Outcomes of Esophageal Replacement: Gastric Pull-Up and Colonic Interposition Procedures

2017 ◽  
Vol 28 (01) ◽  
pp. 022-029 ◽  
Author(s):  
Keren Sloan ◽  
Anna Morandi ◽  
Bhanumathi Lakshminarayanan ◽  
Sharon Cox ◽  
Alastair Millar ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Oral Feeding ◽  
Esophageal Replacement ◽  
Caustic Ingestion ◽  
Colonic Interposition ◽  
Septic Complications ◽  
Anastomotic Strictures ◽  
Group A ◽  
Group B ◽  
Gastric Pull Up

Aim No consensus exists about the optimal surgical technique for esophageal replacement. This study reports the surgical outcomes for the gastric pull-up and the colonic interposition procedures. Materials and Methods A retrospective review of children undergoing esophageal replacement surgery between January 2001 and June 2015 across four different pediatric surgery centers was conducted. Data collected included indications, epidemiology, surgical technique, complications, and outcomes. Patients were divided into group A, those that had a gastric pull-up procedure and group B, those that had a colonic interposition procedure. Results In total, 50 patients were included; 29 in group A and 21 in group B. Indications included esophageal atresia, caustic ingestion, and infective esophageal stricture. The median age at the time of surgery was 13 months. The mean length of follow-up was 5.2 years. Three patients died giving a mortality rate of 6%; 2 in group A and 1 in group B.In both groups, early postoperative complications included infective complications, such as wound infections, sepsis, and pneumonia (11), anastomotic leak (7), and respiratory complications (7). Late complications included adhesive bowel obstruction (2), anastomotic strictures (4), redundancy (1), and jejunostomy problems (1). Septic complications and anastomotic strictures occurred more frequently in group B. Further surgery was needed in eight patients; this was significantly higher in group B. Full oral feeding was achieved within 6 months in 91.5%. Conclusion The gastric pull-up and colonic interposition have comparable mortality and outcomes. The colonic interposition was associated with a higher rate of early septic complications, anastomotic strictures, and need for further surgery.

Bladder neck preservation versus bladder neck excision during radical retropubic prostatectomy: Clinical results

1996 ◽  
Vol 63 (1_suppl) ◽  
pp. 109-111
Author(s):  
G. Muto ◽  
F. Bardari ◽  
D. Piras ◽  
R. Leggero
Keyword(s):  
Bladder Neck ◽  
Clinical Stage ◽  
Cancer Control ◽  
Radical Retropubic Prostatectomy ◽  
Urinary Continence ◽  
Retropubic Prostatectomy ◽  
Anastomotic Strictures ◽  
Group A ◽  
Group B ◽  
Neck Preservation

We evaluated recovery of urinary continence and incidence of vesical neck contractures following radical retropubic prostatectomy in a series of 120 patients with clinical stage A-B-C prostate cancer. 58 patients (group A) underwent radical retropubic prostatectomy with bladder neck preservation and 62 patients (group B) with bladder neck excision and reconstruction. In group A there were no anastomotic strictures and in group B, 6.4%. In the first group we noticed an earlier return of continence, but there were no statistically significant differences in urinary continence between the two groups. Bladder neck preservation does not compromise cancer control as assessed by local or PSA-only failure rates.

Postoperative Complication Assessments of Different Reconstruction Procedures after Total Pharyngolaryngoesophagectomy: Tubular Gastric Pull-Up versus Whole Gastric Pull-Up

2018 ◽  
Vol 84 (12) ◽  
pp. 1927-1931
Author(s):  
Zhenbo Dai ◽  
Qinghua He ◽  
Boyu Pan ◽  
Liren Liu ◽  
Dejun Zhou
Keyword(s):  
Postoperative Complications ◽  
Hypopharyngeal Cancer ◽  
Reconstruction Method ◽  
Observation Study ◽  
Reconstruction Procedure ◽  
Intrathoracic Stomach ◽  
Group A ◽  
Group B ◽  
Medical University ◽  
Gastric Pull Up

Hypopharynx carcinoma tends to be diagnosed at advanced stage and usually has a poor prognosis because of the high incidence of submucosal spreading and lymphatic metastasis. Total pharyngolaryngoesophagectomy (PLE) is mostly used as a curative intervention for this deadly disease, and a commonly used reconstruction method after PLE is gastric pull-up, which could be further divided into tubular gastric pull-up and whole gastric pull-up procedures. Aiming to achieve a precise guidance on optimal reconstruction method after PLE, the present study evaluated the postoperative complications involving in different gastric pull-up procedures in patients with hypopharynx cancer. A total of 52 consecutive patients with hypopharyngeal cancer who underwent total PLE with gastric pull-up reconstruction in Tianjin Medical University Cancer Institute and Hospital between 1996 and 2014 were analyzed in this study. Of these patients, 28 underwent tubular gastric pull-up reconstruction procedure (Group A), whereas 24 underwent whole gastric pull-up reconstruction procedure (Group B). We compared the postoperative complications between these two groups retrospectively. Postoperative anastomotic fistulas occurred in three patients in Group A (3/28) versus eight patients in Group B (8/24), leading to an incidence rate of 10.71 and 33.33 per cent, respectively. The incidence of intrathoracic stomach syndrome was 21.43 per cent in Group A (6/28) versus 58.33 per cent in Group B (14/24), and the incidence of reflux was 35.71 per cent in Group A (10/28) versus 66.67 per cent in Group B (16/24). All of the above postoperative complications exhibited statistical differences between two groups ( P ≤ 0.05). This retrospective observation study suggests that compared with whole gastric pull-up, tubular gastric pull-up is a better reconstruction procedure of choice after PLE, evidenced by reduced incidences of postoperative anastomotic fistula, intrathoracic stomach syndrome, and reflux.

scholarly journals Comparison of early versus late enteral feeding following gut anastomosis.

2020 ◽  
Vol 27 (12) ◽  
pp. 2548-2552
Author(s):  
Zohra Jabeen ◽  
Ramlah Ghazanfor ◽  
Muhammad Usman Akram ◽  
Sara Malik ◽  
Maham Tariq ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enteral Feeding ◽  
Oral Feeding ◽  
P Value ◽  
Age Group ◽  
Bowel Sounds ◽  
Early Oral Feeding ◽  
Group A ◽  
Group B ◽  
Mean Time

Objectives: To compare early feeding versus late enteral feeding following gut anastomosis in term of hospital stay. Study Design: Prospective Randomized Control study. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi. Period: April to October 2017. Material & Methods: All patients, excluding paediatric age group (n= 60) undergoing emergency or non-emergency gut resection with primary anastomosis were incorporated. Two strata were devised. Group A (n=30) received early enteral feeding starting at 12th post-operative hours in form of 100-150ml fluid thrice daily. Group B endured being Nil per oral for 72hrs. Both groups were correlated for timing of return of bowel sounds and timespan of hospital stay. P value < 0.05 was considered noteworthy. Results: Overall 60 patients with 30 in each group were incorporated. They were predominantly males (55%) and belonged to middle age group (Group A=31.73+10.78 years; Group B= 36.00+10.53 years). Mean time for return of bowel sounds in both the groups was 24.40+5.88 hours and 35.20+10.88 hours respectively, which was striking (p value <0.05). Mean length of hospital stay in both the groups was also noteworthy i.e. 5.23+0.72 days and 6.40+1.67 days respectively. Conclusion: In the wake of gut anastomosis, early oral feeding at 12hours is superior to delayed oral feeding after 72hours, in terms of mean time for return of bowel sounds and period of hospital stay.

scholarly journals Comparison of T Tube Ileostomy and Bishop Koop Ileostomy for the Management of Uncomplicated Meconium Ileus

2017 ◽  
Vol 6 (3) ◽  
pp. 56 ◽  
Author(s):  
Md. Samiul Hasan ◽  
Ashrarur Rahman Mitul ◽  
Sabbir Karim ◽  
Kazi Md Noor-ul Ferdous ◽  
Kabirul Islam
Keyword(s):  
Operation Time ◽  
Oral Feeding ◽  
Meconium Ileus ◽  
Safe Procedure ◽  
Interventional Study ◽  
T Tube ◽  
Tube Removal ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Meconium ileus is a common cause of neonatal intestinal obstruction. Various surgical procedures are in practice for uncomplicated meconium ileus. Bishop Koop ileostomy allows distal passage of gut content and uses the distal absorptive area. T tube ileostomy avoids the need for gut resection and formal closure of stoma. The aim of this prospective interventional study was to compare the outcome of T-tube ileostomy and Bishop Koop ileostomy for the treatment of uncomplicated meconium ileus.Materials and methods: It was a prospective interventional study from January 2015 to December 2016. Patients were randomly assigned to the T-tube ileostomy group (group A) and Bishop Koop ileostomy group (group B). The patients were followed up for 6 weeks post-operatively. Surgical outcomes between the two groups were compared.Results: The age range of the patients was 1 to 7 days; majority of the patients were males. Mean operation time of group A (60.76±5.81 minutes) and group B (87.05±6.49 minutes) showed significant difference (p =0.0001). After operation, mean time to start bowel movements in group A (4.90±1.41days) and group B (6.53±2.58 days) showed significant difference (p= 0.020). Times to establish oral feeding, irrigation tube removal and postoperative complications showed no significant difference. All patients that survived in the group B required formal stoma closure, while in the group A stomas closed spontaneously. One patient in the group A had intraperitoneal leakage leading to mortality after second operation. Four patients had leakage in the group B; 2 of them died.Conclusions: T-tube ileostomy was found as an effective and safe procedure for the management of uncomplicated meconium ileus.

scholarly journals Empirical antimicrobial therapy of purulent-septic complications in surgical coloproctology

2019 ◽  
Vol 6 (2) ◽  
pp. 17-23
Author(s):  
Yu. M. Stoiko ◽  
V. G. Gusarov ◽  
A. L. Levchuk ◽  
A. V. Maksimenkov ◽  
D. A. Kolozyan
Keyword(s):  
Antibacterial Therapy ◽  
Antimicrobial Therapy ◽  
Antibiotic Prescribing ◽  
Defined Daily Dose ◽  
Total Consumption ◽  
Septic Complications ◽  
Empirical Antimicrobial Therapy ◽  
Daily Dose ◽  
Group A ◽  
Group B

Object. to optimize antibacterial therapy in patients with coloproctological profile with purulent-septic complications.Materials and methods. A one-center intervention study with historical control was conducted. The intervention began in January 2017, when in the hospital FSBI «N. I. Pirogov National Medical Surgical Center» Russian Ministry of Health introduced strict monitoring of compliance with the protocols of empirical antimicrobial therapy. The study included 62 patients who underwent antibacterial therapy after operations on the colon and rectum in 2016–2017. Patients were divided into two groups with respect to the beginning of the intervention: 2016 – comparison group (A), 2017 – main group (B).Results. There was a slight decrease in the total consumption of antibacterial drugs in coloproctological patients from 823.0 to 691.0 Defined Daily Dose (DDD, established daily dose), as well as the average consumption of antibiotics per patient from 26.5 to 22.3 DDD. An increase in the number of cases of compliance with the approved protocol of empirical antimicrobial therapy (AMT) was revealed from 32.3 % in group A to 67.7 % in group B, p = 0.01. The frequency of adequate empirical antibiotic prescribing increased from 71.0 to 93.5 %, p = 0.042. A significant increase in the frequency of de-escalation of AMT was revealed from 3.2 % in group A to 25.8 % in group B, p = 0.026.Conclusion. Monitoring compliance with empirical AMT protocols allowed to increase the number of cases of adherence to approved protocols, which positively affected the frequency of adequate appointment of empirical AMT, and also led to increase the number of cases of de-escalation of AMT.

DOZ047.37: 5-year follow-up after 17 laparoscopic transhiatal esophagectomy and gastric pull-up (TEGPUL)

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A P Perera ◽  
A Pasten
Keyword(s):  
Operating Time ◽  
Late Complications ◽  
Transhiatal Esophagectomy ◽  
Oral Feeding ◽  
Colon Perforation ◽  
Esophageal Replacement ◽  
Unknown Etiology ◽  
Long Gap ◽  
Gastric Pull Up

Abstract Background Survival in patients with EA. Materials and Methods Between 2011 and 2015, we performed 17 transhiatal esophagectomy and gastric pull-up (TEGPUL) in 8 girls and 9 boys, with a mean age 34 months (range: 8–99 months). All born with EA 65% (11) were acquired long-gap (EA type III, those where a primary anastomosis was initially achieved and then lost because of complications and redo surgeries) and 35% (6) congenital long-gap (EA types I and II). Immediate, mediate, and late complications were recorded. They were contacted by email, Facebook, instagram, and WhatsApp. WHO charts were used for nutritional diagnosis. Results Mean operating time 5.5 hours (3.5–8 hours), mean days of mechanical ventilation 4.5 (2–8 days), mean days of hospitalization 18 (9–40 days), mean time of oral feeding 12.5 days (3–30 days). We contacted 92% of the living patients. Immediate complications (first 14 postoperative days): 3 (18%) reoperative surgery (2 acute gastric obstruction and 1 incidental colon perforation); 3 (18%) patients had perioperative cardiac arrest (2 in-OR and 1 out-OR) all left but one, with neurological sequelae, died on the 12th postoperative day; 8 patients (47%) had a leak of the esophagogastric anastomosis, all health spontaneously in an average of 15 days and high blood pressure in 10 (59%) patients, unknown etiology. Mediate complications (from 15 postoperative days to 3 months): gastric emptying delay 3 (18%), GER 5 (29%), and recurrent lower respiratory infections 9 (53%). Late complications (from 3 months to 5 years): malnutrition 2 (18%), risk of malnutrition 3 (27%), diaphragmatic hernia 1 (9%), upper gastrointestinal bleeding 1 (9%). Postoperative parents satisfaction 100%. Conclusion TEGPUL is a safe and reproducible esophageal replacement technique in patients with long-gap EA, but have a long learning curve. However, more long-term and larger follow-up studies are needed, for which we recommend grouping these patients in a national reference center.

Comparison of the Effectiveness and Safety of Radiofrequency Turbinoplasty and Traditional Surgical Technique in Treatment of Inferior Turbinate Hypertrophy

2005 ◽  
Vol 133 (6) ◽  
pp. 972-978 ◽  
Author(s):  
Matteo Cavaliere ◽  
Giampiero Mottola ◽  
Maurizio Iemma
Keyword(s):  
Surgical Technique ◽  
Nasal Obstruction ◽  
Inferior Turbinate ◽  
Turbinate Hypertrophy ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Inferior Turbinate Hypertrophy ◽  
Submucosal Resection ◽  
And Function

OBJECTIVES: Inferior turbinate hypertrophy is one of the major causes of nasal airway obstruction. Medical treatment often produces insufficient improvements. In these cases, surgical reduction of inferior turbinates can be proposed. Many different techniques are currently available. We prospectively evaluate the safety and effectiveness of radiofrequency volumetric tissue reduction (RFVTR) compared with the traditional surgical technique. METHODS: The study was conducted on 3 groups of 75 patients with symptoms and signs of nasal obstruction associated with inferior turbinate hypertrophy refractory to medical therapy. In group A, the turbinoplasty (TP) was performed using the classical surgical submucosal resection; in group B, the RFVTR was applied to inferior turbinate; and group C patients were not treated and served as control subjects. Nasal endoscopy, visual analogue scale (VAS), anterior active positional rhinomanometry, and saccharin tests were used to assess treatment outcomes at the end of week 1 and months 1 and 3 after surgery. RESULTS: Turbinate edema and secretions decreased significantly ( P < 0.05) in groups A and B from 1 month after surgery. The secretions in group A increased temporarily on the seventh day after surgery. Concerning the nasal obstruction and related symptoms, significant improvement was observed at 1 month after treatment in all patients ( P < 0.05) and continued up to 3 months after surgery ( P < 0.0001). Rhinomanometric measurements demonstrated a significant nasal flow increase at 3 months ( P < 0.0001). The nasal mucociliary transport time increased in group A at week 1. The difference among the 3 groups at month 1 was observed not significant. CONCLUSION: In this study, we demonstrated that both RFVTR and TP are effective in improving nasal obstruction and related nasal symptoms. In support of the RFVTR, different factors are important: it can be performed in local anaesthesia; it does not require a nasal package; it does not cause either a change of mucociliary function or an increase of secretions and crusts; and the patient can be discharged immediately after treatment. Therefore, we suggest that the RFVTR offers an efficient, gentle, and function-maintaining alternative to TP. However, because of the short follow-up, future investigations are needed for a more exhaustive evaluation of equivalency of the 2 turbinate procedures. EBM RATING: B-2

scholarly journals Early Enteral Nutrition in Neonates Following Abdominal Surgery

2018 ◽  
Vol 7 (2) ◽  
pp. 21 ◽  
Author(s):  
G. Raghavendra Prasad ◽  
J. V. Subba Rao ◽  
Amtul Aziz ◽  
T. M. Rashmi ◽  
Saniya Ahmed
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Abdominal Pressure ◽  
Early Enteral Nutrition ◽  
Necrosis Factor Alpha ◽  
Septic Complications ◽  
Tnf Α ◽  
Gut Mucosa ◽  
Group A ◽  
Group B

Introduction: Nil per oral (NPO)/nil by mouth has been the most commonly practiced convention in post-operative period. Misplaced fear of aspiration led to routine prescription of “NPO.” Starvation leads to atrophy of the gut mucosa leading to decreased barrier effect of gut mucosa. This starvation-induced gut mucosal injury increases septic complications and mortality. The study aims at establishing the feasibility and effect of early enteral nutrition (EEN) in neonates following abdominal surgeries.Materials and Methods: A total of 260 cases formed the cohort of prospective cohort study, 79 in EEN - Group “A” and 181 in NPO - Group “B.” Effect of EEN was evaluated with regard to outcome, hospital stay, surgical site infections (SSI), stress markers such as C-reactive protein (CRP), procalcitonin, tumor necrosis factor alpha (TNF α), and neonatal-predisposition, insult/injury, response, organ failure (Neo-PIRO) scores, intra-abdominal pressure (IAP) grade, tolerance of feeds, and time to first stool. Chi-square was the statistical method used. Epi info version 7 was the software used.Results: Group B had higher mortality (20.09%) than Group A (P < 0.05). 33.7 in Group B developed SSI, of which 90% were deep and intracavitary (P < 0.05). Hospital stay was less in Group A (P < 0.05). CRP and Neo-PIRO scores were less in Group A compared to Group B (P < 0.05). TNF-α expression and IAP scores were not statistically significant (P > 0.05). Procalcitonin levels were higher in Group B. Feeds were better tolerated in Group A. First stool appeared earlier in Group A than B. There was no difference in anastomotic leak in both the groups.Conclusion: EEN in neonates following abdominal surgeries is feasible, well tolerated reduces the hospital stay and mortality, and reduces SSIs, and early gut motility could be established.

scholarly journals EFFECT OF LEAD ACETATE ON HISTOOGICAL FEATURES OF LIVER, SKELETAL MUSCLE AND TESTIS AND SERUM TESTOSTERON LEVEL OF LABORATORY ALBINO MICE Mus musculus.

2010 ◽  
Vol 7 (1) ◽  
pp. 424-430
Author(s):  
Baghdad Science Journal
Keyword(s):  
Skeletal Muscle ◽  
Lead Acetate ◽  
Environmental Pollutants ◽  
Histological Section ◽  
Oral Feeding ◽  
Skeletal Muscle Atrophy ◽  
Mild Degree ◽  
Group A ◽  
Albino Mice ◽  
Group B

Lead acetate as one of the environmental pollutants can threats the life of living creatures in many ways, it has a long half-life, accumulates mainly in the soft tissue and leads to adverse effects in these tissues. An experiment was conducted to study the effect of oral feeding of lead acetate on histological features of liver, kidney, testis and muscle of albino mice. Mice were treated with 0.05 mg/100 ml lead acetate (LA) for 10 days (group A) and for and for 20 days (group B) and for 30 days (group C). The histological section of liver of mice group A characterized by slightly blurred trabecular structure with foci of hepatitis which increased with cytoplasmic vacules in group B but in group C liver reveal necrosis, heamorrhage, hepatitis with dysplasia. Testis revealed foci of spermatic hypoplasia in group A, areas of fibrosis and spermatic arrest revealed in group B and C with mild degree of maturation in last group. Skeletal muscle fibers not changed in group A but characterized with focal mononuclear cell infiltration and myositis in group B but necrosis and skeletal muscle atrophy with increase perimuscular adipose tissue and fibrosis revealed in fibers of group C.

scholarly journals Laparoscopic nephrectomy with single-portal access Sitracc® in swines

2012 ◽  
Vol 27 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Fernando Meyer ◽  
Daniel Joaquim Coutinho ◽  
Denise Sbrissia e Silva Gouveia ◽  
Juliana Navarro Lizana ◽  
Luiz Felipe Dziedricki
Keyword(s):  
Surgical Technique ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Surgical Procedures ◽  
Volume Loss ◽  
Surgical Time ◽  
Catholic University ◽  
Group A ◽  
Group B ◽  
Total Nephrectomy

PURPOSE: To analyze the viability of using SITRACC® (single-portal access) to make partial or total nephrectomy in pigs and also to describe the technical difficulties found during these surgical procedures. METHODS: Ten pigs (Landrace specie) with 20kg in average were distributed in two groups: Group A - total right nephrectomy - and Group B - partial left nephrectomy -. The anesthetic procedure was initially done with thiopental (10mg/kg) and maintained with halothane. The surgical procedures were performed inside the Surgical Technique Room from Pontifical Catholic University of Parana (PUCPR). RESULTS: It was analyzed the surgery duration, time to insert SITRACC®, the volemic loss and the size of the organ. In the first surgeries, the surgical time and blood volume loss were higher (between 15 to 43 minutes and 120 to 400 mL, respectively). The more the procedure was performed, the more the surgeons were used to the technique, so the bleeding and the time of surgery was significantly reduced to 15 minutes and 50 mL of blood loss, respectively. The difficulties found were associated with the nippers, however that was not relevant for the surgical technique. It was also found that the intra-body suture caused an expressive volemic loss. CONCLUSION: The total and partial nephrectomy through umbilical single-access by using SITRACC® was feasible and safe in pigs.

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