty two cases of dropped nucleus following 1,196 phacoemulsification procedures in cataract surgery were examined retrospectively to determine the incidence, predisposing factors and visual outcomes of this dreaded complication. All the cases underwent pars plana vitrectomy and the lens fragments were removed with phacofragmotome, vitrectomy cutter or delivered through limbus. The incidence of dropped nucleus was 1.84%. The predisposing factors were hard cataracts (13.6%), polar cataracts (9.1%), previously vitrectomized eyes (4.5%) and high myopia (4.5%). The final visual outcome was > or = 6/12 in 10 eyes (45.5%); complications were seen in 5 eyes (22.7%). The interval between initial surgery and vitrectomy, the method of fragment removal and the type of lens implanted, did not influence the final visual outcome.

Matched MeSH terms: Postoperative Complications
Fulltext The transcolumellar transsphenoidal approach to pituitary tumours: advantanges and limitations

Gendeh BS, Sakina MS, Selladurai BM, Jegan T, Misiran K

Med J Malaysia, 2006 Aug;61(3):349-54.
PMID: 17240588

A retrospective review was performed on 11 patients who had undergone the transcolumellar transsphenoidal hypophysectomy in our center. There were eight females and three males with age ranging from 17 to 72 years (mean 50 years). Ten patients had pituitary macroadenomas and one had suprasellar cyst. The mean follow up duration for these 11 patients post surgery was 7.2 months. Complications included two cerebrospinal leaks, one postoperative sphenopalatine bleed, one septal perforation and one patient developed numbness of the tip of the nose. We found that this approach is a preferred alternative technique especially in smaller Oriental noses with lower complication rate and better aesthetic result.

Matched MeSH terms: Postoperative Complications
Fulltext The role of endoscopic endonasal approach to pituitary tumours: HUKM experience

Gendeh BS, Doi M, Selladurai BM, Khalid BA, Jegan T, Misiran K

Med J Malaysia, 2006 Aug;61(3):343-8.
PMID: 17240587

Surgery for pituitary tumours at our institution was performed by rhinosurgical route by combined procedure by otolaryngologist and neurosurgeons. A retrospective review of case records of patients who had endonasal endoscopic transphenoidal approach for pituitary tumours from September 1998 to December 2004 was performed. A total of 81 trans-sphenoidal surgeries were performed during this study period. Only 68 case records with adequate information were available for review, 56 patients were included in the study and 12 were excluded. There were 24 males (42%) and 32 females (58%). The ethnic distribution, were 29 Malays, 24 Chinese, 2 Indian and 1 others. The age ranged from 16 years to 76 years, with a mean of 46 years. The majority of our patients presented with visual symptoms (38), headache (28), menstrual cycle disturbance or impotence (14) and acromegalic features (16). Forty patients had macroadenoma (71%) and 16 had microadenomas (29%). Thirty-six patients out of 40 macro-adenomas had suprasellar extensions (90%). Only eleven patients had lumbar drain inserted prior to commencement of the surgery and the majority of these were macroadenomas. The common complications encountered were diabetes insipidus (4), cerebrospinal fluid leak (2), meningitis (3), epistaxis (2), septal perforation (2), intercavernous sinus haemorrhage (3) and anterior pituitary insufficiency (2). Our study reveals that endonasal trans-sphenoidal approach is a safe and effective method of management of pituitary adenomas.

Matched MeSH terms: Postoperative Complications
Fulltext Surgical outcome of patients with hyperparathyroidism in a non-specialist surgical ward

Roslani AC, Chang NL

Med J Malaysia, 2006 Oct;61(4):410-5.
PMID: 17243517

Aim of the study was to audit patients who had undergone parathyroidectomy in University of Malaya Medical Centre (UMMC), and compare surgical outcomes with that in the literature. Data on demography, aetiology, surgical indications, pre-operative localization, surgery and complications was obtained retrospectively from medical records of patients undergoing parathyroidectomy between 1st October 2000 to 31st October 2005. Twelve patients were identified. Mean age was 50.6 years. Sixty seven percent were females. The ratio of Chinese, Malays and Indians was 7:4:1. Most surgeries were performed in the last two years (91.7%). Aetiology was mainly tertiary hyperparathyroidism (83%). All patients had pre-operative ultrasound localization. Half underwent total parathyroidectomy without autotransplantation. There were no re-do operations. Mean duration of surgery was 1.96 hours. All patients had abnormal calcium levels at some point following surgery, but 90% were normocalcaemic at last follow up. Other complications were recurrent laryngeal nerve injury (one) and wound infection (one). There were no peri-operative mortalities. The mean duration of hospital stay was 7.75 days (range 3-17 days). The median duration of follow-up was 11 months. The outcome of parathyroidectomy in UMMC is satisfactory with few major complications. Despite this, intensive effort is needed to further improve these results to match those obtained in specialist endocrine centres.

Matched MeSH terms: Postoperative Complications
Massive dissecting intramural duodenal haematoma following endoscopic haemostasis of a bleeding duodenal ulcer

Lukman MR, Jasmi AY, Niza SS

Asian J Surg, 2006 Apr;29(2):98-100.
PMID: 16644511

Intramural duodenal haematoma is a rare injury of the duodenum. Most reported cases are secondary to blunt trauma to the abdomen. Such injury following endoscopic intervention is even rarer, and there are no definite guidelines for its management. We report a case where endoscopic haemostasis of a bleeding duodenal ulcer resulted in a massive dissecting intramural duodenal haematoma with gastric outlet obstruction and obstructive jaundice.

Matched MeSH terms: Postoperative Complications
Fulltext Endovascular stent graft repair of aorto-iliac pseudoaneurysms - Hospital Kuala Lumpur experience

Khang NC, Zainal AA

Med J Malaysia, 2016 02;71(1):17-22.
PMID: 27130738

BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair.

METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined.

RESULTS: The average age was 59.1 years (range 36-77). Comorbidities include hypertension, diabetes mellitus, tuberculosis, prior infection and previous open aneurysmal repair. All patients had raised WBC (>10.0x10(9) /L), ESR or Creactive protein on admission while 50% of patients had fever. Blood cultures were positive in 4 patients. All patients were given antibiotics. Only one in-hospital mortality was noted at day-47 post-procedure. Two patients died of aortoenteric fistula at district hospital eight and 16 months later. One patient died of chronic graft infection two years later. One died of unrelated cause. One patient developed type IB endoleak from internal iliac artery two years later and surgical ligation was performed. The average follow up was 15.8 months.

CONCLUSION: Endovascular stent graft repair for pseudoaneurysm is a viable option compared to open surgery. It is less invasive, has lower operative morbidity and fair outcomes. However, some cases may be due to inflammatory aortitis instead of infective pseudoaneurysm, given the frequent culture-negative results. In order to obtain high yield of bacteria culture for infected pseudoaneurysm, open repair with tissue culture is still the main mode of treatment especially for patients with low comorbidity.

Matched MeSH terms: Postoperative Complications
Comparison of features and outcomes of perforated peptic ulcer between Malaysians and foreigners

Kugan V, Mahadevan DT, Kandasami P

Med J Malaysia, 2016 02;71(1):12-6.
PMID: 27130737

BACKGROUND: Perforated peptic ulcers (PPU) present as serious surgical emergencies that carry high mortality and morbidity. Foreigners with PPU are also managed in our hospital setting. Their inclusion significantly alters the trend and pattern of PPU seen in Malaysia.
AIM: To compare per-operative and post-operative features and outcomes of perforated peptic ulcers between Malaysians and foreigners.
MATERIAL AND METHODS: This was an analytical crosssectional study. All patients who underwent repair of perforated peptic ulcer disease during a 6-year period were included. 50 consecutive patients' records with perforated peptic ulcer were analysed. Data were collected from operation theatre database and hospital medical records. Chi square and t test were performed using SPSS statistical software.
RESULTS: Total of 50 patients, of which 30 were Malaysians and 20 were foreigners. The mean age of Malaysian patients was 58.3 ± 15.2 years whereas the mean age for foreign patients was 30.3 ± 6.7 years, with foreign patients being significantly younger than local patients. Foreigners had significantly smaller ulcers with only 5% of them having ulcers more than 1cm while 36.7% of Malaysian patients had ulcers more than 1cm. Post-operative complications are significantly higher in Malaysian patients (p<0.05) with 40% of Malaysian patients and 10% of foreign patients developing post-operative complications.
CONCLUSION: Foreign patients are younger with significantly smaller perforated ulcers and better post-operative outcomes.

Matched MeSH terms: Postoperative Complications
Meta-Analysis of Early Endoscopic Retrograde Cholangiopancreatography (ERCP) ± Endoscopic Sphincterotomy (ES) Versus Conservative Management for Gallstone Pancreatitis (GSP)

Burstow MJ, Yunus RM, Hossain MB, Khan S, Memon B, Memon MA

Surg Laparosc Endosc Percutan Tech, 2015 Jun;25(3):185-203.
PMID: 25799261 DOI: 10.1097/SLE.0000000000000142

The utility of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) in the treatment of gallstone pancreatitis (GSP) is still contentious.

Matched MeSH terms: Postoperative Complications
Fulltext The surgical outcome of degenerative lumbar spinal stenosis

Razak MA, Ong KP, Hyzan Y

Med J Malaysia, 1998 Sep;53 Suppl A:12-21.
PMID: 10968178

A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Twenty-five patients treated with decompressive surgery in Hospital Kuala Lumpur between January 1992 and August 1996 were reviewed. There were seven males and eighteen females. The average age was 51 years old (range 33 to 64 years old). The diagnosis of degenerative spinal stenosis was made based on the clinical features and was confirmed by radiographic findings. Ninety two percent of the patients had moderate to severe symptoms preoperatively. The types of surgery consisted of laminectomy (n = 15), laminotomy (n = 10), and laminoplasty (n = 1). The surgical outcomes were assessed based on patients' own assessment of symptoms relieved and functional returned to daily activities at least six months after the surgery. The average follow-up period was fifteen months (range 6 months to 42 months). Of these twenty-five patients, 4 (16%) claimed to have excellent results, 11 (44%) had good results, 8 (32%) reported fair, and 2 (8%) judged their surgical treatment as poor with little or no use. There was no anaesthetic, cardiovascular, or thromboembolic complications seen in this study. Four patients had recurrent claudication, one demonstrated localised arachnoiditis, and two had lumbar instability which were not documented preoperatively. One patient had L4 nerve root avulsion with dura torn and another patient had superficial wound infection. We concluded in this study that decompressive surgery offers satisfactory results in patients with moderate to severe degenerative spinal stenosis in short term follow-up.

Matched MeSH terms: Postoperative Complications
Fulltext Surgical treatment of acromio-clavicular dislocation

Leow HK, Hyzan Y, Gan EC, Hassan S

Med J Malaysia, 1998 Sep;53 Suppl A:71-6.
PMID: 10968185

Acromio-clavicular joint (ACJ) dislocation usually occurs in young adults following trauma or sports injury. Fourteen patients underwent surgical treatment for symptomatic total ACJ dislocation (Rockwood and Matsen Type III-VI) in our unit between January 1996 and June 1997. Eight patients were operated within three weeks of injury and six in the chronic period (after three weeks). In the acute group, two patients had Botsworth procedure and six had Weaver-Dunn operations. All six in the chronic group had Rockwood procedure. Nine patients achieved excellent outcome with full range of shoulder movement, pain free and return to work within three months of surgery. Two patients had good outcome. Three other patients had satisfactory outcome with tolerable pain and light duty at three months. Two patients developed chronic shoulder pain and one had painful hypertrophic surgical scar. Two patients had screw breakage requiring revision surgery. In conclusion, surgical treatment for ACJ dislocation produces good results. We suggest that surgical treatment be the treatment of choice for young patients requiring early recovery and good shoulder function.

Matched MeSH terms: Postoperative Complications
Fulltext Thoracoscopic sympathectomy for primary palmar hyperhydrosis: the Penang Hospital experience

Gooi BH, Manjit S, Premnath N

Med J Malaysia, 2002 Mar;57(1):66-9.
PMID: 14569720 MyJurnal

Background: Primary palmar hyperhidrosis is a functionally and socially disabling condition. The choice of treatment is controversial.
Objective: To examine the clinical presentation of primary palmar hyperhidrosis and the results of treatment with thoracoscopic sympathectomy in a local setting.
Materials and Methods: A retrospective study of 7 patients involving 10 sympathectomies between October 1997 and October 2000 was undertaken.
Results: The duration of anaesthesia ranged from 55 to 130 minutes with the majority being 1 hour. The immediate results were good, with all operated limbs dry soon after operation. There was no mortality or serious morbidity in this study. All were satisfied with the results of surgery.
Conclusions: Primary palmar hyperhidrosis is not uncommon but rather underdiagnosed. Thoracoscopic sympathectomy is an effective treatment with minimal complications.

Matched MeSH terms: Postoperative Complications
Fulltext Outpatient procedures for cervical dysplasia: a 3 year review of laser vaporisation and LEEP

Lee KE, Koh CF, Watt WF

Med J Malaysia, 1999 Mar;54(1):47-51.
PMID: 10972004

A 3 year retrospective review (1995 to 1997) of 127 patients with cervical dysplasia who underwent Laser Vaporisation of the cervix and LEEP at the Gynaecological Cancer Centre, KK Women's & Children's Hospital, Singapore, was undertaken. Amongst the patients in the Laser Vaporisation group, the mean age was 37.7 years (SD 8.8), the mean operating time was 14.8 minutes (SD 8.5), 63.6% were given prophylactic antibiotics and the mean follow up period was 15.3 months (SD 12.0), whilst in the LEEP group, mean age was 40.3 years (SD 8.4), mean operating time, 11.8 minutes (SD 4.9), prophylactic antibiotic rate, 53.8% and mean follow up period was 19.1 months (SD 9.3). Mild and moderate haemorrhage post procedure were the only complications encountered, 10.2% (5/49) in the Laser group and 3.8% (3/78) in the LEEP group. 98% (48/49) and 97.4% (76/78) of the Laser and LEEP groups, respectively, were free of disease on follow up. None of the 3 patients with persistent or recurrent disease were diagnosed as having invasive cancer. Overall, there were no significant differences in the patient characteristics, histopathology, operating times, follow up period, the use of prophylactic antibiotics, and complications in the 2 groups. The low complication rate, high disease-free rate and the relatively short operating time of Laser Vaporisation and LEEP in our study suggests that, indeed, both the procedures can be done safely and efficiently in the outpatient setting. However the discrepancy between the histology of colposcopically directed biopsy and that of LEEP specimens suggests that colposcopically directed biopsy may not be as accurate as one might believe, and further studies analysing the concordance between colposcopically directed biopsy and LEEP biopsy histologies are needed.

Matched MeSH terms: Postoperative Complications
The use of modified VBM laryngeal tube compared to Laryngeal Mask Airway during spontaneous ventilation

Chiu CL, Murugasu J, Chan L

Anaesth Intensive Care, 2003 Apr;31(2):187-92.
PMID: 12712784

We have compared the use of the laryngeal mask airway with the new modified laryngeal tube in a prospective randomized controlled study. Sixty ASA 1 or 2 patients, aged 18 to 65 years, scheduled for elective surgery and breathing spontaneously under general anaesthesia, were studied. After preoxygenation, anaesthesia was induced with fentanyl and propofol. The patients were randomized to receive either a laryngeal mask airway or a laryngeal tube. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. We recorded the speed and the ease of insertion, the number of attempts needed to successfully secure the airway and intraoperative complications, such as partial airway obstruction needing airway manipulation. The airway devices were removed with the patients fully awake at the end of surgery. Systolic arterial blood pressure, heart rate and end-tidal CO2 were recorded at various time intervals. Postoperative complications were recorded. We found that the incidence of partial airway obstruction needing intraoperative airway manipulation was higher with the laryngeal tube than with the laryngeal mask airway. We conclude that during spontaneous ventilation the modified laryngeal tube is not as reliable in providing a satisfactory airway and we consider it is not a suitable alternative to the laryngeal mask airway.

Matched MeSH terms: Postoperative Complications
Fulltext Conventional versus endoscopic inferior turbinate reduction: technique and results

Gendeh BS

Med J Malaysia, 2000 Sep;55(3):357-62.
PMID: 11200717

Different modalities of turbinate reduction procedures are available for treatment of vasomotor rhinitis not responding to appropriate medical therapy. Amongst these, conventional inferior turbinectomy (non-endoscopic) is the most widely performed procedure. With the advent of nasal endoscopes, inferior turbinoplasty has been gaining popularity worldwide. The purpose of this study was to compare the post-operative complaints and hospital stay of conventional versus endoscopic inferior turbinate reduction techniques performed non-randomly on 15 and 21 patients of vasomotor rhinitis respectively from January 1998 to December 1999 at Hospital Universiti Kebangsaan Malaysia (HUKM). A total of 36 patients (22 males and 14 females) with a mean age of 30.6 years underwent turbinate reduction procedures during this period with a post-operative follow up ranging from 3 months to 6.7 months (mean 3.8 months). There was a significant difference between the conventional and the endoscopic technique with regards to nasal discomfort (p = 0.05) and dry throat (p = 0.02) which was less severe when performed endoscopically. The average hospital stay in hours by the endoscopic technique was almost half compared to the conventional technique. Due to the improved visualisation and minimal post-operative complaints and reduced hospital stay, the technique of endoscopic inferior turbinoplasty is currently the procedure of choice at our center. In septoplasty when endoscopic instrument is not needed, the standard turbinate reduction procedure is still performed. The availability of pre and post-operative acoustic rhinomanometric evaluation will be helpful as an objective measurement of nasal symptoms in the near future.

Matched MeSH terms: Postoperative Complications

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