383 LAPAROSCOPIC CREATION OF RETROSTERNAL ROUTE FOR GASTRIC CONDUIT RECONSTRUCTION; SAFE AND FEASIBLE PROCEDURE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Manabu Horikawa ◽  
Taro Oshikiri ◽  
Yu Kitamura ◽  
Kazumasa Horie ◽  
Gosuke Takiguchi ◽  
...  
Keyword(s):  
Early Period ◽  
Injury Rate ◽  
Dorsal Side ◽  
Gastric Conduit ◽  
Safe Procedure ◽  
First Choice ◽  
Posterior Mediastinal ◽  
Time Required ◽  
Pleural Injury ◽  
Internal Thoracic Vessels

Abstract   Reconstruction routes after esophagectomy include posterior mediastinal, retrosternal, and subcutaneous route. We have performed posterior mediastinal reconstruction, but this route has higher risks of gastro-tracheal fistula and hiatal hernia. To avoid these complications, now we take the retrosternal route as our first choice by creating the route laparoscopically before pulling-up gastric conduit. We report the successful and safe procedure. Methods We performed laparoscopic creation of retrosternal route in 13 thoracoscopic/robot-assisted minimally invasive esophagectomies since August 2019. In practice, a peritoneal incision at the dorsal side of the xiphoid process is started. Then, via 12 mm port on the surgeon's right hand inserted slightly to the right and cranial side of the umbilical camera port, we dissect loose connective tissues from the caudal side to the cranial side behind the sternum and inside the internal thoracic vessels as landmarks. The time required to create the route and pleural injury rate during the procedure was examined. Results Thirteen cases were divided into two groups as early period group (seven cases) and later period group (six cases) respectively. The time required for route creation was 31.3 minutes(average) in the early period group, and 16.7 minutes in the later period group. There is tendency towards faster in later period group than in earlier one. The overall pleural injury rate was 15% (2 of 13 cases). Although it was difficult to determine the amount of bleeding, it was visually observed that the bleeding during the route creation was lower in the later period group than in the early period group. Conclusion The entire laparoscopic procedure to create retrosternal route makes it easier to observe and preserve the pleura and internal thoracic vessels compared to blind blunt dissection. As a conclusion, laparoscopic creation of retrosternal route for gastric conduit reconstruction is safe and feasible with good learning curve. Video https://www.dropbox.com/sh/p0wc3x46n33jp23/AADwiWHYIEUNUX6qZsERVIOga?dl=0.

scholarly journals Endoscopic submucosal dissection to relieve a flexure of the gastric conduit after esophagectomy

2018 ◽  
Vol 06 (03) ◽  
pp. E350-E353
Author(s):  
Katsumi Yamamoto ◽  
Hiroshi Noro ◽  
Yu Sato ◽  
Akira Kusakabe ◽  
Nobuyuki Tatsumi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Examination ◽  
Gastric Conduit ◽  
Endoscopic Balloon Dilation ◽  
Effective Treatment Option ◽  
Submucosal Dissection ◽  
First Case ◽  
Posterior Mediastinal ◽  
Endoscopic Balloon

Abstract Background and study aims A 70-year-old-man underwent an esophagectomy and posterior mediastinal reconstruction for esophageal cancer that was curatively resected. Although the patient was allowed to eat after surgery, he repeatedly vomited after drinking water or eating meals and required continuous hospitalization. An upper gastrointestinal series and endoscopic examination revealed an obstruction due to the flexure of the gastric conduit, which was repeatedly treated with endoscopic balloon dilation. Endoscopic balloon dilation was completely ineffective, however, because the obstruction was not due to a small lumen diameter, but rather to severe flexure. We hypothesized that the power of contraction provided by ulcer scar formation after mucosal resection could straighten the flexure, and thus removed a piece of the mucosa 8 cm in diameter on the oral side of the flexure by endoscopic submucosal dissection (ESD) 4 months after the esophagectomy. Endoscopic examination on post-ESD Day 10 revealed that the gastric conduit flexure was straightened due to ulcer scarring, and obstruction at the flexure opened over time. Meals were restarted and the patient could eat without vomiting. He was discharged from the hospital 5 weeks after ESD. This is the first case report of obstruction due to flexure of the gastric conduit after esophagectomy that was successfully treated with mucosectomy using ESD. Mucosectomy using ESD may be an effective treatment option for obstruction due to flexure of the gastric conduit after esophagectomy.

PS01.120: INVESTIGATION OF NUTRITIONAL INDICATORS COMPARING RECONSTRUCTION ROUTE AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 84-84
Author(s):  
Akihiro Tokuhisa ◽  
Shinsuke Kanekiyo ◽  
Shigeru Takeda ◽  
Hiroaki Nagano
Keyword(s):  
Survival Rate ◽  
Propensity Score ◽  
Surgical Complications ◽  
Gastric Tube ◽  
Nutritional Evaluation ◽  
Endoscopic Findings ◽  
First Choice ◽  
Posterior Mediastinal ◽  
Conut Score ◽  
Gastric Tube Reconstruction

Abstract Background The gastric tube reconstruction route after esophagectomy is generally adopted posterior mediastinal or retrosternal route. Currently it is selected for each hospital or case. Preoperative and postoperative nutritional assessment, surgical complications and rate of survival are retrospectively compared between Posterior mediastinal routec(Group P) and Retrosternal route (Group R). Methods From January 2006 to December 2015, 198 patients with gastric tube reconstruction after esophagectomy (112 patients in Group P and 86 patients in Group R) were included. Propensity score was calculated and adjusted by multiple logistic regression analysis because bias of background factors occurs. 1) Surgical complications and survival rate, 2) CONUT score as a nutritional evaluation index before, 6 months and 12 months after surgery, 3) Endoscopic findings at 12 months after surgery were examined. Results In Group R, there were more advanced cases with thoracotomy than Group P. As a result of matching these factors as covariates using Propensity score, 27 groups were extracted in each group. 1) Surgical complications and survival rate: There was no difference in the incidence of complications such as arrhythmia, suture failure, pulmonary complications between the two groups. There was no difference between PFS and OS in the two groups. 2) Nutritional Evaluation Indicator: The patients who recognized malnutrition (CONUT score 3 or more) before surgery (group P 9.3% vs. group R 7.4%, P = 0.715), 6 months after surgery (18.0% vs 15.4%, P = 1.000), 12 months after surgery (8.6% vs 22.9%, P = 0.049), group P had good nutritional status for 12 months postoperatively. 3) Endoscopic findings: Anastomotic stenosis (group P 22.5% vs. group R 10.2%, P = 0.052) tended to be few in group R. The occurrence of reflux esophagitis and food residue stagnation was not different between both groups. Conclusion Although short-term benefits such as ease of response to postoperative recurrence and postoperative complications are considered to be in retrosternal reconstruction, as the results of esophageal cancer treatment outcome improve, longer term of nutrition etc is taken from the viewpoint. The posterior mediastinal route is the first choice in our department. Disclosure All authors have declared no conflicts of interest.

scholarly journals Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sato ◽  
Satoru Motoyama ◽  
Akiyuki Wakita ◽  
Yuta Kawakita ◽  
Yushi Nagaki ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Gastric Conduit ◽  
University Hospital ◽  
Logistic Analysis ◽  
Handsewn Anastomosis ◽  
Surgical Sutures ◽  
Posterior Mediastinal

Abstract The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326–277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

scholarly journals Visualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies

2015 ◽  
Vol 22 (5) ◽  
pp. 554-557 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Kazutoshi Hida ◽  
Masaaki Takeda ◽  
Takafumi Mitsuhara ◽  
Mizuki Morishige ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Gentian Violet ◽  
Dorsal Side ◽  
Injection Technique ◽  
Csf Flow ◽  
Thoracic Spinal Cord ◽  
Subarachnoid Injection ◽  
Thoracic Spinal ◽  
First Choice ◽  
The Web

Surgical lysis of the thickened arachnoid membrane is the first choice of treatment in spinal arachnoid pathologies that cause flow disturbances or blockage of CSF. However, it is important to consider that while extensive lysis of the arachnoid may temporarily provide a wide pathway for CSF, an extensive lytic procedure may later cause secondary adhesion. Thus, it is ideal for the proper extent of the arachnoid lysis to be determined after careful analysis of regional CSF flow. The authors report their limited experience with intraoperative visualization of CSF flow in spinal arachnoid pathologies. Two patients with a dorsal arachnoid web (DAW) with cervical syringomyelia and 1 patient with focal adhesive arachnoiditis causing edema of the spinal cord were surgically treated at the authors' institution between 2007 and 2013. In all cases, the presence of a DAW or focal adhesive arachnoiditis was suspected from the findings on MRI, namely 1) an indentation on the upper thoracic spinal cord and 2) syringomyelia and/or edema of the spinal cord above the indentation. Exploratory surgery disclosed a transversely thickened arachnoid septum on the dorsal side of the indented cord. To prove blockage of the CSF by the septum and to decide on the extent of arachnoid lysis, regional CSF flow around the arachnoid septum was visualized by subarachnoid injection of gentian violet solution close to the web. Injected dye stagnated just close to the arachnoid septum in all cases, and these findings documented CSF blockage by the septum. In 2 cases, a 2-minute observation showed that the injected dye stayed close to the web without diffusion. The authors performed not only resection of the web itself but also lysis of the thickened arachnoid on both sides of the spinal cord to make a CSF pathway on the ventral side. In the third case, the dye stagnated close to the web at first but then diffused through the nerve root to the ventral CSF space. The lysis procedure was completed after exclusive removal of the dorsal web. Postoperative MR images confirmed reduction of the syrinx and/or improvement of the edema in all cases, suggesting that the extent of arachnoid lysis was optimal in each case. No adverse effect was observed after subarachnoid injection of gentian violet. The authors believe that their technique of visualizing regional CSF flow will be helpful to decide the optimal extent of lysis in some local arachnoid pathologies.

Total removal of the posterior mediastinal gastric conduit due to gastric cancer after esophagectomy

2004 ◽  
Vol 85 (4) ◽  
pp. 204-208 ◽  
Author(s):  
Hirofumi Akita ◽  
Yuichiro Doki ◽  
Osamu Ishikawa ◽  
Ko Takachi ◽  
Isao Miyashiro ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Conduit ◽  
Total Removal ◽  
Posterior Mediastinal

scholarly journals SIRT1+ Adipose Derived Mesenchymal Stromal Stem Cells (ASCs) Suspended in Alginate Hydrogel for the Treatment of Subchondral Bone Cyst in Medial Femoral Condyle in the Horse. Clinical Report

2020 ◽  
Vol 16 (6) ◽  
pp. 1328-1334
Author(s):  
Paweł Golonka ◽  
Katarzyna Kornicka-Garbowska ◽  
Krzysztof Marycz
Keyword(s):  
Stem Cells ◽  
Subchondral Bone ◽  
Therapeutic Potential ◽  
Bone Cyst ◽  
Clinical Report ◽  
Safe Procedure ◽  
Alginate Hydrogel ◽  
Cell Based Therapy ◽  
First Choice ◽  
Stromal Stem Cells

AbstractStem cell based therapy are now commonly applied in human and veterinary medical practice especially in orthopaedics. Mesenchymal stromal stem cells isolated from adipose tissue (ASC) are first choice option due to relatively non-invasive and safe procedure of tissue harvesting. However, ASC therapeutic potential strongly rely on patients general health condition, age and life-style. For that reason, to enhance therapeutic potential of cells, they are modified in vitro using different approaches. Previous studies have shown, that ASC treated with resveratrol, herein called SIRT+, are characterised by decreased senescence, increased proliferation rate and improved clinical outcome in autologous therapies. Herein, SIRT + cells in alginate hydrogel were applied to 5 years old warm breed mare was clinically evaluated due to the left hind lameness due to subchondral bone cyst. The therapeutic effect was assessed by the analysis of lameness score and radiological evaluation. This case report demonstrates the therapeutic potential of SIRT + cells in the treatment of orthopaedics disorders in horses as complete bone remodelling occurred after therapy and horse came back to training.

scholarly journals Safety and Efficacy of Bilateral Simultaneous Percutaneous Nephrolithotomy

2019 ◽  
Vol 17 (01) ◽  
pp. 114-118 ◽  
Author(s):  
Mahesh Bahadur Adhikari ◽  
Sumeet Karna ◽  
Atul Kasaju
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Tertiary Hospital ◽  
Safe Procedure ◽  
Safety And Efficacy ◽  
Stone Free Rate ◽  
Grade Ii ◽  
Time Required ◽  
Free Rate ◽  
Grade Iii

Background: To evaluate the safety and efficacy of bilateral simultaneous percutaneous nephrolithotomy in one tertiary hospital in Nepal.Methods: Retrospective study was done for all patients that underwent bilateral simultaneous percutaneous nephrolithotomy in our center from January 2010 to December 2017. The study included 36 male and 16 female patients with totalof 104renal units at an average age of 37 years (range 3 -65 years). Five patients were planned for bilateral simultaneous Percutaneous nephrolithotomy, but intraoperatively the procedure was aborted after completion of only one side due to various factors. All PCNL were performed in prone position under general anesthesia.Results: In91.2% of the patients, bilateral simultaneous percutaneous nephrolithotomy could be performed as planned. Average time required for bilateral simultaneous percutaneous nephrolithotomy was 94 ± 38.8mins (range 25 – 170 mins) with average hemoglobin drop of 1.85 ± 1.30gm% (range 0.1 - 4.2gm%) and no significant change in serum creatinine levels. Multiple access tracts (>1) had to be created in 3 renal units. Most of the renal stones were Guy’s stone score (GSS) 1 and 2 whereas 15.4% were GSS of 3 and 4.Overall stone free rate was 94% with significant residual stones (>4mm) in 6 renal units which were subjected to extracorporeal shockwave lithotripsy (SWL) on a later date (Clavien-Dindo Grade: III-a). Bladder clot evacuation was done in one patient (Clavien-Dindo Grade: III-b). Blood transfusion was required in two patients and two patients developed postoperative sepsis (Clavien-Dindo Grade: II). One patient developed hydrothorax which was managed successfully (Clavien-Dindo Grade: III-a). Conclusions: Bilateral simultaneous Percutaneous nephrolithotomy is feasible and safe procedure, given that the patients are appropriately selected based upon Guy’s stone score, stone burden, pelvi-calyceal anatomy and overall health status.Keywords: Bilateral simultaneous;endourology; percutaneous nephrolithotomy; urolithiasis.

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