scholarly journals Transrectal endoscopic drainage with vacuum-assisted therapy in patients with anastomotic leaks following rectal cancer resection

2021 ◽  
Author(s):  
Mateusz Jagielski ◽  
Jacek Piątkowski ◽  
Grzegorz Jarczyk ◽  
Marek Jackowski
Keyword(s):  
Anastomotic Leakage ◽  
Endoscopic Treatment ◽  
Malignant Tumors ◽  
Vacuum Therapy ◽  
Endoscopic Drainage ◽  
Anastomotic Leaks ◽  
Rectal Tumors ◽  
Invasive Treatment ◽  
Protective Ileostomy ◽  
The Mean

Abstract Background Surgery is the gold standard for the treatment of malignant tumors of the rectum. Intestinal anastomotic leakage remains a serious complication of colorectal surgery. The efficacy and safety of transrectal endoscopic drainage by vacuum therapy in patients with intestinal anastomotic leakage after surgical treatment of middle and distal rectal tumors were assessed. Methods Prospective analysis of treatment outcomes among patients undergoing surgery for middle and distal rectal tumors at the Department of General, Gastroenterological, and Oncological Surgery of the Ludwik Rydygier Collegium Medicum in Bydgoszcz and Nicolaus Copernicus University in Torun from 2016 to 2019 was conducted. Results Seventy-nine patients with middle and distal rectal tumors underwent laparoscopic resection. Intestinal anastomotic leak was identified in 18 (22.79%) patients [all men, mean age 61.39 (43–86) years] during the postoperative period. Primary protective ileostomy was performed in 8/18 (44.44%) patients. All 18 patients were treated with endoluminal vacuum therapy via transrectal endoscopic drainage. The mean time from surgery to the diagnosis of leakage and initiation of endoscopic treatment was 16 (3–728) days. The mean number of endoscopic procedures per patient was 6 (1–11). The mean duration of endoscopic treatment was 22 (4–43) days. Complications of endotherapy occurred in 2/18 (11.11%) patients treated endoscopically for bleeding from the abscess cavity. Success of endoluminal vacuum therapy was achieved in 17/18 (94.44%) patients. Moreover, 5/18 (27.78%) patients required ileostomy during the endoscopic treatment. The mean follow-up period was 368 (118–724) days. Long-term success of transrectal endoscopic drainage using vacuum-assisted therapy was achieved in 15/18 (83.33%) patients. Conclusions Endoscopic rectal drainage using vacuum-assisted therapy is an effective and safe minimally invasive treatment in patients with intestinal anastomotic leaks following resection procedures within the middle and distal rectum.

scholarly journals Kis méretű vesedaganatok patológiai és biológiai jellemzőinek elemzése a tumorméret alapján

2021 ◽  
Vol 162 (42) ◽  
pp. 1693-1697
Author(s):  
Csaba Berczi ◽  
Zsolt Bacsó ◽  
László Bidiga ◽  
Judit Nagy ◽  
Tibor Flaskó
Keyword(s):  
Tumor Size ◽  
Malignant Tumors ◽  
Benign Lesion ◽  
Renal Tumors ◽  
Biological Behavior ◽  
Invasive Treatment ◽  
Renal Masses ◽  
Significant Difference ◽  
The Mean ◽  
Grade 3

Összefoglaló. Bevezetés: A kis méretű vesedaganatok között lényegesen gyakoribbak a benignus elváltozások, és a kis malignus tumorok biológiai tulajdonságai is kedvezőbbek, mint a nagyobb daganatokéi. Célkitűzés: Szerzők a kis méretű vesetumorok tulajdonságait vizsgáltuk különböző alcsoportokban. Módszer: 2000. január 1. és 2015. január 1. között 1272 beteg esetén végeztünk műtétet vesedaganat miatt. Közülük 496 betegnek volt kis méretű vesetumora. A betegek átlagéletkora 59 ± 12 év volt. A betegeket a tumorméret alapján három csoportba osztottuk. Az 1. csoportban a daganat mérete ≤4 cm, a 2. csoportban ≤3 cm és a 3. csoportban ≤2 cm volt. Eredmények: Az eltávolított daganat nagysága átlagosan 29 ± 8 mm volt. A szövettan 418 esetben (84%) malignus, míg 78 alkalommal (16%) benignus elváltozást mutatott. A 2 cm-nél kisebb daganatoknál malignitás csak az esetek 73,2%-ában fordult elő. A malignus és a benignus tumorok méretében szignifikáns eltérés volt (p = 0,008). Rosszul differenciált daganat – grade 3. és 4. – az esetek 10,8%-ában, 14,4%-ában, illetve 20,7%-ában volt jelen, amikor a tumorméret kisebb mint 2 cm, 2,1–3 cm, illetve 3,1–4,0 cm volt. A vesecarcinomáknál az átlagosan 10 éves utánkövetési idő alatt progresszió az esetek 5,5%-ában fordult elő. Következtetés: A kis méretű vesetumor az összes vesedaganat 39%-át tette ki. Ezek nagy része malignus volt, és benignus elváltozás az esetek 16%-ában fordult elő. A malignitás előfordulása a 2 cm-nél kisebb tumoroknál volt a legalacsonyabb. A tumorméret szoros összefüggést mutatott a malignitás gyakoriságával és a daganat differenciáltságával. A kedvező patológiai és biológiai eredmények alapján a 2 cm alatti daganatoknál felmerül annak lehetősége, hogy esetükben az aktív követés vagy minimálisan invazív kezelés alkalmazása kerüljön előtérbe. Orv Hetil. 2021; 162(42): 1693–1697. Summary. Introduction: The incidence of benign lesions is more common in small renal masses (SRMs) and biological behavior of small malignancies is better compared to larger ones. Objective: The authors measured the characteristics of SRMs in different subgroups. Method: From January 1, 2000 to January 1, 2015, 1272 patients underwent surgery for renal tumors. In 496 of the 1272 cases, the patients had SRMs. The mean age of the patients was 59 ± 12 years. Based on the sizes, the SRMs were divided into three groups. The sizes of the renal tumors were ≤4 cm in Group 1, ≤3 cm in Group 2 and ≤2 cm in Group 3. Results: The mean diameter of the removed SRMs was 29 ± 8 mm. Histology confirmed renal cell carcinoma in 418 cases (84%), while benign tumor was present in 78 patients (16%). However, with the tumor size ≤2 cm, malignancy was detected in 73.2% of the cases. There was a significant difference in the sizes of the malignant and the benign masses (p = 0.008). Grade 3 or 4 tumors were present in 10.8%, 14.4% and 20.7% when the tumor size was ≤2 cm, 2.1 to 3 cm, and 3.1 to 4 cm in diameter, respectively. During the mean 10-year follow-up period, tumor progression was detected only in 5.5% of malignancies. Conclusion: In 39% of all cases, the patients had SRMs. The majority of SRMs were malignant, and benign lesion occurred only in 16% of the cases. The incidence of malignant tumors was the lowest when the size of SRMs was ≤2 cm. The size of the tumor was highly associated with probability of malignancy and tumor grading. Based on the favorable pathological and biological results in tumors below 2 cm, active surveillance or minimally invasive treatment could be the preferred management. Orv Hetil. 2021; 162(42): 1693–1697.

scholarly journals Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience

2021 ◽  
Vol 14 ◽  
pp. 175628482110328
Author(s):  
Rachel Hallit ◽  
Mélanie Calmels ◽  
Ulriikka Chaput ◽  
Diane Lorenzo ◽  
Aymeric Becq ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Endoscopic Treatment ◽  
Gastric Resection ◽  
Endoscopic Management ◽  
Endoscopic Drainage ◽  
Anastomotic Leaks ◽  
Internal Drainage ◽  
Ivor Lewis ◽  
Esophageal Stents ◽  
Postoperative Leak

Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively ( p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage ( p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.

PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 76-76
Author(s):  
Keat How Teoh ◽  
Kelvin Voon ◽  
Shyang Yee Lim ◽  
Premnath Nagalingam
Keyword(s):  
Endoscopic Treatment ◽  
Esophageal Stricture ◽  
Endoscopic Dilatation ◽  
Line Treatment ◽  
First Line ◽  
Benign Esophageal Stricture ◽  
Anastomotic Strictures ◽  
Esophageal Strictures ◽  
The Mean ◽  
First Line Treatment

Abstract Background Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia. Methods A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017. Results The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05). Conclusion Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success. Disclosure All authors have declared no conflicts of interest.

scholarly journals Anastomotic leakage following resection of the esophagus – Introduction of an endoscopic scoring system

2020 ◽  
Author(s):  
Jeannine Bachmann ◽  
Marcus Feith ◽  
Christoph Schlag ◽  
Mohamed Abdelhafez ◽  
Marc Martignoni ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Treatment Time ◽  
Malignant Tumors ◽  
Special Focus ◽  
High Morbidity ◽  
Endoscopic View ◽  
University Of Munich ◽  
Tracheobronchial System ◽  
Postoperative Leakage ◽  
Treatment Improvement

Abstract Background Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. MethodsPatients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. EndoscopyIn this retrospective analysis the focus is to describe different patterns of leakage of the anastomosis. Results We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of development of a fistula to the tracheobronchial system increased with higher grades of leakage. ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with special focus on prospective analysis.

scholarly journals A rare case of pseudocyst in remnant pancreas after classical pancreaticoduodenectomy- treated by endoscopic drainage

2017 ◽  
Vol 4 (5) ◽  
pp. 1797
Author(s):  
Senthilkumar Perumal ◽  
Jeswanth Sathyanesan ◽  
Ravichandran Palaniappan
Keyword(s):  
Female Patient ◽  
Rare Case ◽  
Malignant Tumors ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Cystic Lesions ◽  
Periampullary Carcinoma ◽  
Pancreatic Anastomosis ◽  
Remnant Pancreas

Pancreatic pseudocysts comprise more than 80 % of the cystic lesions of the pancreas. Here we report a 45-year-old female patient who developed a symptomatic pseudocyst in the remnant pancreas following classical pancreaticoduodenectomy for periampullary carcinoma. The pancreatic anastomosis was pancreaticogastrostomy- Dunking technique. She underwent endoscopic cystogastrostomy. Recurrence should always be ruled out before diagnosing pseudocyst in remnant pancreas following pancreaticoduodenectomy for malignant tumors.

scholarly journals EVALUATION OF RISK FACTORS AFFECTING ANASTOMOTIC LEAKAGE AFTER REPAIR OF ESOPHAGEAL ATRESIA

2015 ◽  
Vol 28 (3) ◽  
pp. 161-162 ◽  
Author(s):  
Shahnam ASKARPOUR ◽  
Mehran PEYVASTEH ◽  
Hazhir JAVAHERIZADEH ◽  
Nasim ASKARI
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Esophageal Atresia ◽  
Case Control Study ◽  
Case Control ◽  
Anastomotic Leaks ◽  
Factors Affecting ◽  
Control Study

Background: Anastomotic leak are reported among neonates who underwent esophageal atresia. Aim: To find risk factors of anastomotic leakage in patients underwent esophageal repair. Methods: All cases with esophageal atresia were included. In this case control study, patients were classified in two groups according to presence or absence of anastomotic leaks. Duration of study was 10 years. Results: Sixty-one cases were included. Mean±SD age at time of surgery in patients with leakage and without leakage was 9.50±7.25 and 8.83±6.93 respectively (p=.670). Blood transfusion and two layer anastomosis had significant correlation with anastomotic leakage. Conclusion: Blood transfusion and double layer anastomosis are associated with higher rate of anastomotic leakage.

scholarly journals Malignant Eyelid Tumors in India: A Study of 536 Asian Indian Patients

2018 ◽  
Vol 5 (3) ◽  
pp. 210-219 ◽  
Author(s):  
Swathi Kaliki ◽  
Nandini Bothra ◽  
Kavya Madhuri  Bejjanki ◽  
Arpita Nayak ◽  
George Ramappa ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Asian Indian ◽  
Malignant Tumors ◽  
Tumor Location ◽  
Sebaceous Gland Carcinoma ◽  
Gland Carcinoma ◽  
The Mean ◽  
Asian Indian Population ◽  
Tumor Extent

Purpose: To study the proportion of eyelid malignant tumors in an Asian Indian population and to review their clinical features and outcomes. Methods: This is a retrospective study of 536 patients. Results: The mean age at presentation with eyelid malignancy was 58 years. Histopathology-proven diagnoses of these patients included sebaceous gland carcinoma (SGC) (n = 285, 53%), basal cell carcinoma (BCC) (n = 128, 24%), squamous cell carcinoma (SCC) (n = 99, 18%), and miscellaneous tumors (n = 24, 4%). The statistically significant differences between eyelid malignant tumors included age at presentation, tumor location, and tumor extent. The clinicopathological correlation of SGC, BCC, SCC, and miscellaneous tumors was 91, 86, 46, and 38% (p = 0.001), respectively. Comparing SGC with BCC, SCC, and miscellaneous tumors, SGC was more commonly associated with tumor recurrence (21 vs. 3, 8, and 13%; p = 0.001), systemic metastasis (13 vs. 0, 4, and 13%; p = 0.001), and death (9 vs. 0, 4, and 0%; p = 0.004). Compared to SGC, BCC, and SCC, locoregional lymph node metastasis was more common with miscellaneous tumors (26 vs. 16, < 1, and 8%; p = 0.001) over a mean follow-up period of 19 months. Conclusion: In Asian Indians, SGC is twice as common as BCC and 3 times more common than SCC. SGC is associated with poorer prognosis compared to other eyelid malignant tumors.

scholarly journals The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yu Mu ◽  
Linxian Zhao ◽  
Hongyu He ◽  
Huimin Zhao ◽  
Jiannan Li
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Meta Analysis ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leakage Rate ◽  
Protective Ileostomy ◽  
Clinically Significant

Abstract Background Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery. Methods Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale. Results We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I2 = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups. Conclusion The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

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