scholarly journals P-EGS24 Surgical case series of incarcerated diaphragmatic hernias following oesophagectomy for oesophageal cancer. Single centre experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Charef Raslan ◽  
Mohamed Alasmar ◽  
Ram Chaparala
Keyword(s):  
Minimally Invasive ◽  
Diaphragmatic Hernia ◽  
Case Series ◽  
Invasive Procedure ◽  
High Volume ◽  
Emergency Laparotomy ◽  
Time Interval ◽  
Incarcerated Hernia ◽  
Observation Study ◽  
Open Operation

Abstract Background Incarcerated post-oesophagectomy diaphragmatic hernia (IPODH) is a recognised surgical emergency and potentially hazardous event. Information regarding the natural course for this emergency and guidelines regarding the management were not described clearly in literature. This case series aim to review patients who presented as emergency with IPODH Methods This observation study is conducted at Salford Royal Hospital that has one of the largest oesophago-gastric unit in United Kingdom.  A 7-year period (April 2013 - April 2020) retrospective data collection is performed using prospectively maintained database. We reviewed the presentation and management course for all patients who presented as emergency with IPODH.  Results We identified 341 patients who underwent oesophagectomies over the seven-year period. Seven patients (2%) developed IPODH which required emergency surgery. All these patients underwent 2 stage oesophagectomies. Out of these, 5 patients had laparoscopic assisted procedure (hybrid), 1 patient had minimally invasive procedure and another patient had open operation. Mean time interval from esophagectomy to the acute incarcerated hernia presentation was 23 months. Only 1 patient developed acute diaphragmatic hernia on day 4 post-oesophagectomy.   The incarcerated hernia contents were reported as small bowels (4 patients), gastric conduit (2 patients) and colon (1 patient). Dealing with these acute emergency cases can be difficult as the hernia contents are threatened. Therefore, most of these patients underwent emergency laparotomy, only 1 patient had laparoscopic procedure to repair the incarcerated hernia. Collagen mesh used to repair the defect only in 2 patients, whereas the rest of the patients had the defect repaired with primary sutures only.  Conclusions Minimally invasive techniques were associated with a higher incidence of post-oesophagectomy diaphragmatic hernia compared with open techniques. These hernias can lead to a significant and serious risk when they present with incarceration. The risk of the acute manifestation and significant post-repair morbidity support long-term surveillance for post-oesophagectomy diaphragmatic hernia and elective surgical treatment. Laparoscopic repair of non-complicated diaphragmatic hernia is feasible and effective in high-volume centres.

scholarly journals EMBOLIZATION OF RENAL ANGIOMYOLIPOMA: CASE SERIES

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Ghania Masood ◽  
Iffat Rehman ◽  
Saquib Khawar ◽  
Khurram A Mufti ◽  
Imran K. Niazi
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Case Series ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Renal Angiomyolipoma ◽  
Minimally Invasive Procedure ◽  
Benign Lesions ◽  
Current Standard ◽  
Spontaneous Haemorrhage

Renal angiomyolipomas (AML) are benign lesions usually left alone. However, lesions larger than 4 cm carry the risk of spontaneous haemorrhage and need treatment. Angiography and embolisation are the current standard of care particularly in patients with high operative risks. Angio-embolisation is a safe, minimally invasive procedure preserving maximum renal parenchyma, with the added advantage of preventing peri-procedural morbidity. Two cases of AML are presented in this case series. Key words: Angiomyolipoma, embolisation, renal 

scholarly journals Three-Dimensional Radiographic Outcome of Free-Handed Flaplessly Placed Mini Dental Implants in Edentulous Maxillae after 2-Years Function

2020 ◽  
Vol 9 (7) ◽  
pp. 2120
Author(s):  
Luc Van Doorne ◽  
Pedram Gholami ◽  
Jan D’haese ◽  
Geert Hommez ◽  
Gert Meijer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Dental Implants ◽  
Three Dimensional ◽  
Case Series ◽  
Invasive Procedure ◽  
Radiographic Evaluation ◽  
Invasive Treatment ◽  
Prospective Case Series ◽  
Cbct Analysis ◽  
Bone Condition

Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5–6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. Results: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.

CONTEMPORARY NEONATAL INTENSIVE CARE MANAGEMENT IN CONGENITAL DIAPHRAGMATIC HERNIA: DOES THIS OBVIATE THE NEED FOR FETAL THERAPY?

2009 ◽  
Vol 20 (4) ◽  
pp. 319-339 ◽  
Author(s):  
DESMOND BOHN
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Case Reports ◽  
Rescue Therapy ◽  
Intervention Strategy ◽  
Case Series ◽  
High Volume ◽  
Vasodilator Therapy ◽  
Operative Stabilization ◽  
Pulmonary Vasodilator

The management of congenital diaphragmatic hernia (CDH) in the newborn infant has changed radically since the first successful outcomes were reported 60 years ago. Then it seemed a surgical problem with a surgical solution – do an operation, remove the intestines and solid viscera from the thoracic cavity, repair the defect and allow the lung to expand. CDH in that era was regarded as the quintessential neonatal surgical emergency. The expectation was that urgent surgery would result in improvement in lung function and oxygenation. That approach persisted up to the 1980s when it was realized that the problem was far more complex and involved both an abnormal pulmonary vascular bed as well as pulmonary hypoplasia. The use of systemically delivered pulmonary vasodilator therapy, principally tolazoline, became a focus of interest in the 1980s with small case reports and case series suggesting improved survival. In the 1990s, based on studies that showed worsening thoracic compliance and gas exchange following surgical repair, deferred surgery and pre-operative stabilization became the standard of care. At the same time extracorporeal membrane oxygenation (ECMO) was increasingly used either as part of pre-operative stabilization or as a rescue therapy after repair. Other centres chose to use high frequency oscillatory ventilation (HFOV). Despite all these innovations the survival in live born infants with CDH did not improve to more than 50% in large series published from high volume centres. However, in the past 10 years there has been an appreciable improvement in survival to the extent that many centres are now reporting survival rates of greater than 80%. Probably the biggest impact on this improvement has been the recognition of the role that ventilation induced lung injury plays in mortality and the need for ECMO rescue. This has ushered in an era of a lung protective or “gentle ventilation” strategy which has been widely adopted as a standard approach. While there have been these radical changes in postnatal management attempts have been made to improve outcome with prenatal interventions, starting with prenatal repair, which was abandoned because of preterm labour. More recently there has been increasing experience in the use of balloon occlusion of the trachea as a prenatal intervention strategy with patients being selected based on prenatal predictors of poor outcome. This approach can only be justified if those predictors can be validated and the outcomes (death or serious long term morbidity) can be shown to be better than those currently achievable, namely 80% survival in high volume CDH centres rather than the 50–60% survival frequently quoted in historical papers.

Arthroscopic Resection of Wrist Volar Synovial Cyst: Technique Description and Case Series

2021 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
João Pedro Farina Brunelli ◽  
Vicente Carratalá ◽  
Márcio Aita ◽  
Gustavo Mantovani ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Case Series ◽  
Invasive Procedure ◽  
Synovial Cyst ◽  
Good Alternative ◽  
Open Technique ◽  
Small Joint ◽  
Safe Technique ◽  
Synovial Cysts

Abstract Background Arthroscopy nowadays has become a widespread technique for the treatment of orthopaedic pathologies. Small-joint arthroscopy has evolved and, through direct visualization, enables diagnosis and immediate treatment of intra-articular lesions. The arthroscopic resection has become a minimally invasive alternative for the open technique. We intend to describe the technique, literature review, and results of arthroscopy for the surgical treatment of wrist volar synovial cysts. Methods Thirty-nine patients submitted to arthroscopy for the treatment of wrist volar synovial cyst were included and assessed in this study, during the period of January 2015 to May 2017 with a complete assessment in minimum follow-up of 6 months. The technique was indicated for patients with pain and functional impairment for longer than 4 months, with no improvement with conservative measures, or for patients with cosmetic complaints, or those who presented the cyst for more than 3 months. Results We demonstrated good outcomes in regard to pain, range of motion, and complications in arthroscopic resection of volar wrist ganglion. Conclusion Arthroscopic resection of volar synovial is a useful and safe technique. It is a low-morbidity, minimally invasive procedure that carries few complications and is a good alternative to the open technique.

Modified Minimal Incision Subcapital Osteotomy for Hallux Valgus Correction

2013 ◽  
Vol 6 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Andrea Scala ◽  
Domenico Vendettuoli
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Rating Scale ◽  
Case Series ◽  
Invasive Procedure ◽  
Delayed Union ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Minimal Incision ◽  
Student’S T

The potential advantages of minimal incision surgery for hallux valgus (HV) correction are the following: reduced surgical exposure, diminished soft-tissue stripping, and less blood supply impairment. These advantages imply fewer complications. We retrospectively reviewed patients who were consecutively treated with a modified minimally invasive osteotomy from January 2006 until December 2009 for HV deformity. We radiographically assessed the HV angle, 1-2 intermetatarsal (IM) angle, and tibial sesamoid position. Clinical outcomes were determined using the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS HMI) Clinical Rating Scale. A paired Student’s t test was used to determine significance, with P < .01. There were 126 patients (146 feet) with an average age of 52.6 years and an average postoperative follow-up of 29.1 months. Preoperatively, the average HV angle was 32.3°, and postoperatively, it was 4.5° (P < .01). The preoperative average IM angle was 14.4°, whereas postoperatively, it was 4.8° (P < .01). The average tibial sesamoid position was 6.3 preoperatively and 2.5 postoperatively (P < .01). The average AOFAS HMI score was 54.6 preoperatively and 85.3 postoperatively (P < .01). There were 15 postoperative complications (10.3%) that included hallux varus, painful hardware, and delayed union. The results are comparable with those of traditional open techniques, with the additional advantages of a minimally invasive procedure. Level of Evidence: Therapeutic, Level IV: Retrospective case series

scholarly journals MINIMALLY INVASIVE LUMBAR ARTHRODESIS AND PERCUTANEOUS PEDICLE SCREWS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 19 (4) ◽  
pp. 249-254
Author(s):  
VINICIUS DE MELDAU BENITES ◽  
FABIO VEIGA DE CASTRO SPARAPANI ◽  
EDUARDO AUGUSTO IUNES ◽  
FRANZ JOOJI ONISHI ◽  
THIAGO SALATI ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Case Reports ◽  
Surgical Techniques ◽  
Case Series ◽  
Pedicle Screws ◽  
Invasive Procedure ◽  
Cochrane Library ◽  
Disc Disease ◽  
Level Of Evidence

ABSTRACT A systematic review of the literature was performed in order to organize, evaluate, and select evidences available about the safety and efficacy of minimally invasive percutaneous arthrodesis with percutaneous pedicle screws in the treatment of patients with degenerative disc disease (and other spinal pathologies) as compared to conventional arthrodesis. PubMed, EMBASE and Cochrane Library databases were consulted to locate clinical trials and case reports/case series published in English between 2014 and 2019. After selection according to the inclusion/exclusion criteria, 21 of the 197 articles identified were chosen for a complete reading and used for the present review. Although the level of evidence of most of the studies included made the demonstration of efficacy and superiority among the surgical techniques reviewed difficult, the findings related to the minimally invasive procedure indicate a safe and reliable approach for the treatment of lumbar diseases. Level of evidence II; Systematic review of literature.

scholarly journals Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 298
Author(s):  
Gaia Colletti ◽  
Chiara Maura Ciniselli ◽  
Stefano Signoroni ◽  
Ivana Maria Francesca Cocco ◽  
Andrea Magarotto ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Risk ◽  
Minimally Invasive ◽  
Total Colectomy ◽  
Early Stage ◽  
Rectal Stump ◽  
Case Series ◽  
Lower Rectal Cancer ◽  
P Value ◽  
Time Interval

Background: The balance between quality of life and colorectal cancer risk in familial adenomatous polyposis (FAP) patients is of primary importance. A cut-off of less than 30 polyps under 1 cm of diameter in the rectum has been used as an indication for performing ileo-rectal anastomosis (IRA) in terms of lower rectal cancer risk. This study aimed to assess clinical and surgical features of FAP patients who developed cancer of the rectal stump. Methods: This retrospective study included all FAP patients who underwent total colectomy/IRA from 1977 to 2021 and developed subsequent rectal cancer. Patients’ features were reported using descriptive statistics by considering the overall case series and within pre-specified classes of age (<20, 20–30, and >30 years) at first surgery. Results: Among the 715 FAP patients, 47 (6.57%, 95% confidence interval: 4.87; 8.65) developed cancer in the rectal stump during follow-up. In total, 57.45% of the population were male and 38.30% were proband. The median interval between surgery and the occurrence of rectal cancer was 13 years. This interval was wider in the youngest group (p-value: 0.012) than the oldest ones. Twelve patients (25.53%) received an endoscopic or minimally invasive resection. Amongst them, 61.70% were Dukes stage A cancers. Conclusions: There is a definite risk of rectal cancer after total colectomy/IRA; however, the time interval from the index procedure to cancer developing is long. Minimally invasive and endoscopic treatments should be the procedures of choice in patients with early stage cancers.

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