Surgical Approach to Bismuth Type I and II Hilar Cholangiocarcinomas

2007 ◽  
Vol 246 (6) ◽  
pp. 1052-1057 ◽  
Author(s):  
Takashi Ikeyama ◽  
Masato Nagino ◽  
Koji Oda ◽  
Tomoki Ebata ◽  
Hideki Nishio ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Type I

scholarly journals 3D printing-based Ganz approach for treatment of femoral head fractures: a prospective analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jinwu Wang ◽  
Leyi Cai ◽  
Linzhen Xie ◽  
Hua Chen ◽  
Xiaoshan Guo ◽  
...  
Keyword(s):  
Femoral Head ◽  
3D Printing ◽  
Blood Loss ◽  
Surgical Approach ◽  
Type I ◽  
Type Ii ◽  
Femoral Head Fracture ◽  
Hip Function ◽  
The Mean

Abstract Background Femoral head fractures are uncommon injuries. Open reduction and internal fixation (ORIF) of femoral head fracture is the preferred treatment for most patients. There are several surgical approaches and treatments for this difficult fracture. However, the optimal surgical approach for the treatment of femoral head fracture remains controversial. Meanwhile, the operation is difficult and the complications are numerous. We prospectively reviewed patients with femoral head fractures managed surgically through the 3D printing-based Ganz approach to define a better approach with the least morbidity. Patients and methods Between 2012 and 2017, a total of 17 patients were included in this study. An exact 1:1 3D printing model of the injured hip side was fabricated for each patient and simulated surgery was finished preoperative. The surgical approach was performed as described by Ganz. Functional assessment was performed using the modified Merle d’Aubigne scores. The reduction of the fracture was evaluated according to Matta’s criteria. The incidence of complications, such as heterotopic ossification (HO) and avascular necrosis (AVN), and the need for additional surgery were also documented. Results Twelve of 17 patients (four females and eight males) were available for 2 years follow-up. The mean follow-up was 35 months (25–48 months). Average age for the 12 patients was 39.9 ± 12.2 years. According to the Pipkin classification, four patients were type I fracture, three patients were type II fracture, and five patients were type IV fracture. The mean operative time was 124.2 ± 22.1 min, and the estimated blood loss was 437.5 ± 113.1 ml. According to Merle d’ Aubigne scores, excellent results were achieved in six of the 12 patients; four good and two poor results occurred in the rest of the patients. On the radiograph evaluation, fracture reduction was defined as anatomical in eight patients, and imperfect in four. Most patients had good outcomes and satisfactory hip function at last follow-up. Almost all great trochanteric osteectomy healed uneventfully. One patient developed symptomatic AVN of the femoral head and underwent THA at 3 years. After THA, she regained a good hip function with the ability to return to work and almost no reduction in sports activities. Heterotopic ossification was found in four cases (type I-1, type II-2, and type III-1). Conclusions The 3D printing-based Ganz approach provides a safe and reliable approach and satisfactory results of treatment in femoral head fractures. Using 3D printed model for the fracture of the femoral head, the fracture can be viewed in every direction to provide an accurate description of fracture characteristics, which contributes to make a reasonable surgical plan for patients. In addition, the 3D printing-based Ganz approach can obtain excellent surgical exposure and protection of the femoral head blood supply, reduce the operation time and intraoperative blood loss, make the precise osteotomy, anatomically fix the intra-articular fragments, and effectively reduce postoperative complications. Trial registration We register our research at http://www.researchregistry.com. The Unique Identifying Number (UIN) from the Research Registry of the study is researchregistry4847.

Oral-facial-digital syndrome type I: Surgical approach and a case report

2014 ◽  
Vol 67 (3) ◽  
pp. 396-398 ◽  
Author(s):  
M. García González ◽  
M. Pombo Castro ◽  
D. Vela Nieto ◽  
J. Caramés Bouzán
Keyword(s):  
Case Report ◽  
Surgical Approach ◽  
Type I ◽  
Syndrome Type

scholarly journals Buttocks Hard as Rocks: Not Wanted after Aortic Dissection Repair

Aorta ◽  
2018 ◽  
Vol 06 (01) ◽  
pp. 037-040 ◽  
Author(s):  
Maude Cameron-Gagné ◽  
Luc Bédard ◽  
Valérie Lafrenière-Bessi ◽  
Marie-Hélène Lévesque ◽  
François Dagenais ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Compartment Syndrome ◽  
Surgical Approach ◽  
Type I ◽  
Gluteal Compartment Syndrome

AbstractThe authors report the case of a patient developing a gluteal compartment syndrome after DeBakey type I dissection repair. Prompt recognition and treatment led to successful results. The surgical approach to the gluteal compartment is described.

Tracheal Agenesis: Vertical Division of the Native Esophagus – A Novel Surgical Approach and Review of the Literature

2020 ◽  
pp. 000348942096212
Author(s):  
Alexander J. Straughan ◽  
Collin F. Mulcahy ◽  
Anthony D. Sandler ◽  
Nancy M. Bauman ◽  
David Steinhorn ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Alimentary Tract ◽  
Healing Process ◽  
Operative Management ◽  
Type I ◽  
Review Of The Literature ◽  
Tracheal Agenesis ◽  
Proximal Esophagus ◽  
Vertical Division ◽  
Cervical Trachea

Introduction: Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. Methods: Case report and literature review. Results: A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. Conclusion: We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.

scholarly journals Effect of a Rapidly Degrading Presolidified 10 kDa Chitosan/Blood Implant and Subchondral Marrow Stimulation Surgical Approach on Cartilage Resurfacing in a Sheep Model

Cartilage ◽  
2016 ◽  
Vol 8 (4) ◽  
pp. 417-431 ◽  
Author(s):  
Angela D. Bell ◽  
Mark B. Hurtig ◽  
Eric Quenneville ◽  
Georges-Étienne Rivard ◽  
Caroline D. Hoemann
Keyword(s):  
Subchondral Bone ◽  
Surgical Approach ◽  
Bone Repair ◽  
Collagen Type ◽  
Volume Fraction ◽  
Factor Viia ◽  
Blood Clot ◽  
Cartilage Defects ◽  
Type I ◽  
Marrow Stimulation

Objective This study tested the hypothesis that presolidified chitosan-blood implants are retained in subchondral bone channels perforated in critical-size sheep cartilage defects, and promote bone repair and hyaline-like cartilage resurfacing versus blood implant. Design Cartilage defects (10 × 10 mm) with 3 bone channels (1 drill, 2 Jamshidi biopsy, 2 mm diameter), and 6 small microfracture holes were created bilaterally in n = 11 sheep knee medial condyles. In one knee, 10 kDa chitosan–NaCl/blood implant (presolidified using recombinant factor VIIa or tissue factor), was inserted into each drill and Jamshidi hole. Contralateral knee defects received presolidified whole blood clot. Repair tissues were assessed histologically, biochemically, biomechanically, and by micro–computed tomography after 1 day ( n = 1) and 6 months ( n = 10). Results Day 1 defects showed a 60% loss of subchondral bone plate volume fraction along with extensive subchondral hematoma. Chitosan implant was resident at day 1, but had no effect on any subsequent repair parameter compared with blood implant controls. At 6 months, bone defects exhibited remodeling and hypomineralized bone repair and were partly resurfaced with tissues containing collagen type II and scant collagen type I, 2-fold lower glycosaminoglycan and fibril modulus, and 4.5-fold higher permeability compared with intact cartilage. Microdrill holes elicited higher histological ICRS-II overall assessment scores than Jamshidi holes (50% vs. 30%, P = 0.041). Jamshidi biopsy holes provoked sporadic osteonecrosis in n = 3 debrided condyles. Conclusions Ten kilodalton chitosan was insufficient to improve repair. Microdrilling is a feasible subchondral marrow stimulation surgical approach with the potential to elicit poroelastic tissues with at least half the compressive modulus as intact articular cartilage.

Two-stage palliative surgical approach for pulmonary atresia (Type I)

1970 ◽  
Vol 26 (6) ◽  
pp. 646-647
Author(s):  
E.F. Luckstead ◽  
Leone Mattioli ◽  
Ivan K. Crosby ◽  
William A. Reed ◽  
Antoni M. Diehl
Keyword(s):  
Surgical Approach ◽  
Pulmonary Atresia ◽  
Type I ◽  
Two Stage

scholarly journals Mixed type of total anomalous pulmonary venous connection: diagnosis, surgical approach and outcomes

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ming Xiang ◽  
Chun Wu ◽  
Zhengxia Pan ◽  
Quan Wang ◽  
Linyun Xi
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Bypass ◽  
Surgical Approach ◽  
Computed Tomography Angiography ◽  
Classification System ◽  
Mixed Type ◽  
Survival Rates ◽  
Pulmonary Venous Obstruction ◽  
Type I ◽  
Anomalous Pulmonary Venous Connection

Abstract Purpose To summarize the diagnosis and treatment of 13 patients with mixed-type total anomalous pulmonary venous connection (TAPVC) and propose another classification for mixed TAPVC. Methods A retrospective review of 13 patients with mixed TAPVC undergoing repair at a single institution was conducted between January 2010 and November 2019. The diagnosis of mixed-type TAPVC was made in all patients using echocardiography combined with computed tomography angiography. According to the mixed TAPVC anatomy, there were 3 patients with type I TAPVC (2 + 2 veins), 10 patients with type II TAPVC (3 + 1 veins) and no patients with type III TAPVC. Correspondingly, there was 1 patient with the “SVC + VV” subtype, 2 patients with the “CS + C” subtype, 8 patients with the “CS + VV” subtype, 1 patient with the “CS + SVC” subtype and 1 patient with the “RA + SVC” subtype according to our classification system. All patients underwent cardiopulmonary bypass surgery. Results The median weight at surgery was 4.6 ± 1.0 kg (3.4–7.3 kg), and the median age at surgery was 96.2 ± 81.2 days (10–242 days). The median cardiopulmonary bypass time was 132.7 ± 25.1 min (range, 100 to 190 min). The cross-clamping time was 69.2 ± 14.4 min (range, 45 to 88 min). The hospital mortality rate was 7.7% (1 of 13), with late mortality occurring in 1 patient because of pulmonary venous obstruction (PVO) 7 months after surgery. The average follow-up after surgery was 3.4 ± 2.2 years (range, 5 months to 8 years). The survival rates at 3 and 5 years were both 90.9% ± 8.7% (95% CI: 73.8–108%). All remaining surviving patients were asymptomatic. Conclusion Mixed TAPVC can be repaired with good results in children and can be correctly diagnosed with echocardiography combined with computed tomography angiography. The classification system we propose is pragmatic and can guide the surgical approach.

scholarly journals Mixed type of total anomalous pulmonary venous connection: diagnosis, surgical approach and outcomes

2020 ◽  
Author(s):  
Ming Xiang ◽  
Chun Wu ◽  
Zhengxia Pan ◽  
Quan Wang ◽  
Linyun Xi
Keyword(s):  
Computed Tomography ◽  
Cardiopulmonary Bypass ◽  
Surgical Approach ◽  
Computed Tomography Angiography ◽  
Classification System ◽  
Mixed Type ◽  
Survival Rates ◽  
Pulmonary Venous Obstruction ◽  
Type I ◽  
Anomalous Pulmonary Venous Connection

Abstract Purpose To summarize the diagnosis and treatment of 13 patients with mixed-type total anomalous pulmonary venous connection (TAPVC) and propose another classification for mixed TAPVC. Methods A retrospective review of 13 patients with mixed TAPVC undergoing repair at a single institution was conducted between January 2010 and November 2019. The diagnosis of mixed-type TAPVC was made in all patients using echocardiography combined with computed tomography angiography. According to the mixed TAPVC anatomy, there were 3 patients with type I TAPVC (2+2 veins), 10 patients with type II TAPVC (3+1 veins) and no patients with type III TAPVC. Correspondingly, there was 1 patient with the “SVC+VV” subtype, 2 patients with the “CS+C” subtype, 8 patients with the “CS+VV” subtype, 1 patient with the “CS+SVC” subtype and 1 patient with the “RA+SVC” subtype according to our classification system. All patients underwent cardiopulmonary bypass surgery. Results The median weight at surgery was 4.6±1.0 kg (3.4-7.3 kg), and the median age at surgery was 96.2±81.2 days (10-242 days). The median cardiopulmonary bypass time was 132.7±25.1 minutes (range, 100 to 190 min). The cross-clamping time was 69.2±14.4 minutes (range, 45 to 88 min). The hospital mortality rate was 7.7% (1 of 13), with late mortality occurring in 1 patient because of pulmonary venous obstruction (PVO) 7 months after surgery. The average follow-up after surgery was 3.4 ± 2.2 years (range, 5 months to 8 years). The survival rates at 3 and 5 years were both 90.9% ± 8.7% (95% CI: 73.8%-108%). All remaining surviving patients were asymptomatic. Conclusion Mixed TAPVC can be repaired with good results in children and can be correctly diagnosed with echocardiography combined with computed tomography angiography. The classification system we propose is pragmatic and can guide the surgical approach.

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