Endoscopic sphincterotomy with gallbladder Left in situ versus open surgery for common bileduct calculi

AbstractObjective:The inhaled sharp foreign body is usually amenable to bronchoscopic extraction. When this fails, management poses a challenge. We present a logical approach to the inhaled pin inaccessible to the bronchoscope.Case report:A 12-year-old girl presented to the accident and emergency unit after accidentally inhaling a pin. Multiple attempts with both rigid and flexible bronchoscopy failed to access the pin, which had lodged distally in the anteromedial basal segment of the left lung. Eventually, the pin was extracted at thoracotomy.Conclusion:We discuss the reasons for extracting such pins, as opposed to leaving them in situ, and when to proceed from endoscopy to open surgery. Such knowledge is useful, not only to guide the multidisciplinary team in their combined approach to this unique challenge, but also to explain to the patient the rationale for the proposed treatment protocol.

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In-situ ESWL in the treatment of ureteral stones

Urologia Journal ◽

10.1177/039156039506201s27 ◽

1995 ◽

Vol 62 (1_suppl) ◽

pp. 100-102 ◽

Cited By ~ 1

Author(s):

E. Frego ◽

M. Scanzi ◽

B. Taher ◽

M. Tosana ◽

S. Cosciani Cunico

Keyword(s):

Effective Treatment ◽

Open Surgery ◽

Ureteral Stones ◽

Treatment Rate ◽

Stone Size ◽

Successful Technique

— 185 patients with ureteral stones were treated with ESWL (118 with lumbar ureteral stones, 63 pelvic, 4 sacroiliac). 182 patients (98.3%) were treated with ESWL in-situ by means of a Dornier MFL-5000 lithotriptor. Stone size varied from 0.6 to 1.4 cm (mean 0.9 cm); 145 patients (86.9%) were stone-free after one treatment. The re-treatment rate was 13% for lumbar ureteral stones, 25% for sacroiliac and 12.5% for pelvic stones. We report no complications. 11 patients (6.04%) had to be treated subsequently with ureteroscopic fragmentation and 4 (2.19%) with open surgery. We conclude that in-situ ESWL is also a safe and effective treatment for distal ureteral stones, for which ureteroscopy is also a successful technique but with higher morbidity, and should therefore be performed in case of failure of ESWL. We have more chance of success if the in-situ treatment is performed as soon as possible.

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Complications in Minimally Invasive Versus Open Surgery for Intermediate- to High-Grade Spondylolisthesis: A 10-Year Retrospective, Multicenter Experience

Neurosurgery ◽

10.1093/neuros/nyz310_820 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Asad Mehmood Lak ◽

Abdullah M Abunimer ◽

Amina Rahimi ◽

Ian Tafel ◽

Hasan Aqdas Zaidi

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Open Reduction ◽

Open Surgery ◽

No Reduction ◽

High Rate ◽

High Grade ◽

Neural Injury ◽

Reduction Group

Abstract INTRODUCTION High-grade spondylolisthesis is a relatively uncommon condition. The optimal surgical approach for management remains debatable. Although in-situ fusion is preferred due to its lower risk of neural injury, it does not correct spinal alignment. In contrast, reduction corrects the deformity and provides a high rate of fusion, but has the potential for high rates of neural injury. We herein report our experience and surgical outcomes following minimally invasive versus open management of intermediate- to high-grade spondylolisthesis. METHODS A multicenter, retrospective cohort analysis of adult patients aged more than 18 yr with grade II or higher spondylolisthesis, who underwent surgery from January 2008 until February 2019, was performed. RESULTS Sixty-two patients were included in the final analysis. A total of 41 patients were treated with an open approach and 21 with a minimally invasive surgical approach (MIS). More specifically, 18 patients underwent in-situ fusion, 11 underwent MIS reduction, and 33 had an open reduction. The total rate of complications was 40.3%. The rate of complications in the MIS group was 52.3% compared to 34.1% in the open surgery group (P = .166). The rate of complications was 27.8% in the in-situ fusion group, 72.7% in the MIS-reduction group, and 36.4% in the open-reduction group. Our comparisons of the rate of complications in the no-reduction group vs the MIS-reduction group, and the MIS-reduction group vs the open-reduction group were statistically significant (P = .027 and P = .07, respectively). However, there was no statistically significant difference between the rate of complications in the no-reduction group vs the open-reduction group (P = .757), nor between the rate of complications in the MIS group vs the open surgery group (P = .166). CONCLUSION MIS reduction is associated with a high rate of complications in the management of high-grade spondylolisthesis.

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Cholecystectomy outcomes after endoscopic sphincterotomy in patients with choledocholithiasis: A meta-analysis

10.21203/rs.2.18040/v2 ◽

2020 ◽

Author(s):

Jie Xu ◽

Chuang Yang

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Sphincterotomy ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Recurrent Pancreatitis ◽

Significant Difference ◽

Risk Patients ◽

Gallbladder In Situ

Abstract Background Endoscopic sphincterotomy is the standard treatment for common bile duct stones.There is different evidence considering complications specifically biliary pancreatitis and cholangitis with the use of cholecystectomy after endoscopic sphincterotomy.The purpose of this article is to compare the positive cholecystectomy after endoscopic treatment of common bile duct stones, whether the incidence of recurrent pancreatitis cholangitis is reduced, especially in high-risk patients. Methods We searched Pubmed(1990-2019)、Embase(1990-2019)和 Cochrane(1990-2019)database for trials comparing the 2 strategies for gallstones after ES.A related article on the removal of gallbladder after endoscopic sphincterotomy was collected,followed by analysis of each group using RevMan. Results We have adopted a total of 8 studies, including 7 randomized controlled trials and 1 retrospective study. A total of 12718 patients were included in the study, 4922 in the early cholecystectomy group, and 7795 in the gallbladder in situ group.During the follow-up period, 41 patients had pancreatitis after endoscopic sphincterotomy in the cholecystectomy group, and 177 patients in the wait-and-see group. The incidence of pancreatitis in the gallbladder in situ group was significantly reduced(RR 0.38, 95%CI 0.27 to 0.53, P < 0.00001,I 2 =0%).The incidence of cholangitis and jaundice in the removal of the gallbladder group was also less than that in the preserved gallbladder group(RR 0.31, 95%CI 0.26 to 0.38, P < 0.00001,I 2 =0%).There was no significant difference in mortality between the two groups(RR 0.73, 95%CI 0.52 to 1.02, P =0.07,I 2 =14%).There is a significant difference in cholecystitis or biliary colic(RR 0.25, 95% CI 0.21 to 0.29, P < 0.00001,I 2 =28%). Conclusions Early endoscopic cholecystectomy after removal of common bile duct stones can effectively reduce biliary complications such as recurrent pancreatitis, cholangitis and cholecystitis. This is still true for high-risk patients, and has no significant effect on the mortality of patients. After ES,laparoscopic cholecystectomy should be recommended.

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