Open Diverticulectomy and Cricopharyngotomy for Symptomatic Zenker's Diverticulum after Endoscopic Diverticuloesophagostomy

2019 ◽  
Vol 85 (3) ◽  
pp. 284-287
Author(s):  
Takuya Ogami ◽  
Joel Richter ◽  
John Jacobs ◽  
Vic Velanovich
Keyword(s):  
Surgical Resection ◽  
Medical Records ◽  
Operative Time ◽  
Symptomatic Improvement ◽  
Zenker’S Diverticulum ◽  
Open Resection ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Persistent Symptoms ◽  
The Mean

Two of the accepted treatments for symptomatic Zenker's diverticula are open resection of the diverticulum with cricopharyngotomy and transoral, endoscopic diverticuloesophagostomy with cricopharyngotomy. We report our experience with open surgical resection of the diverticulum with repeat cricopharyngotomy in patients with persistent symptoms after endoscopic diverticuloesophagostomy. This is a retrospective review of patients who underwent open surgical resection of the diverticulum, with repeat cricopharyngotomy in patients with persistent symptoms after endoscopic diverticuloesophagostomy. Medical records were reviewed for demographics, surgical detail, short-term complications, and symptomatic outcomes. Four patients underwent open resection of a Zenker's diverticulum with repeat cricopharyngotomy. There were two men and two women, with a mean age of 77.5 years. The mean operative time was 56 minutes and median length of stay was two days. All patients had improvement in dysphagia. Surgical diverticulectomy with cricopharyngotomy after failed endoscopic diverticuloesophagostomy is a technically challenging operation. However, symptomatic improvement can be achieved.

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

scholarly journals Complex pulmonary aspergilloma treated by cavernostomy

2014 ◽  
Vol 41 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Paula dos Santos Marsico Pereira da Silva ◽  
Giovanni Antonio Marsico ◽  
Marcell Alex Ferraz Araujo ◽  
Fernando Soares Vannucci Braz ◽  
Heron Teixeira Andrade dos Santos ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Records ◽  
Operative Time ◽  
Lung Resection ◽  
Signs And Symptoms ◽  
Etiologic Agent ◽  
Treatment Alternative ◽  
Pulmonary Aspergilloma ◽  
The Mean ◽  
Pulmonary Bleeding

Objective: To evaluate the effectiveness of cavernostomy in patients with complex fungal balls.Methods: We analyzed the medical records of patients undergoing cavernostomy between January 2005 and May 2013, evaluating: age, gender, preoperative signs and symptoms, predisposing disease, preoperative tests, location of the aspergilloma, etiologic agent, cavernostomy indication, postoperative outcome.Results: Ten patients were male. The mean age was 42.9 years (34-56). The most frequent symptom was repeated pulmonary bleeding. Cavernostomy was proposed for patients at high risk for lung resection. It was performed in 17 patients and all of them had pulmonary tuberculosis sequelae, with cavitations. The indication in all cases was hemoptysis and elimination of phlegm. The cavernostomies were performed in a single surgical procedure. In all 17 patients the cavity was left open after the withdrawal of the mycetoma. In all patients hemoptysis ceased immediately. Operative mortality was 9.5% (1).Conclusion: cavernostomy is an effective treatment alternative in patients at high risk. It may be useful in some patients with complex aspergilloma, irrespective of lung function or bilateral disease. It is technically easy, has low-risk, saves parenchyma, and may be performed in a single operative time.

Assessment of Safety and Applicability of Laparoscopic vs Open Non Anatomical Resection of Hepatocellular Carcinoma in Cirrhotic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Mahfouz Mohammed ◽  
Hany Saeed Abdel Basset ◽  
Mohammed Abd Almegeed Elsayed ◽  
Ahmed Abdel Basset Hegazi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Short Term ◽  
Open Liver Resection ◽  
Resection Group ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
The Mean

Abstract Background Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Liver surgery was one of the last frontiers reached by minimally invasive surgery. Surgical technique and equipment evolved to overcome technical limitations, making laparoscopic liver resections (LLR) safe and feasible. Surgeons developed skills in a stepwise approach, beginning with low complexity operations for benign diseases and reaching high-complexity surgeries for malignant cases and living donor organ harvesting. Objective s: The aim of the study is to compare short term results of laparoscopic versus open hepatectomy regarding to intra operative details and post-operative management and complications for achieving a safe hepatic resection for treatment of HCC in cirrhotic patients. Patients and Methods In this prospective study, a comparison between laparoscopic resection and open resection was done to compare short-term results between laparoscopic and open liver resection. This study was conducted on 30 patients with hepatocellular carcinoma. 15 patients (50%) were treated by laparoscopic liver resection (Group A) while the other 15 patients (50%) were treated by open liver resection (Group B). Results Regarding the demographic data, the presence of past history of medical condition and the preoperative laboratory results, no statistical significance was found. The mean operative time has statistically significant difference between the 2 groups, with decreased operative time in the laparoscopic group (P < 0.001). The mean blood loss has no statistically significant difference relations between the 2 groups, (P = 0.866) with conversion rate of (13.3%) happened in two cases. Conclusion Laparoscopic liver resection is a safe and feasible treatment option for HCC in cirrhotic patient needing minor resection at laparoscopic segments (II, III, IVa,V,VI). Laparoscopic liver resection for HCC has superior short- term and comparable oncological outcomes to open liver resection. LLR should be performed for carefully selected patients and by an expert surgical team.

Minimization of Wound With the Assistance of a Needle Grasper in Single-Incision Laparoscopic Appendectomy

2019 ◽  
Vol 26 (5) ◽  
pp. 536-544
Author(s):  
Beom-Jin Kim ◽  
Jong Won Kim ◽  
Yoo Shin Choi ◽  
Yong Gum Park ◽  
Beom Gyu Kim ◽  
...  
Keyword(s):  
Laparoscopic Appendectomy ◽  
Medical Records ◽  
Operative Time ◽  
Single Incision ◽  
Pain Intensity Score ◽  
Short Term ◽  
Umbilical Incision ◽  
Telephone Interviews ◽  
Intensity Score ◽  
Glove Port

Background. Technical difficulties and pain from large wounds have prevented the widespread use of single-incision laparoscopic appendectomy (SILA). This study aimed to evaluate the efficacy of our newly developed needle grasper (Endo Relief)-assisted SILA (NASILA). Methods. For NASILA, about a 12-mm umbilical incision was made, and a glove port was introduced. A needle grasper was then introduced through a 2.5-mm wound on the suprapubic area. For SILA, a 2.5-cm transumbilical wound was made. The medical records of patients who underwent SILA or NASILA from June 2017 to September 2017 were retrospectively reviewed. Operative and short-term postoperative outcomes and results of telephone interviews for scars were compared. Results. A total of 49 patients in the SILA group (male: 40.8%) and 12 in the NASILA group (male: 50.0%) were included. Appendicitis status (not perforated:perforated without abscess:perforated with abscess) was significantly different between the 2 groups (SILA vs NASILA, 30:18:1 vs 4:6:2, P = .027). Additional trocars were inserted in 9 patients (18.4%) of the SILA group. The operative time was significantly shorter (43.3 ± 33.6 vs 54.1 ± 15.6 minutes, P = .012), and the highest numerical pain intensity score during the first 24 hours after surgery was significantly lower (2.4 ± 0.7 vs 3.0 ± 0.9, P = .038) in the NASILA group than in the SILA group. Hospital stay, postoperative complications, and complaint of scar were not significantly different between the 2 groups. Conclusions. NASILA was not inferior to SILA regarding cosmetic results. Operative convenience is higher in NASILA than in SILA, and the smaller surgical wound in NASILA minimizes postoperative pain.

scholarly journals Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy in children: a single-institution prospective cohort study

2019 ◽  
Vol 6 (8) ◽  
pp. 2860
Author(s):  
Nguyen Thanh Xuan ◽  
Ho Huu Thien ◽  
Phan Hai Thanh ◽  
Pham Anh Vu ◽  
Nguyen Huu Son ◽  
...  
Keyword(s):  
Choledochal Cyst ◽  
Operative Time ◽  
Bile Leakage ◽  
Short Term ◽  
Cyst Excision ◽  
Drain Removal ◽  
Laparoscopic Excision ◽  
The Mean ◽  
Mean Time ◽  
Time To Drain

Background: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy is gaining popularity as a treatment for choledochal cyst in children. The aim of this study is to determine the feasible and safe of the laparoscopic excision with Roux-en-Y hepaticojejunostomy, and evaluate the short-term outcomes after treatment for children with choledochal cyst.Methods: A prospectively of 51 consecutive pediatric patients undergoing laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon cysts at Hue Central Hospital from June 2012 to December 2017 was studied.Results: The mean operative time was 214.7±67.95 minutes (range, 100~360 minutes), including the time for intraoperative cholangiography. There were two children requiring blood transfusion. Time to first flatus was 40.35±28.55 hours in average. The mean time to drain removal was 2.89±1.02 days. Mean postoperative hospital stay was 9.31±3.43 days. 6 out of 51 cases having early complications, including 2 cases of pancreatitis and 4 cases of bile leakage. Most of cases (90.5%) were classified as good after 10 days to 3 months of follow-up.Conclusions: Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was feasible and safe in children. The short-term outcomes were good in most cases. 

scholarly journals Stapled trans-anal rectal resection for the surgical management of obstructed defecation syndrome: our experience in Bangladesh

2020 ◽  
Vol 11 (1) ◽  
pp. 11-16
Author(s):  
Asif Almas Haque ◽  
Md Rajibul Haque Talukder ◽  
Hasina Alam
Keyword(s):  
Private Hospital ◽  
Operative Time ◽  
Rectal Resection ◽  
Obstructed Defecation ◽  
Symptomatic Improvement ◽  
Major Morbidity ◽  
Obstructed Defecation Syndrome ◽  
Structural Abnormalities ◽  
The Mean

Background: Obstructed defecation syndrome (ODS) is one of the commonest constipation related disorders confronted by surgeons in Bangladesh. Stapled transanal rectal resection (STARR) is a novel surgical technique specific for ODS. This study was designed to evaluate the effectiveness of STARR on patients with ODS in Bangladesh. Methods: Thirty (30) female patients (age: 46±13.2 years) with ODS, were selected for this observational study, from July 2016 to July 2019, in a private hospital of Dhaka. Patients were interviewed with standardized questionnaire at study enrolment and up to 3 months postoperatively. Surgical outcome was quantified according to the Longo’s Modified ODS score (MODS). Results: At initial consultation, the mean Longo’s MODS score was 17.6+1.9. Mean operative time was 39+6.2 minutes. Commonest complication was ‘staple line bleeding’ in 24(80%) patients intraoperatively & ‘defecatory urgency’ in 18(60 %) patients postoperatively. At postoperative 3-month follow-up, statistically significant (p<0.05) symptomatic improvement in Longo’s MODS score (6.9+2.5) was observed in 27(90%) patients. Ten (33.3%) of patients judged their final clinical outcome as ‘excellent’, 11(36.7%) as ‘good’, and 6(20%) as ‘moderate’, with 3(10%) having ‘poor/no improvement’. Conclusion: After analyzing our results, we conclude that STARR is an effective procedure for the treatment of ODS due to structural abnormalities and can be performed safely without any major morbidity. Birdem Med J 2021; 11(1): 11-16

Short-term Results Of Sclerotherapy With 3% Polidocanol Foam For Symptomatic Second- And Third-degree Haemorrhoidal Disease

2019 ◽  
Author(s):  
Pierluigi Lobascio ◽  
Rita Laforgia ◽  
Eugenio Novelli Novelli ◽  
Fabrizio Perrone ◽  
Maria Di Salvo ◽  
...  
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Cost Effective ◽  
Daily Activities ◽  
Anal Continence ◽  
Short Term ◽  
Haemorrhoidal Disease ◽  
Post Operative Pain ◽  
Symptom Scores ◽  
The Mean

Abstract Background.Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most common proctological diseases. Sclerotherapy (ST) with 3% polidocanol foam induces an inflammatory reaction with sclerosis of the submucosal tissue and consequent suspension of the haemorrhoidal tissue. The aim of this study was to evaluate the short-term effectiveness and safety of ST with 3% polidocanol foam for the treatment of symptomatic second- and third-degree HD. Methods.A total of 66 patients with symptomatic second- and third-degree HD underwent a single ST session between March 2017 and July 2018. A visual analogue scale score was used to assess post-operative pain and patient satisfaction. The symptoms severity and anal continence were investigated through a self-reported questionnaire and Vaizey score, respectively, at baseline, at 4 weeks and after 1 year. Results. Fifty-seven out of 66 patients were male (86.3%), and the mean age was 52 (29-75; SD ± 12) years. The mean operative time was 4.5 (2-6; SD ± 1.23) minutes. No intraoperative complications and no drug-related side effects occurred. The overall success rate was 78.8% (52/66 patients) after a single ST session and 86% after two ST sessions (57/66 patients). The mean treatment effect, obtained comparing preoperative and T5 symptom scores in each patient, showed a mean change of 7.88 (p<0.001). All patients resumed their normal daily activities the day after the procedures. Conclusions.ST with 3% polidocanol foam is a safe, cost-effective and repeatable conservative treatment.

Keystone-Designed Perforator Island Flaps for the Coverage of Traumatic Pretibial Defects in Patients With Comorbidities

2017 ◽  
Vol 16 (4) ◽  
pp. 302-309 ◽  
Author(s):  
Chi Sun Yoon ◽  
Sang Il Kim ◽  
Hoon Kim ◽  
Kyu Nam Kim
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Medical Records ◽  
Operative Time ◽  
Free Flaps ◽  
Defect Size ◽  
Soft Tissue Defects ◽  
Algorithmic Approach ◽  
The Mean ◽  
Tissue Defects

Reconstruction of pretibial skin and soft-tissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Here, we present a retrospective review of our experience with pretibial reconstruction using the keystone-designed perforator island flap (KDPIF) in patients with comorbidities. All defects resulted from nononcological causes. We describe the expanding versatility of KDPIF reconstruction for pretibial defects and suggest a simple algorithmic approach. The medical records of 9 patients who underwent reconstruction with a KDPIF to cover a pretibial defect between May 2016 and June 2017 were reviewed. Clinical and operative data were collected. All 9 KDPIFs fully survived. The defect size varied from 3 × 2 cm2 to 8 × 6 cm2. The flap size varied from 5 × 3 to 20 × 10 cm2. The mean operative time was 90.4 minutes (range = 37-127 minutes). No postoperative complications occurred. The cosmetic results were favorable, and all patients were satisfied with the final outcomes. Thus, the KDPIF is a good reconstruction modality with few complications and provides an alternative to free flaps for pretibial defect reconstruction in patients with comorbidities.

881 Long and Short-Term Results of Endoscopic Management of Zenker's Diverticulum

2011 ◽  
Vol 73 (4) ◽  
pp. AB157 ◽  
Author(s):  
Isaac Raijman ◽  
Dang Nguyen ◽  
Shail Maheshwari ◽  
Douglas S. Fishman
Keyword(s):  
Endoscopic Management ◽  
Zenker’S Diverticulum ◽  
Short Term ◽  
Zenker's Diverticulum
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