TITLE:
Evaluation of Intraoperative Iatrogenic Lesions and Postoperative Complications in 1140 Patients Treated for Carpal Tunnel Syndrome in the Orthopedic Surgery and Traumatology Department of the Moulins-Yzeure Hospital Center in France
AUTHORS:
Saint Luc Mungina Sedou, Charlène Tshitala, Jean-François Dumez, Issifou Moumouni, Kevin Ndangi, Kibadi Kapay
KEYWORDS:
Carpal Tunnel, Iatrogenic Complications, Patient Outcome, Surgical Treatment
JOURNAL NAME:
Surgical Science,
Vol.14 No.12,
December
21,
2023
ABSTRACT: Introduction: Carpal tunnel syndrome is a more
common form of upper limb canal syndrome, resulting from compression of the
median nerve in the carpal tunnel, but is particularly troublesome. Medical
treatment is often unsuccessful, and surgical treatment usually involves
transection of the annular ligament. The aim of this study was to assess
iatrogenic intraoperative and postoperative complications, as well as patient
outcomes following the use of conventional and endoscopic surgery in the
surgical management of carpal tunnel syndrome. Hypothesis: Are nerve, vascular
and tendon injuries of iatrogenic origin always present in the surgical management
of carpal tunnel syndrome, even though this surgery is performed on an
outpatient basis? Patients and methods: This retrospective series is composed
of 1140 patients, 230 men and 910 women, mean age 58.6 ± 16.4 years, operated on between 2010 and 2020 for
carpal tunnel syndrome by conventional surgery and under endoscopy. Medical
records, operative reports and consultation letters were consulted. All
patients were reviewed regularly at one month post-op until recovery. Results:
No nerve, vascular or tendon damage was noted, and at a maximum follow-up of 2
years, 20 patients had recurred, i.e.
a 2.51% failure rate. Scar disunion was observed in 0.9%, wound infection in
0.9% and scar fibrosis in 0.9%. 92.98% of patients underwent outpatient
surgery, irrespective of the type of anesthesia or surgical technique used.
Patients who stayed in hospital for a short time were suffering from carpal
tunnel syndrome associated with compression of the ulnar nerve in Guyon’s
canal, for which both the median and ulnar nerves were freed during the same
operation, under general anaesthetic. All patients were able to return to their
previous activity within 30 days of surgery. Conclusion: Intraoperative
iatrogenic complications, notably nerve, vascular and tendon lesions, were not
identified despite the large sample size. On the other hand, postoperative skin
complications related to scarring, such as wound disunion, fibrosis and
recurrence, were present despite low rates.