Transoral Incisionless Fundoplication: Initial Experience in Patients Referred to an Integrated Academic Institution

2011 ◽  
Vol 77 (10) ◽  
pp. 1386-1389 ◽  
Author(s):  
Allan Nguyen ◽  
Thomas Vo ◽  
Xuan-Mai T. Nguyen ◽  
Brian R. Smith ◽  
Kevin M. Reavis
Keyword(s):  
Gastric Surgery ◽  
Late Complications ◽  
Initial Experience ◽  
Additional Time ◽  
Transoral Incisionless Fundoplication ◽  
Working Space ◽  
Symptom Scores ◽  
The Mean ◽  
New Treatment

Transoral incisionless fundoplication is a new treatment for patients with gastroesophageal reflux disease. We present our initial experience with 10 patients undergoing this procedure with varying past surgical histories. All procedures were performed under general nasotracheal anesthesia. RAND-36 and Visual Analog Scale symptom scores were collected at pre and postoperative appointments for a mean of 9.2 months. The mean procedure time was 68 minutes. There were no intraoperative or postoperative complications. Patients with prior pancreaticoduodenectomy had observed reduced working space due to prior distal gastrectomy and required additional insufflation due to no pyloric resistance to insufflation of the small bowel. The patient with prior fundoplication required additional time and force for fastener penetration of the resultant scar from the partially disrupted fundoplication. All patients were discharged within 23 hours of the procedure. Throughout the follow-up period, patients reported gradual changes in medication requirements and symptom scores. There were no late complications. Transoral incisionless fundoplication is technically safe in well-selected patients including those with prior esophageal and gastric surgery.

scholarly journals Late Complications following Endoscopic Sphincterotomy for Choledocholithiasis: A Swedish Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
A. Langerth ◽  
L. Brandt ◽  
A. Ekbom ◽  
B.-M. Karlson
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Sphincterotomy ◽  
Acute Cholangitis ◽  
Common Bile Duct Stones ◽  
Population Based ◽  
Late Complications ◽  
Swedish Population ◽  
The Mean

In order to assess the risk of long-term complications following endoscopic sphincterotomy (ES) for common bile duct stones (CBDS), we conducted a cohort study. The study included 1,113 patients who underwent ES for CBDS in six different hospitals in central Sweden between 1977 and 1990. Through the use of the Swedish population registry, each patient was assigned five population-based controls matched for sex and age. Linkage to the Inpatient Registry yielded information on morbidity and mortality for the patients as well as for the controls. After one year of washout, there were 964 patients available for follow-up. The mean age was 70.6 years, 57% were women, and the mean length of follow-up was 8.9 years. The patients’ overall morbidity was significantly higher and we observed a tendency towards increased mortality as well. Recurrent CBDS was diagnosed in 4.1% of the patients. Acute cholangitis with a hazard ratio (HR) of 36 (95%CI 11–119.4) was associated with recurrent CBDS in 39% of the patients. HR for acute pancreatitis was 6.2 (95%CI 3.4–11.3) and only one patient had CBDS at the same time. In conclusion, we consider acute pancreatitis and cholangitis both as probable long-term complications after ES.

scholarly journals LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Maurizio Gentile ◽  
Michele De Rosa ◽  
Gabriele Carbone ◽  
Vincenzo Pilone ◽  
Francesca Mosella ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Operative Time ◽  
Randomized Study ◽  
Late Complications ◽  
The Third ◽  
Effective Instrument ◽  
The Mean ◽  
Complications Rate

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.

scholarly journals Results and Lessons Learned on Robotic Assisted Kidney Transplantation

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mireia Musquera ◽  
Lluis Peri ◽  
Tarek Ajami ◽  
Ignacio Revuelta ◽  
Laura Izquierdo ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Minimally Invasive ◽  
Late Complications ◽  
Lessons Learned ◽  
Ureteral Stenosis ◽  
Robotic Assisted ◽  
Conversion To Open Surgery ◽  
Invasive Method ◽  
The Mean

Introduction. Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. Results. During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4±13.4 and 50 (61%) were male. Mean body mass index was 25±4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197±42 and 47±9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25±38.1 to 189.75±25.3 (p<0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. Conclusions. The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.

scholarly journals Modified Mainz Pouch II (sigma rectum pouch) urinary diversion: 12 years experience

2007 ◽  
Vol 54 (4) ◽  
pp. 73-77 ◽  
Author(s):  
I. Ignjatovic ◽  
D. Basic
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Urinary Diversion ◽  
Life Quality ◽  
Late Complications ◽  
Anastomotic Site ◽  
Mainz Pouch Ii ◽  
The Mean

Objective: To analyze the outcome of Mainz Pouch II urinary diversion related to complications and life quality. Patients and Methods: From 1995 to 2006, a total of 67 patients (60 male and 7 female, mean age 58.4 years, range 48 to 70) who underwent modified ureterosigmoidostomy (Mainz Pouch II) procedure have been retrospectively analyzed. The mean follow-up was 18 (1 - 72) months and it was available for 56 patients (84%). Early and late postoperative complications as well as quality of life after surgery were analyzed. An clinical questionairre has been used for examination specific urinary diversion items. Results: Early postoperative complications (<30 days) we-re detected in 9 patients (13%) and late complications (>30 days) in 19 patients (28%). Early complications consisted of urine leakage of moderate degree in 5 (7%) and ileus requiring surgical revision in 4 (6%) patients. The late complications included acute pyelonephritis in 12 patients (18%) and uretero-sigmoidal anastomotic site stenosis in 7 (11%). Ureterosigmoidal anastomotic site stenosis was detected in 7 patients with 7 renoureteric units (RU). In 4 RU, metal Strecker stent was successfully applied. In 3 RU, permanent nephrostomy catheter was applied. Oral alkalizing agents were applied in 22 patients (33%) due to metabolic acidosis. Two patients died due to severe acidosis. Continent rate was 96%. The mean voiding frequency during the day and night was 5.2+1.8 and 2.7+ 0.5, respectively. Global life quality was bad for 3 (8%), acceptable for 15 (38%) and good for 22 (54%) patients. Conclusion: The Mainz Pouch II urinary diversion is simple and safe procedure regarding complications rate, continence and quality of life. It is good alternative to other forms of continent urinary diversion. Patient selection and compliance following by meticulous follow-up are of utmost importance for successful operative outcome.

Aneurysm Volumes After Endovascular Repair of Ruptured vs Intact Aortic Aneurysms: A Retrospective Observational Study

2020 ◽  
pp. 152660282096248
Author(s):  
José Oliveira-Pinto ◽  
Rita Soares-Ferreira ◽  
Nelson F. G. Oliveira ◽  
Elke Bouwens ◽  
Frederico M. Bastos Gonçalves ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Late Complications ◽  
Aortic Aneurysms ◽  
First Year ◽  
Volume Changes ◽  
Tertiary Referral ◽  
Abdominal Aortic ◽  
The Mean ◽  
The Impact

Purpose To compare changes in abdominal aortic aneurysm (AAA) sac volume between endovascular aneurysm repairs (EVAR) performed for ruptured (rEVAR) vs intact (iEVAR) AAAs and to determine the impact of early volume shrinkage on future complications. Materials and Methods A retrospective analysis was performed of all patients undergoing standard infrarenal EVAR from 2002 to 2016 at a tertiary referral institution. Only patients with degenerative AAAs and with 30-day and 1-year computed tomography angiography (CTA) imaging were included. Early sac shrinkage was defined as a volume sac reduction >10% between the first (<30-day) and the 1-year CTA. The primary endpoint was to compare AAA sac volume changes between patients undergoing rEVAR (n=51; mean age 71.0±8.5 years; 46 men) vs iEVAR (n=393; mean age 72.3±7.5 years; 350 men). Results are reported as the mean difference with the interquartile range (IQR Q1, Q3). The secondary endpoint was freedom from aneurysm-related complications after 1 year as determined by regression analysis; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results At baseline, the rEVAR group had larger aneurysms (p<0.001) and shorter (p<0.001) and more angulated (p=0.028) necks. Aneurysm sac volume decreased more in the rEVAR group during the first year [−26.3% (IQR −38.8%, −12.5%)] vs the iEVAR group [−11.9% (IQR −27.5%, 0); p<0.001]. However, after the first year, the change in sac volume was similar between the groups [−3.8% (IQR −32.9%, 31.9%) for rEVAR and −1.5% (IQR −20.9%, 13.6%) for iEVAR, p=0.74]. Endoleak occurrence during follow-up was similar between the groups. In the overall population, patients with early sac shrinkage had a lower incidence of complications after the 1-year examination (adjusted HR 0.59, 95% CI 0.39 to 0.89, p=0.01). Conclusion EVAR patients treated for rupture have more pronounced aneurysm sac shrinkage compared with iEVAR patients during the first year after EVAR. Patients presenting with early shrinkage are less likely to encounter late complications. These parameters may be considered when tailoring surveillance protocols.

Outcome of Partial Nail Avulsion Followed by Matricectomy Either With Phenol (80-88%) or With Electro Cautery for Toenails

2021 ◽  
Vol 15 (8) ◽  
pp. 2043-2045
Author(s):  
Tahir Hamid ◽  
Muhammad Rizwan Qadir ◽  
Ahmad Raza Nsar ◽  
Rizwan Saleem ◽  
Abdur Rehman ◽  
...  
Keyword(s):  
Late Complications ◽  
Purulent Discharge ◽  
P Value ◽  
Serous Discharge ◽  
Group A ◽  
The Mean ◽  
One Year ◽  
Group B ◽  
Ingrown Toenails

Aim: To compare partial nail avulsion followed by matricectomy either with phenol (80-88%) or with electro cautery for Stage 2 & 3 ingrown toenails for early and late postoperative complications. Methods: This study was conducted at department of surgery Nawaz Sharif social security teaching hospital Lahore for one year from 01-01-2018 to 31-12-2018. One hundred patients full filling inclusion criteria were included in the study and divided into two equal groups A and B. Partial nail avulsion done in both groups followed by chemical matricectomy with phenol (80-88%) in group A and patients in group B matricectomy done with electrocautry. Results: The mean age in group A is 19.7± 8.08 years and in group B is 20.20± 6.9 years, both groups comparable p-value (0.74).In early post-operative complications in group A 17(34%) patients and 14(28%) patients in group B experienced mild pain p-value is (0.66). 6(12%) of group A patients and 6(12%) of group B patients experienced moderate pain p-value (01). 1(2%) of group A patient and 2(4%) of group B patients experienced severe pain p-value (01). 02(4%) patients of group A and 02(4%) patients of group B had serous discharge p-value(01). 1(2%) of group B patients have purulent discharge, however, no patients in group A patients have purulent discharge p-value (01). 1(2%) patients of group A and 2(4%) patients of group B had recurrence at three months follow up p-value (01). 2(4%) patients of group A and 4(8%) patients of group B had recurrence at six months follow up p-value (0.68). Conclusion: Partial nail avulsion followed by matricectomy either with Phenol 80-88% or with electrocautry are comparable in early and late complications. Keywords: Ingrown toenails, partial matricectomy

Creation of the Miami Pouch During Laparoscopic-Assisted Pelvic Exenteration: The Initial Experience

2009 ◽  
Vol 19 (3) ◽  
pp. 466-470 ◽  
Author(s):  
Gwénaël Ferron ◽  
Timothy Yong Kuei Lim ◽  
Christophe Pomel ◽  
Michel Soulie ◽  
Denis Querleu
Keyword(s):  
Operative Time ◽  
Pelvic Exenteration ◽  
Iliac Fossa ◽  
Initial Experience ◽  
Pelvic Malignancies ◽  
The Mean ◽  
Continent Diversion ◽  
Laparoscopic Assisted ◽  
Mean Time

Purpose:To describe the initial experience of laparoscopic hand-assisted Miami pouch in a group of patients undergoing pelvic exenterations for pelvic malignancies.Materials and Methods:Thirteen female patients underwent laparoscopic-assisted pelvic exenteration in our center between September 2000 and November 2007. Six of them had the Miami pouch created for urinary diversion. The continent diversion was created extracorporeally through a right iliac fossa minilaparotomy.Results:The mean total operative time for the laparoscopic-assisted exenteration and reconstruction was 382 minutes (range, 270-480 minutes), but specifically for the Miami pouch, it took a mean time of 106 minutes (range, 90-130 minutes). Four patients (66.7%) had postoperative urinary tract infection that resolved with antibiotics. One patient had a ureteral stenosis requiring stenting and one had a Miami pouch cutaneous fistula that required a fistulectomy. The mean follow-up was 23 months (range, 9-48 months). All patients were continent and were able to self-catheterize approximately 3 to 6 times/d.Conclusions:It is technically feasible to incorporate the creation of the Miami continent urinary pouch through a minilaparotomy during laparoscopic pelvic exenteration without compromising the benefits of laparoscopic surgery.

scholarly journals Proposal of Measurement Occasions for Unbiased Evaluation of Psychotherapy

2021 ◽  
pp. 1-6
Author(s):  
Edgar Geissner ◽  
Petra Maria Ivert ◽  
Manfred Schmitt
Keyword(s):  
Single Case ◽  
Treatment Evaluation ◽  
Time Interval ◽  
Short Time Interval ◽  
Symptom Scores ◽  
The Mean ◽  
Therapy Success ◽  
Short Time ◽  
Simplified Calculation

Studies complementing the assessment of symptoms right before (t1), right after therapy (t2), and at follow-up (t3) with an assessment of symptoms preceding the waiting period without intervention (t0) have revealed substantial t0–t1 changes. We discuss this phenomenon based on our own data and address the following questions: does it make sense to compare symptoms at the beginning of therapy (t1) with symptoms at the end of therapy (t2) or at follow-up (t3)? Or does it make more sense to use t0 instead of t1? We argue for the latter alternative based on the following reasons. (1) Symptom descriptions at t0 are realistic. (2) Expecting therapy success mitigates symptom descriptions at t1. (3) Security signals emitted from the therapy context also mitigate symptoms, especially anxiety, at t1. (4) Regression toward the mean reduces the validity of single occasion assessments. Controlling for regression requires two occasions of measurement with a short time interval at t0 (t01 and t02). It follows from this reasoning that therapy success should be evaluated using the t02–t2 and t02–t3 intervals. Single case evaluations require reliable critical differences. This will be illustrated using a concrete example. The validity of treatment evaluation can be increased via the elimination of non-pathological symptom scores. A simplified calculation of cut-off scores can facilitate applied treatment evaluation. Unspecific t0–t1 changes do not challenge therapy effects according to t1–t2 changes. Rather, they are part of the whole therapy process.

scholarly journals A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xicheng Deng ◽  
Peng Huang ◽  
Jinwen Luo ◽  
Jinghua Wang ◽  
Liwen Yi ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Three Dimensional ◽  
Optimal Timing ◽  
Initial Experience ◽  
Improved Outcomes ◽  
3D Printed ◽  
Logistic Regressions ◽  
The Mean ◽  
Scan Data

Abstract Objective Conservative treatment with a vacuum bell (VB) for pectus excavatum (PE) has now been gradually popularized as an alternative to surgery. We describe our initial experience with a novel three dimensional (3D) printed VB device. Methods Prospectively collected data of all patients who started using a 3D printed VB in 2018 at our institution were analyzed. Linear and logistic regressions were used to identify factors associated with effectiveness of device usage. Results In total, forty-two patients with a median age of 3.6 years were treated with the device. The median follow-up duration was 11.1 months and the mean initial Depth Ratio (DR) was 0.129. There were no permanent sequelae from side effects. Thirty patients with at least one follow-up body scan data showed varying improvement (z = − 4.569, p = 0.0000). Linear regression suggested that longer usage improved outcomes (R2 = 0.235, p = 0.014). By logistic regression there was a trend of younger ages and less initial DR for better improvement though neither was statistically significant (p = 0.086, 0.078, respectively). Conclusion Our initial experience has shown the 3D printed VB may be as effective as other conventional VBs and could be used as an alternative to surgical treatment for selected patients with PE. More experience and studies with this type of VB are needed to demonstrate its superiority with regard to the 3D printing design and optimal timing and indication for use.

scholarly journals Thoracoscopic Surgery for Posterior Mediastinal Mass: Our Initial Experience

2019 ◽  
Vol 15 (2) ◽  
pp. 75-79
Author(s):  
Ranjan Sapkota ◽  
Prakash Sayami
Keyword(s):  
Mediastinal Mass ◽  
Thoracoscopic Surgery ◽  
Surgical Techniques ◽  
Tumor Diameter ◽  
Initial Experience ◽  
Mediastinal Tumors ◽  
Benign Schwannoma ◽  
Posterior Mediastinal ◽  
The Mean

Background: Thoracoscopic surgery has been increasingly used for a variety of indications. Posterior mediastinal tumors form an important component of a thoracic surgeon’s workload. This report represents a summary of our initial experience in thoracoscopic management of such tumors. Methods: We retrospectively reviewed the clinical and operative data from records over the study period. We also describe our usual perioperative management and surgical techniques. Results: A total of 11 patients, 8 being females, were operated during the period of 30 months. Seven were incidental findings, and chest pain was the commonest presentation in symptomatic patients. The mean age of the patients was 38.7 years; mean tumor diameter was 4.4 cm; eight had benign schwannoma, and no patient had a malignant tumor. Mean operative duration was 175.5 min; there were no conversions and no transfusion was required. Mean length of stay in the hospital was 5.6 days. There were no perioperative deaths or major complications. Three minor complications were recorded. Follow-up (4 to 18 months) was uneventful. Conclusions: Thoracoscopic management of posterior mediastinal tumors is feasible and safe.

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