scholarly journals P-OGC27 Chyle Leak following Oesophagectomy: ‘A Retrospective 10-year Single-Site Experience of a Tertiary Centre.’

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Paul Koroma ◽  
Madhu Chaudhury ◽  
Alana Greenlees ◽  
Christopher Ball ◽  
Vinutha Shetty ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Intervention ◽  
Chest Drain ◽  
Median Length ◽  
Chyle Leak ◽  
Upper Gi ◽  
Tertiary Centre ◽  
Upper Gi Cancer ◽  
High Index Of Suspicion ◽  
Early Surgical Intervention

Abstract Background Chyle leak is a relatively uncommon but well-recognised complication following Oesophagectomy which carries significant morbidity and mortality if not treated actively. Evidence suggests the incidence rate of chyle leak post oesophagectomy can range from 0.4% to 21%. The aim of this study was to describe our experience in managing this complication. Methods This was a retrospective study, using the electronic database, to analyse our incidence of chyle leak in all patients who underwent elective oesophagectomy from April 2009 to December 2019 in a Tertiary Upper GI cancer centre. The diagnosis was confirmed by high persistent chest drain output, the colour of the fluid produced in the chest drain and its ‘content’ including fluid triglyceride levels and the presence of chylomicrons. Results Between 2009-2019, a total of 550 patients underwent Oesophagectomy. The median length of stay was 13 (Range 3 to 148) days. The median age was 63 years (45 to 82) with M:F 2:1. Chyle leak was identified in 24 patients (4.4%); Patients who were managed surgically were 83.3%(n = 20) with a median LOS of 20 days (Range 11 to 148) and mortality of 5%(n = 1). 16.7%(n = 4) were managed conservatively with a median LOS of 31 days (Range 14 to 51) and mortality of 0%.  All 24 patients with chyle leak had neoadjuvant chemotherapy as part of treatment with radical intent.  Conclusions Low mortality rates with chyle leak can be achieved with a high index of suspicion and early surgical intervention. This is crucial in reducing the length of stay in hospital and morbidity. Conservative management is suitable in low volume chyle leak and cases clinically responding to medical management.

P215 THE COMPLEX BENIGN UPPER GI MDT - A QUALITY IMPROVEMENT INITIATIVE FROM A TERTIARY CENTRE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Soulat Raza Syed ◽  
Anderson Aneke Ikenna ◽  
Sharples Alistair ◽  
Bradbury C ◽  
Evans Stephanie ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Expert Advice ◽  
Quality Improvement Initiative ◽  
Treatment Pathway ◽  
Upper Gi ◽  
Tertiary Centre ◽  
Predominant Symptom ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Upper Gi Cancer

Abstract Introduction The Upper GI cancer Multidisciplinary team (MDT) has become an essential and integral part of the cancer treatment pathway in the management of Oesophagogastric (OG) cancer. There exists an need for the MDT management of complex benign diseases of the oesophagus which can be equally rewarding if proper decision making for treatment is achieved in this potentially challenging group of patients. Methods We explore the utility of a Benign Complex MDT model consisting of Surgeons, Gastroenterologists, radiologists and GI Physiologists in a tertiary teaching hospital setting. A retrospective review of 72 patients who were discussed in the Complex Benign UGI MDT over a 2 year was undertaken. The referral pattern, decisions and outcomes have been analysed. All results were analysed using SPSS version 23. Results are reported in median +/- ranges or percentages where applicable. Results Patients had median age of 57 years with 62.5% being women. 30/72 (41.7%) patients had previous surgery. Majority of the referrals were made by surgeons 61/72 (84.7%) followed by gastroenterologist 10/72 (13.9%). Dysphagia was the predominant symptom in 34/72 (47.2%) patients followed by reflux in 31/72 (43%) patients and 19.4% patients had a combination. The purpose of an MDT referral was expert advice in 45/72 (62.5%) and consideration of surgery in 23/72 (31.9%) patients. The recommendations of the MDT was further clinic review (30%), further investigation (30.5%), surgery (18%), discharge (11%). MDT changed patient’s management in 30/72 (41.7%) cases. Conclusion Our results show that surgery was recommended less frequently after initial MDT discussions in patients who were initially referred for potential surgical advice. The management of complex benign conditions of the oesophagus can be challenging particularly after initial interventions. A MDT approach to the management of these patients can be recommended as equally vital to their management on recommending/avoiding further surgical or endoscopic interventions.

scholarly journals Fungal infective endocarditis of polytetrafluoroethylene pulmonary valve with Paecilomyces species following tetralogy of Fallot correction

2020 ◽  
Vol 7 (5) ◽  
pp. 1666
Author(s):  
Sumeet Anand ◽  
Swaminathan Vaidyanathan ◽  
Mustafa Janeel ◽  
Neville A. G. Solomon
Keyword(s):  
Infective Endocarditis ◽  
Early Diagnosis ◽  
Tetralogy Of Fallot ◽  
Laboratory Tests ◽  
Pulmonary Valve ◽  
Surgical Intervention ◽  
Immunocompromised Host ◽  
Bacterial Endocarditis ◽  
High Index Of Suspicion ◽  
Early Surgical Intervention

Fungal infective endocarditis of the prosthetic pulmonary valve in non immunocompromised host is growing phenomena attributed to the increased use of prosthetic materials. High mortality and neurovascular sequalae is commonly seen in such case if treatment is delayed. Often misdiagnosed as bacterial endocarditis due to closely resembling clinical features and lack of inexpensive and readily available laboratory tests, the diagnosis is often delayed. High index of suspicion and early surgical intervention is needed for early diagnosis and management

Impact of Socio-Economic Deprivation on Mortality Rates after Upper GI Cancer Surgery

Endoscopy ◽  
2006 ◽  
Vol 38 (11) ◽  
Author(s):  
Y Leigh ◽  
J Seagroatt ◽  
S Cole ◽  
M Goldacre ◽  
P McCulloch
Keyword(s):  
Mortality Rates ◽  
Cancer Surgery ◽  
Economic Deprivation ◽  
Upper Gi ◽  
Gi Cancer ◽  
Upper Gi Cancer

708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Han ◽  
H White ◽  
K Bosch ◽  
M Nair
Keyword(s):  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Lower Gastrointestinal Bleeding ◽  
University Hospital ◽  
British Society ◽  
Shock Index ◽  
Surgical Department ◽  
Upper Gi ◽  
Cardiovascular Comorbidities ◽  
New Guidelines

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

scholarly journals Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
The Mean ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

Tracheoinnominate fistula: surgical management of an iatrogenic disaster

2006 ◽  
Vol 120 (8) ◽  
pp. 676-680 ◽  
Author(s):  
R W Ridley ◽  
J B Zwischenberger
Keyword(s):  
Operating Room ◽  
Surgical Management ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Pectoralis Major Muscle ◽  
Muscle Flap ◽  
Rare Condition ◽  
Innominate Artery ◽  
Significant Potential ◽  
High Index Of Suspicion

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

Early Surgical Intervention for Infective Endocarditis

2002 ◽  
Vol 10 (4) ◽  
pp. 298-301 ◽  
Author(s):  
Hong Sheng Zhu ◽  
Pei Yan Yao ◽  
Jia Hao Zheng ◽  
A Thomas Pezzella
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Complex Disease ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

scholarly journals Correction to: Early surgical intervention for structural infantile spasms in two patients under 6 months old: a case report

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Haiyan Yang ◽  
Zhiquan Yang ◽  
Jing Peng ◽  
Yehong Huang ◽  
Zhuanyi Yang ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Infantile Spasms ◽  
Early Surgical Intervention

Mycobacterium mageritense infection following mastectomy and breast reconstruction requiring triple antibiotic therapy and surgical debridement

2021 ◽  
Vol 14 (2) ◽  
pp. e237618 ◽  
Author(s):  
Christie Alyce Joya ◽  
Cara Deegan ◽  
Todd D Gleeson
Keyword(s):  
Antibiotic Therapy ◽  
Surgical Intervention ◽  
Treatment Guidelines ◽  
Perforator Flap ◽  
Published Data ◽  
Gastrointestinal Distress ◽  
Deep Inferior Epigastric Perforator ◽  
Infectious Disease Specialists ◽  
Systemic Symptoms ◽  
Early Surgical Intervention

A 40-year-old woman was referred to infectious disease specialists for a Mycobacterium mageritense skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for M. mageritense, her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient’s treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with M. mageritense that do not respond to conventional treatment.

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