P54 INCIDENCE AND OUTCOME OF HIATAL HERNIA AFTER OESOPHAGECTOMY: COMPARISON OF TRADITIONAL OPEN AND MINIMALLY INVASIVE APPROACH

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Sanberg Ljungdalh Jonas ◽  
Markus Stilling Nicolaj ◽  
Patrick Ainsworth Alan ◽  
Hareskov Larsen Michael
Keyword(s):  
Minimally Invasive ◽  
Hiatal Hernia ◽  
Malignant Disease ◽  
University Hospital ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Electronic Patient Records ◽  
Invasive Approach ◽  
High Morbidity Rate

Abstract Aim The primary aim of this retrospective study is to evaluate the incidence of symptomatic and asymptomatic hiatal hernia (HH) in patients who have undergone intended curative open or minimally invasive oesophagectomy (MIO) for cancer of the oesophagus in a high-volume surgical centre. The secondary aim is to describe the treatment and outcome after HH treatment. Background & Methods MIO for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy without compromising disease free or overall survival1. HH of abdominal viscera other than the gastric conduit is an infrequent but potentially life-threatening complication following oesophagectomy. HH may present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery2,3. Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality4. In meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy5. However, studies on the subject, often do not describe whether patients are asymptomatic or simply have not been examined for the existence of HH. The actual HH incidence may therefore be underestimated and may be more sufficiently reported when including patient material with comprehensive follow-up. This retrospective cohort study includes all patients (n≈455) who have undergone curative intended resection for malignant disease in the oesophagus at The Department of Surgery, Odense University Hospital, from 1th January 2012 – 31th December 2018. Patient demography, perioperative data including surgical approach and follow-up, including occurrence and treatment of hiatal hernia, mortality and recurrence of malignant disease will be extracted from complete electronic patient records. Follow-up ranges from 6-84 months. Primary outcome is occurrence of hiatal hernia after oesophagectomy determined by CT-scan or during surgery. Results As of abstract deadline for ESDE 2019, we have only just received permission for the study from The Danish Patient Safety Authority and can unfortunately not present our results yet. However, we expect that results are ready for presentation at ESDE 2019 and hope for your understanding.

Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

2010 ◽  
Vol 124 (5) ◽  
Author(s):  
A Trinidade ◽  
V Sekhawat ◽  
Z Andreou ◽  
J Meldrum ◽  
S Kamat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Head And Neck ◽  
Clinical Course ◽  
Retropharyngeal Abscess ◽  
Morbidity Rate ◽  
Suction Catheter ◽  
High Morbidity ◽  
Pharyngeal Wall ◽  
Invasive Approach ◽  
High Morbidity Rate

AbstractIntroduction:Citrobacter freundiiis a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension.Objective:To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course.Method:Case report.Results:The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery.Conclusion:Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

P117 THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
A Cossu ◽  
P Parise ◽  
F Puccetti ◽  
M Palucci ◽  
R Cerchione ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Consecutive Series ◽  
Ivor Lewis ◽  
High Morbidity Rate ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Background Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age. Methods A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD). Results As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. p=0.001), mortality (0% group A, 3% group B and 5.5% group C. p=0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. p=0.001). A statistically significant higher incidence of anastomostic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-group. Conclusions Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy.

scholarly journals Laryngotracheal Stenosis: Clinical Aspects and Management Challenges

2021 ◽  
Author(s):  
Meryem Lahjaouj ◽  
Khadija El Bouhmadi ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
Reda Abada ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Morbidity Rate ◽  
Clinical Aspects ◽  
Partial Laryngectomy ◽  
High Morbidity ◽  
Laryngotracheal Stenosis ◽  
Severe Condition ◽  
T Tube ◽  
High Morbidity Rate

Abstract Laryngotracheal stenosis (LTS) is a severe condition with a high morbidity rate, described as the narrowing of the upper airway diameter. The etiology of acquired LTS is dominated by prolonged tracheal intubation. The diagnosis is based on endoscopic examination and computed tomography scan imaging providing an exact analysis of the lesion, with precise measurements.We report a descriptive retrospective review based on the analysis of the medical records of a cohort of 18 patients, treated between January 2015 and January 2018 for an acquired LTS.The results showed predominance in young males. The majority (73%) was hospitalized in a reanimation unit under tracheal intubation while the others (27%) underwent a tracheostomy. The location of the stenosis was tracheal in 69% of the patients, laryngeal in 23%, and laryngotracheal in 8%, and the degree of obstruction exceeded 70% in 11.2%. The endoscopic treatment was based on dilatation and endoluminal calibration by the Montgomery T-tube in 77.7% of our patients, circumferential resection by CO2 laser in 11.1%, and endoscopic posterior cordectomy in 11.1% of the cases. The surgical treatment relied on the resection of the stenosis followed by T-tube calibration in 61.1% of our patients, the resection with a termino-terminal anastomosis in 11%, and supraglottic partial laryngectomy in one patient. The follow-up showed major improvement in the clinical symptomatology, but the biggest challenge in LTS remains the occurrence of restenosis.LTS is a severe condition and needs to be always considered in patients with inspiratory dyspnea and a medical history of tracheal intubation. It requires exhaustive endoscopic and imaging exploration with multidisciplinary management and long-term follow-up to prevent and detect the early signs of an eventual recurrence.

Outcomes of nonagenarians with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Echarte Morales ◽  
P.L Cepas Guillen ◽  
G Caldentey ◽  
E Martinez Gomez ◽  
J Borrego-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk Population ◽  
High Morbidity ◽  
Baseline Characteristic ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
All Cause Mortality

Abstract Background Myocardial infarction (MI) in nonagenarians is associated with high morbidity and mortality. Nonetheless, this population has typically been underrepresented in cardiovascular clinical trials. Objective The aim of this study was to evaluate outcomes of nonagenarian patients presenting with MI who underwent either conservative or invasive management. Methods We retrospectively included all consecutive patients equal to or older than 90yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristic and procedural data. In-hospital and at 1-year follow-up all-cause mortality and major adverse cardiovascular events were assessed. Results 523 patients (mean age 92.6±2 years; 60% females) were analyzed. Overall, 184 patients (35.2%) underwent percutaneous coronary intervention (PCI), increasing over the years, mostly in STEMI group (from 16% of patients in 2005 to 75% in 2018). PCI was preferred in those subjects with less prevalence of disability for activities of daily living (p&lt;0.01). The use of a radial access (76.6%) and bare metal stents (52.7%) was predominant. No significant differences were found in the incidence of major bleeding events or MI-related mechanical complications between both strategies. During index hospitalization, 99 (18.9%) patients died. Whereas no differences were found in the NSTEMI group (p=0.61), a significant lower in-hospital mortality was observed in STEMI group treated with PCI (p&lt;0.01). At one-year follow up, 203 (38.8%) patients died, most of them due to a cardiovascular cause (60.6%). PCI was related to a lower all-cause mortality in either NSTEMI (p&lt;0.01) or STEMI groups (p&lt;0.01) however, lower cardiovascular mortality was only found in STEMI group (p=0.03). Conclusion An invasive approach was performed in over a third of nonagenarian patients, carrying prognostic implications and with a few numbers of complications. PCI seems to be the preferred strategy for STEMI in this high-risk population in spite of age. Figure 1 Funding Acknowledgement Type of funding source: None

Impact of biomineralization on resin/biomineralized dentin bond longevity in a minimally invasive approach: An “in vitro” 18-month follow-up

2021 ◽  
Vol 37 (5) ◽  
pp. e276-e289
Author(s):  
Kelly Maria Moreira ◽  
Luiz Eduardo Bertassoni ◽  
Robert Phill Davies ◽  
Felipe Joia ◽  
José Francisco Höfling ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Surveillance of influenza A H1N1 2009 among school children during 2009 and 2010 in São Paulo, Brazil

2012 ◽  
Vol 45 (5) ◽  
pp. 563-566 ◽  
Author(s):  
Sandra Baltazar Guatura ◽  
Aripuana Sakurada Aranha Watanabe ◽  
Clarice Neves Camargo ◽  
Ana Maria Passos ◽  
Sheila Negrini Parmezan ◽  
...  
Keyword(s):  
School Children ◽  
Influenza A ◽  
Respiratory Infections ◽  
Vaccination Campaign ◽  
Sao Paulo ◽  
Morbidity Rate ◽  
High Morbidity ◽  
São Paulo ◽  
High Morbidity Rate ◽  
Influenza A H1n1

INTRODUCTION: Influenza A H1N1 2009 is associated with a high morbidity rate among children around the world, including Brazil. This survey was conducted on samples of symptomatic children (< 12 years) to investigate the influenza virus as the etiological agent of respiratory infections in a day care school in a health facility during the first and second pandemic wave of H1N1 (2009-2010) in São Paulo, Brazil. METHODS: Influenza infections were determined by real-time PCR in 34% (47/137) of children with a median age of 5 years (8 months - 12 years), from June to October 2009 and in 16% (14/85) of those with median age of 6 years (1-12 years), from March to November 2010. RESULTS: In general, most positive cases (64%) occurred in children aged 5-12 years, this age group was significantly the most affected (39.8%, p = 0.001, OR = 8.3, CI 95% 1.9-36.9). Wheezing was reported by 31% (19/61) and dyspnea by 23% (14/61) of the studied patients. An outbreak of influenza H1N1 with an attack rate of 35.7% among children (median age 6 years) was documented in April 2010, before the vaccination campaign against the pandemic virus was extended for children up to 5 years in Brazil. CONCLUSIONS: Therefore, the study reinforces the recommendation to immunize school children to reduce the incidence of the disease.

scholarly journals A Staged Treatment of Symptomatic Lumbar Intraspinal Synovial Cysts

2019 ◽  
Vol 5 (22;5) ◽  
pp. E451-E456
Author(s):  
Kyung-Hoon Kim
Keyword(s):  
Minimally Invasive ◽  
Surgical Procedures ◽  
Facet Joint ◽  
University Hospital ◽  
Pain Clinic ◽  
Level Of Evidence ◽  
Endoscopic Surgical Procedures ◽  
Number Of Patients ◽  
Synovial Cysts

Background: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from the zygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In cases of LISCs resistant to conservative treatments, various minimally invasive percutaneous spinal techniques (MIPSTs) may be applied prior to open surgery. Objectives: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistant to conservative treatments were evaluated. Study Design: An institutional review board approved retrospective chart review. Setting: University hospital inpatients referred to our pain clinic. Methods: Review of charts of all patients who underwent MIPSTs for symptomatic LISCs resistant to conservative treatments during a time period of 13 years at a university hospital pain clinic. Patients with symptomatic LISCs resistant to conservative treatments were treated with 3-staged MIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injection of corticosteroids (ARI), endoscopic cyst enucleation (ECE), and endoscopic superior facetectomy (ESF) by a single pain specialist. A symptom-free period after each intervention was evaluated. Recurrence was defined as the same recurrent symptomatic radicular pain with confirmation of the LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 years were included. Results: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and 19 patients (51.4%) who had recurring symptoms received ECE. Ten patients (52.6%) who had rerecurring symptoms after ECE received ESF. There was no recurrence after ESF. Limitations: This retrospective and observational study with a limited number of patients does not represent a high level of evidence. Conclusions: This information provided the recurrence rate after each intervention. Half of the patients who went on to receive ARI experienced recurrence, whereas half of the patients with recurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrence within the 3-year study period. Key words: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticular injection, minimally invasive surgical procedures, needle biopsy, nerve root compression, radiculopathy, synovial cysts

Sutureless Aortic Valve Implantation through an Upper V-Type Ministernotomy: An Innovative Approach in High-Risk Patients

2013 ◽  
Vol 8 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Francesca Chiaramonti ◽  
Pierandrea Farneti ◽  
Stefano Bevilacqua ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Mean ◽  
Valve Implantation

Objective Aortic valve replacement in minimally invasive approach has shown to improve clinical outcomes even with a prolonged cardiopulmonary bypass and aortic cross-clamp (ACC) time. Sutureless aortic valve implantation may ideally shorten operative time. We describe our initial experience with the sutureless 3f Enable (Medtronic, Inc, ATS Medical, Minneapolis, MN USA) aortic bioprosthesis implanted in minimally invasive approach in high-risk patients. Methods Between May 2010 and May 2011, thirteen patients with severe aortic stenosis underwent aortic valve replacement with the 3f Enable bioprosthesis through an upper V-type ministernotomy interrupted at the second intercostal space. The mean ± SD age was 77 ± 3.9 years (range, 72–83 years), 10 patients were women, and the mean ± SD logistic EuroSCORE was 15% ± 13.5%. Echocardiography was performed preoperatively, at postoperative day 1, at discharge, and at follow-up. Clinical data, adverse events, and patient outcomes were recorded retrospectively. The median follow-up time was 4 months (interquartile range, 2–10 months). Results Most of the implanted valves were 21 mm in diameter (19–25 mm). The CPB and ACC times were 100.2 ± 25.3 and 66.4 ± 18.6 minutes. At short-term follow-up, the mean ± SD pressure gradient was 14 ± 4.9 mm Hg; one patient showed trivial paravalvular leakage. No patients died during hospital stay or at follow-up. Conclusions The 3f Enable sutureless bioprosthesis implanted in minimally invasive approach through an upper V-type ministernotomy is a feasible, safe, and reproducible procedure. Hemodynamic and clinical data are promising. This innovative approach might be considered as an alternative in high-risk patients. Reduction of CPB and ACC time is possible with increasing of experience and sutureless evolution of actual technology.

scholarly journals Nuss Procedure for a Patient with Negative Haller Index

2018 ◽  
Vol 06 (01) ◽  
pp. e18-e22 ◽  
Author(s):  
Mariela Dore ◽  
Paloma Triana Junco ◽  
Carlos De La Torre ◽  
Alejandra Vilanova-Sánchez ◽  
Monserrat Bret ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Vena Cava ◽  
Forced Expiratory Volume ◽  
Exercise Intolerance ◽  
Nuss Procedure ◽  
Invasive Approach ◽  
History Of ◽  
Ventilation Pattern

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

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