Modified Technique of Doubly Folded Peritoneal Flap Interposition in Transabdominal Vesicovaginal Fistula Repair: Our Experience of 36 Cases

2020 ◽  
Vol 104 (11-12) ◽  
pp. 928-932
Author(s):  
Shashi Kant Tewary ◽  
Ranjit Kumar Das ◽  
Arpan Choudhary ◽  
Supriyo Basu ◽  
Ranjan Kumar Dey
Keyword(s):  
Vesicovaginal Fistula ◽  
Operative Time ◽  
Open Repair ◽  
De Novo ◽  
Modified Technique ◽  
Suitable Alternative ◽  
Peritoneal Flap ◽  
Estimated Blood Loss ◽  
De Novo Urgency

<b><i>Purpose:</i></b> Correction of vesicovaginal fistula (VVF) using interpositional flaps is an established procedure. In open repair, omental flap gives good results. However, its availability in all the cases is questionable. We utilized our technique of doubly folded peritoneal flap and assessed the outcome of the repair. <b><i>Methods:</i></b> Retrospective observational study included 36 cases of open VVF repair, performed during 2010–2019. Preoperative clinical examination, cystoscopy, and imaging were performed routinely. Open transvesical repair as described by O’Conor was performed and doubly folded peritoneal flap was utilized. Intra- and postoperative parameters were recorded. The outcome was assessed after 21 days of catheter removal. A minimum of 6 months of follow-up was done. <b><i>Results:</i></b> Mean age was 44 ± 18 years, and 97.2% of VVF were iatrogenic, mainly after hysterectomy (75.0%) and caesarean section (22.2%). Fistula size ranged from 0.6 to 5.5 cm. Five cases had multiple fistulas and 3 cases were recurrent. Mean flap length and width were 8.0 ± 2.4 and 5.1 ± 1.1 cm, respectively. Mean operative time and estimated blood loss were 94 ± 15 min and 155 ± 45 mL, respectively. Fourteen of 36 patients developed complications of Clavien-Dindo grade I/II. Thirty-five out of 36 cases (97.2%) were cured and remained dry for 6 months after surgery. Three cases reported de-novo urgency and were treated medically. Satisfaction level was good in 91.2% of cases. <b><i>Conclusion:</i></b> Transvesical repair using doubly folded peritoneal flap provides an excellent and durable outcome. It is a suitable alternative to the omental interpositional flap.

scholarly journals Our Minimally Invasive Sacrocolpopexy Experiences in Pelvic Organ Prolapse Treatment

2021 ◽  
Author(s):  
Kamil Gökhan Şeker ◽  
Emre Sam ◽  
Yusuf Arıkan ◽  
Ahmet Hacıislamoğlu ◽  
Abdulmuttalip Şimşek ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Minimally Invasive ◽  
Operative Time ◽  
De Novo ◽  
Treatment Success ◽  
Conservative Surgery ◽  
Pelvic Organ ◽  
Robotic Sacrocolpopexy ◽  
De Novo Urgency

Objective: We aimed to evaluate the results of our minimally invasive (laparoscopic and robotic) sacrocolpopexy operations in patients with pelvic organ prolapse (POP). Materials and Methods: Demographic characteristics, intraoperative and postoperative data of 15 patients for whom we applied laparoscopic or robotic sacrocolpopexy due to symptomatic Grade 2 or higher apical POP based on POP-Q classification between September 2014 and September 2018. Treatment success was defined as Grade 0 or 1 POP in POP examination in the final surveillance. Results: Mean age of the patients was 60.4 ± 8.3 (49-82) years. Four patients (26.7%) were operated using robotic and eleven patients (73.3%) using laparoscopic methods. Uterus conservative surgery was applied in all patients excluding one. Mean operative time was 183.3 ± 21.4 (145-220) minutes and mean hospital stay of the patients was 2.8 ± 0.7 (2-4) days. Intraoperative and postoperative complications developed in a total of two patients (13.3%). Mean duration of follow-up was calculated as 12.1 ± 4.8 (8-24) months. De novo urgency urinary incontinence developed in two patients and stress incontinence in one patient. Based on the physical examination in the follow-ups, 14 patients (93.3%) had Grade 0 and one patient had (6.7%) asymptomatic Grade 2 anterior POP. Conclusion: Minimally invasive sacrocolpopexy is an efficient and safe surgical option for prolapse repair in symptomatic advanced stage POP cases.

scholarly journals Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

2013 ◽  
Vol 3 (1) ◽  
pp. 3 ◽  
Author(s):  
Nosratollah Nezakatzgoo ◽  
Janet Colli ◽  
Matthew Mutter ◽  
Sheg Aranmolate ◽  
Robert Wake
Keyword(s):  
Partial Nephrectomy ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Oral Intake ◽  
Pathological Examination ◽  
Tumor Diameter ◽  
Renal Masses ◽  
Estimated Blood Loss ◽  
Average Operative Time

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

Radiofrequency bipolar coagulation for radical hysterectomy: Technique, feasibility and complications

2003 ◽  
Vol 13 (2) ◽  
pp. 187-191
Author(s):  
A. Ercoli ◽  
A. Fagotti ◽  
M. Malzoni ◽  
G. Ferrandina ◽  
T. Susini ◽  
...  
Keyword(s):  
Blood Loss ◽  
Radical Hysterectomy ◽  
Operative Time ◽  
Bipolar Coagulation ◽  
Maximal Diameter ◽  
Estimated Blood Loss ◽  
Safe Technique ◽  
Radiofrequency Coagulation ◽  
Vessel Dissection

This study describes the surgical technique and intra- and postoperative complications associated with the use of a radiofrequency bipolar coagulator in a series of 18 Piver type III-IV radical hysterectomies performed in cervical cancer patients. Preliminary vessel-by-vessel dissection of the lateral parametria was possible in 17 out of 18 (94%) cases, and a direct application of a radiofrequency bipolar coagulation instrument was performed to coagulate the posterior and anterior parametrial tissues in all cases. We were able to easily coagulate isolated vessels up to 5 mm of maximal diameter. In no case were clamps or hemoclips necessary to complete hemostasis. We did not observe any parametrial vessel damage or heat-related injury of the surrounding normal tissue. The median size of the parametria removed was 44 mm (range 31–58) and nodes were detected in 15 cases (83%). Median operative time and estimated blood loss for the whole procedure including systematic pelvic and aortic lymphadenectomy was 250 min (range 200–410) and 550 ml (range 400–2500), respectively. Median follow-up time was 9 months (range 5–13). No complications specifically related to the use of radiofrequency coagulation were found. In conclusion the radio-frequency coagulation with this instrument appears to be a safe technique that is particularly useful in reducing blood loss and operative time without affecting radicality in patients undergoing radical hysterectomy.

scholarly journals Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures

2018 ◽  
Vol 12 (5) ◽  
pp. 488-492 ◽  
Author(s):  
L.-K. Chen ◽  
B. T. Sullivan ◽  
P. D. Sponseller
Keyword(s):  
Operative Time ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Level Of Evidence ◽  
Femur Fractures ◽  
Estimated Blood Loss ◽  
Postoperative Length ◽  
Flexible Nails

Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. Level of Evidence: III

scholarly journals Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987046 ◽  
Author(s):  
Xianfeng Ren ◽  
Feng Gao ◽  
Siyuan Li ◽  
Jiankun Yang ◽  
Yongming Xi
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Atlantoaxial Dislocation ◽  
Efficacy And Safety ◽  
Estimated Blood Loss ◽  
Irreducible Atlantoaxial Dislocation ◽  
The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

scholarly journals INTERESFINCTERIAL LIGATION OF FISTULA TRACT (LIFT) FOR PATIENTS WITH ANAL FISTULAS: A BRAZILIAN BI-INSTITUTIONAL EXPERIENCE

2017 ◽  
Vol 30 (4) ◽  
pp. 235-238 ◽  
Author(s):  
Sérgio Eduardo Alonso ARAÚJO ◽  
Marcelli Tainah MARCANTE ◽  
Carlos Ramon Siveira MENDES ◽  
Alexandre Bruno BERTONCINI ◽  
Victor Edmond SEID ◽  
...  
Keyword(s):  
Success Rate ◽  
Operative Time ◽  
Fistula Tract ◽  
Anal Fistulas ◽  
Modified Technique ◽  
External Orifice ◽  
Institutional Experience ◽  
Observational Cohort ◽  
Intersphincteric Fistula

ABSTRACT Background : The best treatment for anal fistula should extirpate infection and promote healing of the tract, whilst preserving the anal sphincter complex and full continence. Aim: To analyze the success rate after a modified technique for ligation of the intersphincteric fistula tract (LIFT) for patients with anal fistulas. Methods: A prospective (observational cohort study) Brazilian bi-institutional experience with a modified (ligation of the intersphincteric fistula tract without excision) LIFT technique was undertaken. A clinical database was settled for the following variables: age, gender, BMI, comorbidities, distance between external orifice and the anus, previous fistula surgery, type of fistula, operative time, intra- and postoperative complications, duration of follow-up, and success rate. Results: Between November 2015 and January 2017, 38 patients with transsphincteric fistulas were operated on using the modified LIFT procedure. Seventeen (44.7%) were men. Median age was 41 (18-67) years. Median BMI was 26.4 (22-38) kg/m2. Five (13.2%) had undergone previous surgery. The fistula was transsphincteric in all cases. Median follow-up was 32 (range, 14-56) weeks. Success was observed in 30 (79%) patients. Conclusions: The LIFT technique without excision of the fistula tract proved to be safe and effective for transsphincteric anal fistulas.

TVT and TOT: a comparison between these two techniques based on our clinical experience

2008 ◽  
Vol 75 (4) ◽  
pp. 232-236
Author(s):  
A. Tamai ◽  
A. Donazzan ◽  
V. Gallo ◽  
S. Durante
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Voiding Dysfunction ◽  
De Novo ◽  
Single Side ◽  
De Novo Urgency ◽  
Group A ◽  
Group B

Aim of the Study A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI. Materials and Methods. In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines. Results. Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).

scholarly journals Laparoscopic Management of Interstitial Ectopic Pregnancies

2014 ◽  
Vol 6 (3) ◽  
pp. 163-166
Author(s):  
Shyam V Desai ◽  
Gaurav S Desai ◽  
Jessi Levi
Keyword(s):  
Ectopic Pregnancy ◽  
Operative Time ◽  
Laparoscopic Management ◽  
Ectopic Gestation ◽  
Estimated Blood Loss ◽  
Laparoscopic Excision ◽  
Interstitial Ectopic Pregnancy ◽  
Ectopic Pregnancies

ABSTRACT This illustration describes the successful laparoscopic management of interstitial ectopic pregnancy. Three women underwent laparoscopic excision for interstitial ectopic gestation. Mean operative time was 49.4 ± 8.4 minutes (41- 69 mins). Estimated blood loss was 50 ± 4 ml. There were no intraoperative or postoperative complications. Duration of hospital stay was 24 ± 3 hours. All patients are doing well on follow-up. The authors demonstrate the role of laparoscopic excision and conclude that this technique, when performed by experienced surgeons, allows for improved dexterity and is a safe and effective method in the management of interstitial ectopic pregnancy. How to cite this article Desai GS, Levi J, Desai SV. Laparoscopic Management of Interstitial Ectopic Pregnancies. J South Asian Feder Obst Gynae 2014;6(3):163-166.

Laparoscopic single port radical prostatectomy in the 2020: Why not? Our experience

2021 ◽  
pp. 039156032199355
Author(s):  
Giuseppe Sortino ◽  
Willy Giannubilo ◽  
Manuel Di Biase ◽  
Andrea Marconi ◽  
Maurizio Diambrini ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Personal Experience ◽  
Functional Outcomes ◽  
Operative Time ◽  
Safe Procedure ◽  
Estimated Blood Loss ◽  
High Risk Disease ◽  
Oncological Results ◽  
The Mean

Objectives: To analyze the feasibility, safety and advantages of Laparo-Endoscopic Single-site Surgery radical prostatectomy (LESS-RP) based on our personal experience. Patients and methods: Details of 520 patients were retrospectively analyzed, from 2009 to 2019. Extraperitoneal approach, with only two accesses (2.5 cm and 5 mm respectively) was used to perform radical prostatectomy. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. Results: The mean age was 66.6 ± 5.6 years. Mean PSA level was 9 ± 3.5 ng/ml. According to D’Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 116 (22.4%), 275 (52.8%), and 129 (24.8%) respectively. Mean operative time was 156 ± 43 min. Mean estimated blood loss was 214 ± 93 ml. Positive surgical margins (PSMs) were detected in 110 (21.2%) patients. PSM rates in pT2 and pT3 stages were 20.1% and 22.9%, respectively. The overall complication rate was 9.2%, based on the modified Clavien classification. The 12 months continence and potency rates were 90.9% and 49.1%, respectively. The biochemical recurrence rate was 6.8%, at the median follow-up time of 26.7 months (IQR 12–32). Conclusions: Our analyses show that LESS-RP is a safe procedure, if performed by surgeons with adequate experience and skills. Unlike the classic laparoscopic prostatectomy, this technique allows better aesthetic and psychological results, reduced postoperative pain, and a faster return to normal daily activity with the same functional and oncological results.

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