380 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: OUTCOME OF VARIOUS LEAKAGE TREATMENTS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Van Workum ◽  
M Verstegen ◽  
S Ubels ◽  
G Hannink ◽  
B Klarenbeek ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Primary Outcome ◽  
Muscle Flap ◽  
Final Analysis ◽  
Primary Treatment ◽  
Healing Time ◽  
Tube Placement ◽  
Treatment Modalities ◽  
Detailed Data ◽  
Full Study

Abstract   Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which initial treatments are most effective for what type of leak. We aimed to investigate the effectiveness of initial treatments of AL in daily clinical practice. Methods The TENTACLE—Esophagus is a multinational retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction in the period 2011–2019 were included. Detailed data regarding casemix, surgery, leak characteristics (e.g. organ failure, leak circumference, contamination, drains present) and treatment (e.g. hours from diagnosis to treatment, treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Regression analysis will be used to analyze the effectiveness of primary treatments after correction for patient-, surgery- and leak characteristics. The full study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1407 patients with AL from 70 centers in 20 countries is currently being validated and is awaiting final analysis. Preliminary results showed that AL was diagnosed 0–43 days after surgery and 90-day mortality rate was 11.1%. Primary treatments included re-operation (23.0%), stenting (16.8%), radiological drainage (10.5%), tube placement through the defect in the leak cavity (8.7%) and endoVAC placement (3.4%). Re-operations (n = 323) were drainage only (54.6%), oversewing the leak (15.5%), anastomotic resection and re-anastomosis (5,3%), repair with muscle flap (2.5%), disconnection and esophagostomy (11.8%) and other or unknown procedures (10.3%). Conclusion This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of AL.

679 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: EFFICACY OF DIFFERENT INITIAL TREATMENT STRATEGIES FOR ANASTOMOTIC LEAKAGE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sander Ubels ◽  
Moniek Verstegen ◽  
Stefan Bouwense ◽  
Gerjon Hannink ◽  
Peter Siersema ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Primary Outcome ◽  
Treatment Strategies ◽  
Primary Treatment ◽  
Healing Time ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Secondary Treatment ◽  
Detailed Data ◽  
Leakage Characteristics

Abstract   Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which primary treatments are most effective for which type of leak. We aimed to investigate the effectiveness of different primary treatments of AL. Methods International retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction were included in the period 2011-2019. Detailed data regarding case mix, resection, leakage characteristics (e.g. organ failure, leak circumference, contamination, drains present) and leakage treatment (e.g. hours from diagnosis to treatment, primary and secondary treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Different clinically relevant leakage groups have been defined. Efficacy of different treatment strategies adjusted for leakage severity will be analyzed in these clinical groups. The study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1451 patients with AL was collected from 71 centers in 20 countries. Data accuracy was 96.5%. Preliminary results showed that the overall 90-day mortality was 11.6%. The analysis of TENTACLE—Esophagus data is currently being performed and efficacy of different leakage treatment strategies is being assessed. The efficacy of initial leakage treatment strategies will be ready to be presented at the ISDE meeting. Conclusion This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence-based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of anastomotic leakage.

120 Genicular Nerve Radio-Frequency Ablation in The Treatment of Anterior Knee Pain in Patients with Osteoarthritis of The Knee Joint: Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Farrugia ◽  
C Tinning
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Comparative Studies ◽  
Primary Outcome ◽  
Final Analysis ◽  
Primary Outcome Measure ◽  
Sensory Innervation ◽  
Osteoarthritis Of The Knee ◽  
Pain Scores ◽  
Anterior Knee

Abstract Anterior knee pain is one of the main symptoms in osteoarthritis, resulting from the rich sensory innervation of its capsule. Pain control can be difficult to achieve, with non-responders to conservative and medical therapy often requiring a total knee replacement. Radiofrequency ablation (RFA) is a novel technique that could be beneficial in managing anterior knee pain by targeting the genicular nerves around the knee; however, its routine use is not included in current guidelines. A literature search identified fifty-two results, which underwent screening using a study protocol and the final literature sources, of varying levels of evidence, underwent critical appraisal and analysis. The primary outcome included the significant improvement of pain scores from baseline, against their respective control treatments. The ten studies included in the final analysis consisted of seven comparative studies and three non-comparative studies. Literature showed significant improvement in their mean pain scores, all meeting the primary outcome measure. Most studies also showed significant improvement from the control treatments used. Current literature shows evidence that genicular nerve RFA is an effective and safe treatment modality in the management of anterior knee pain secondary to osteoarthritis. However, the literature available is limited and further comparative studies are required.

scholarly journals Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

2021 ◽  
Vol 10 (15) ◽  
pp. 3307
Author(s):  
Aleksandra Zgryźniak ◽  
Joanna Przeździecka-Dołyk ◽  
Marek Szaliński ◽  
Anna Turno-Kręcicka
Keyword(s):  
Ocular Hypertension ◽  
Laser Energy ◽  
Open Angle Glaucoma ◽  
Biological Effects ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty

Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.

scholarly journals Lactobacillus Kefiri LKF01 (Kefibios®) for Prevention of Diarrhoea in Cancer Patients Treated with Chemotherapy: A Prospective Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 385
Author(s):  
Michele Ghidini ◽  
Mariaceleste Nicoletti ◽  
Margherita Ratti ◽  
Gianluca Tomasello ◽  
Veronica Lonati ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Final Analysis ◽  
Clinical Effectiveness ◽  
High Grade ◽  
Combination Therapies ◽  
Grade 3 ◽  
Lactobacillus Kefiri ◽  
A Prospective Study

Diarrhoea is one of the main side effects that cancer patients face. The literature showsthat the incidence of chemotherapy (CT)-induced diarrhoea (grade 3–4) in treated patients is in the range of 10–20%, particularly after 5-fluorouracil (5-FU) bolus or some combination therapies of irinotecan and fluoropyrimidines. The aim of the present study was to evaluate the clinical effectiveness of Lactobacillus kefiri LKF01 (Kefibios®) in the prevention or treatment of CT-related diarrhoea in the cancer population. We conducted a prospective observational study. Patients enrolled were adults treated for at least four months with 5-FU-based CT. Kefibios® was administered to patients every day. The primary outcome was the evaluation of the incidence of grade 3–4 CT-induced diarrhoea. We included 76 patients in the final analysis. A 6.6% incidence of high-grade diarrhoea was found in the evaluated population (4.7% of patients treated with 5-FU-based therapy and 8.5% of patients treated with capecitabine-based CT). The overall incidence of high-grade diarrhoea observed was higher in the 1st and 2nd cycles (3.9%), with a subsequent sharp reduction from the 3rd cycle (1.3%) and negativisation from the 5th cycle. Lactobacillus kefiri LKF01 (Kefibios®) is safe and effective in preventing severe diarrhoea in cancer patients receiving 5-FU or capecitabine-based treatment.

scholarly journals Endoscopic stent insertion for anastomotic leakage following oesophagectomy

2013 ◽  
Vol 95 (1) ◽  
pp. 43-47 ◽  
Author(s):  
M Schweigert ◽  
N Solymosi ◽  
A Dubecz ◽  
RJ Stadlhuber ◽  
H Muschweck ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Stent Implantation ◽  
Fatal Outcome ◽  
Invasive Procedure ◽  
High Volume ◽  
Primary Treatment ◽  
Stent Insertion ◽  
Endoscopic Stent ◽  
Life Threatening ◽  
Life Threatening Complication

Introduction Intrathoracic anastomotic leakage following oesophagectomy is a crushing condition. Until recently, surgical re-exploration was the preferred way of dealing with this life threatening complication. However, mortality remained significant. We therefore adopted endoscopic stent implantation as the primary treatment option. The aim of this study was to investigate the feasibility and results of endoscopic stent implantation as well as potential hazards and pitfalls. Methods Between January 2004 and December 2011, 292 consecutive patients who underwent an oesophagectomy at a single high volume centre dedicated to oesophageal surgery were included in this retrospective study. Overall, 38 cases with anastomotic leakage were identified and analysed. Results A total of 22 patients received endoscopic stent implantation as primary treatment whereas a rethoracotomy was mandatory in 15 cases. There were no significant differences in age, frequency of neoadjuvant therapy or ASA grade between cases with and without a leak. However, patients with a leak were five times more likely to have a fatal outcome (odds ratio: 5.10, 95% confidence interval: 2.06–12.33, p<0.001). Stent migration occurred but endoscopic reintervention was feasible. In 17 patients (77%) definite closure and healing of the leak was achieved, and the stent was removed subsequently. Two patients died owing to severe sepsis despite sufficient stent placement. Moreover, stent related aortic erosion with consecutive fatal haemorrhage occurred in three cases. Conclusions Stent implantation for intrathoracic oesophageal anastomotic leaks is feasible and compares favourably with surgical re-exploration. It is an easily available, minimally invasive procedure that may reduce leak related mortality. However, it puts the already well-known risk of stent-related vascular erosion on the spot. Awareness of this life threatening complication is therefore mandatory.

scholarly journals Healing Rates of Venous Leg Ulcer Using Four Layer Bandage and Short Stretch Bandage- A Comparative Study in Aspect of Bangladesh

2020 ◽  
Vol 16 (2) ◽  
pp. 78-85
Author(s):  
Rakibul Hasan ◽  
Md Saif Ullah Khan ◽  
Mainul Mahmud ◽  
Samaresh Chandra Saha ◽  
Sourav Bhowmick
Keyword(s):  
Primary Outcome ◽  
Single Layer ◽  
Leg Ulcer ◽  
Chronic Venous Disease ◽  
Treatment Modalities ◽  
Secondary Outcome ◽  
P Value ◽  
Venous Disease ◽  
Venous Leg Ulcer ◽  
Time Duration

Background: Chronic venous leg ulcer is one of the common medical conditions encounter by the vascular surgeons in Bangladesh. Many of these patients develop venous leg ulcer as a sequel of the disease. In advance chronic venous disease such as development of ulcer, single or multilayer dressings are usually used. Objective: To find out a compression therapy (single layer crepe/short stretch bandage and multilayer/four layer bandage) in patients with venous leg ulcer. Materiel & Methods: This study was conducted on 200 patients with in last two years, march 2017 to february 2019 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Department of vascular surgery. In which 100 patients with venous leg ulcer where treated with four layer bandage and another 100 patients with same condition were treated with single layer crepe bandage. Before application of bandage, proper history of patient was taken and duplex scan was done. The primary outcome was measured by time duration of ulcer healing. Secondary outcome included incidence and number of adverse events in every patient. Results: Healing time of venous ulcers was accessed with periodic interval. The four layer bandage was associated with significantly shorter time of healing. P value reached from unpaired t-test. Primary outcome shows 68% of patients who received four layer bandages achieved healing within one month. On the other hand, 12% of patients who received single layer/crepe bandage did so. Conclusion: Four layer bandages heals venous leg ulcer more rapidly than the single layer crape bandage. These data suggest that the benefits observed the consistent despite prognosis is different. Patients with large ulcers have poor healing prognosis regardless of its treatment modalities. University Heart Journal Vol. 16, No. 2, Jul 2020; 78-85

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