Evaluation of Pelvic Anastomosis by Endoscopic and Contrast Studies Prior to Ileostomy Closure: Are Both Necessary? A Single Institution Review

2020 ◽  
Vol 86 (10) ◽  
pp. 1296-1301
Author(s):  
Cyrus A. Farzaneh ◽  
Mehraneh D. Jafari ◽  
William Q. Duong ◽  
Areg Grigorian ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
Anastomotic Stricture ◽  
Preoperative Evaluation ◽  
Standard Technique ◽  
Flexible Endoscopy ◽  
Contrast Enema ◽  
Ileostomy Closure ◽  
Defunctioning Stoma ◽  
Anastomotic Complications ◽  
Significant Difference ◽  
Contrast Studies

Contrast enema is the gold standard technique for evaluating a pelvic anastomosis (PA) prior to ileostomy closure. With the increasing use of flexible endoscopic modalities, the need for contrast studies may be unnecessary. The objective of this study is to compare flexible endoscopy and contrast studies for anastomotic inspection prior to defunctioning stoma reversal. Patients with a protected PA undergoing ileostomy closure between July 2014 and June 2019 at our institution were retrospectively identified. Demographics and clinical outcomes in patients undergoing preoperative evaluation with endoscopic and/or contrast studies were analyzed. We identified 207 patients undergoing ileostomy closure. According to surgeon’s preference, 91 patients underwent only flexible endoscopy (FE) and 100 patients underwent both endoscopic and contrast evaluation (FE + CE) prior to reversal. There was no significant difference in pelvic anastomotic leak (2.2% vs. 1%), anastomotic stricture (1.1% vs. 6%), pelvic abscess (2.2% vs. 3.0%), or postoperative anastomotic complications (4.4% vs. 9%) between groups FE and FE + CE ( P > .05). Flexible endoscopy alone appears to be an acceptable technique for anastomotic evaluation prior to ileostomy closure. Further studies are needed to determine the effectiveness of different diagnostic modalities for pelvic anastomotic inspection.

Comparing Outcomes of the Standard Technique of Endoscopic DCR with Its Modifications: A Retrospective Analysis

2018 ◽  
Vol 160 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Subodh Kumar ◽  
Awadhesh Kumar Mishra ◽  
Ashwani Sethi ◽  
Ajay Mallick ◽  
Nidhi Maggon ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Preoperative Evaluation ◽  
Tertiary Care ◽  
Operating Time ◽  
Standard Technique ◽  
Success Rates ◽  
Retrospective Case ◽  
Case Record ◽  
Significant Difference ◽  
Endoscopic Dcr

Objective To compare the outcomes of various techniques of endoscopic dacryocystorhinostomy (DCR). Study Design Retrospective case record analysis. Settings Tertiary care referral center. Subject and Methods Retrospective analysis of case records was carried out pertaining to the period from January 1996 to September 2017 with respect to patients who had undergone endoscopic DCR with either the standard technique or one of its modifications. Case notes showing well-documented preoperative evaluation, operative details, postoperative assessment, and minimum 6-month follow-up were considered. The outcomes were measured on the basis of patients’ postoperative symptoms, clinical examination, and sac-syringing results. Results A total of 423 patients were included in the study. Of these, 169 underwent standard endoscopic DCR; 87, endoscopic DCR with stent; 19, endoscopic DCR with mitomycin C; 62, powered DCR; 29, laser-assisted DCR; and 57, balloon DCR. There was no statistically significant difference in success rates, recurrences, or complications of various techniques at 3 or 6 months. Mean operating time was lowest for balloon DCR (mean ± SD, 27.1 ± 3.1 minutes), followed by standard endoscopic DCR (38.2 ± 3.6 minutes; P = .001). Conclusion Standard endoscopic DCR and its more sophisticated modifications were equally effective and safe in managing distal nasolacrimal drainage obstruction. Balloon DCR, followed by standard endoscopic DCR, was significantly faster than other techniques.

Transthoracic Extracorporeal Gastric Conduit Preparation for Minimally Invasive Ivor-Lewis Esophagectomy

2015 ◽  
Vol 10 (4) ◽  
pp. 236-240
Author(s):  
Anna L. McGuire ◽  
Sebastien Gilbert
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Minimally Invasive Esophagectomy ◽  
Gastroesophageal Junction ◽  
Laparoscopic Approach ◽  
Tumor Location ◽  
Gastric Conduit ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
Significant Difference

Objective During totally minimally invasive esophagectomy (MIE), the gastric conduit is typically constructed via laparoscopy. Trauma from laparoscopic instruments, inability to palpate the gastroepiploic arcade, and challenges in optimal positioning of the stomach for intra-abdominal stapling have led to the widespread use of laparotomy as part of hybrid MIE procedures. Our objective was to evaluate the safety of transthoracic extracorporeal gastric conduit preparation. We hypothesize that this alternative technique is equivalent in safety to the laparoscopic approach. Methods This is a retrospective comparison of laparoscopic and transthoracic extracorporeal gastric conduit preparation with regard to anastomotic and respiratory outcomes. Results During a 3-year period, 30 patients underwent MIE with a right intrathoracic anastomosis (extracorporeal conduit, 15; laparoscopic conduit, 15). Mean age (58.6 vs 67 years, P = 0.59), tumor location (gastroesophageal junction vs middle and lower esophageal, P = 0.27), and histology (adenocarcinoma vs other 26.7%, P = 0.68) were similar between groups. Anastomotic technique and operating surgeon were the same for all patients. Patients in the laparoscopic gastric conduit group were more likely to have undergone induction chemoradiotherapy (40% vs 80%, P = 0.030). There was no significant difference between groups with respect to anastomotic complications, including anastomotic leak and anastomotic stricture (20% vs 13.3%, P = 0.70). Transthoracic gastric conduit preparation was not associated with increased respiratory complications (8% vs 12%, P = 0.09). Conclusions Transthoracic gastric conduit preparation is a simple, minimally invasive alternative laparotomy for gastric conduit preparation during MIE. No additional incision is required. The technique may help surgeons overcome shortcomings of the laparoscopic approach without impacting perioperative risk.

Postoperative monitoring of children with obstructive sleep apnea syndrome

2014 ◽  
Vol 155 (18) ◽  
pp. 703-707 ◽  
Author(s):  
Pálma Benedek ◽  
Gabriella Kiss ◽  
Eszter Csábi ◽  
Gábor Katona
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Preoperative Evaluation ◽  
Sleep Apnea Syndrome ◽  
Study Patient ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Apnea Syndrome

Introduction: Treatment of pediatric obstructive sleep apnea syndrome is surgical. The incidence of postoperative respiratory complications in this population is 5–25%. Aim: The aim of the authors was to present the preoperative evaluation and monitoring procedure elaborated in Heim Pál Children Hospital, Budapest. Method: 142 patients were involved in the study. Patient history was obtained and physical examination was performed in all cases. Thereafter, polysomnography was carried out, the severity of the obstructive sleep apnea syndrome was determined, and the patients underwent tonsilloadenotomy. Results: 45 patients with mild, 50 patients with moderate and 47 patients with severe obstructive sleep apnea syndrome were diagnosed. There was no complication in patients with mild disease, while complications were observed in 6 patients in the moderate group and 24 patients in the severe group (desaturation, apnea, stridor, stop breathing) (p<0.000). In patients with severe obstructive sleep apnea syndrome, no significant difference was noted in preoperative apnoea-hypapnea index (p = 0.23) and in nadir oxygen saturation values (p = 0.73) between patients with and without complication. Conclusions: Patients with severe obstructive sleep apnea syndrome should be treated in hospital where pediatric intensive care unit is available. Orv. Hetil., 2014, 155(18), 703–707.

scholarly journals Efficacy of Low-Pressure Inflation of Oversized Drug-Coated Balloon for Coronary Artery Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Katsumi Ueno ◽  
Norihiko Morita ◽  
Yoshinobu Kojima ◽  
Hiroki Kondo ◽  
Hiroshi Takahashi ◽  
...  
Keyword(s):  
Propensity Score Analysis ◽  
Standard Technique ◽  
Low Pressure ◽  
Target Lesion ◽  
Late Lumen Loss ◽  
Frequent Use ◽  
Significant Difference ◽  
Artery Disease ◽  
Late Restenosis ◽  
Drug Coated Balloon

Objectives. This study sought to assess the efficacy of oversized drug-coated balloon (DCB) inflation at low pressure for the prevention of acute dissections and late restenosis. Background. The major limitation of DCB coronary angioplasty is the occurrence of severe dissection after inflation of DCB. Methods. Between 2014 and 2018, 273 consecutive patients were retrospectively studied. 191 lesions (154 patients) treated by oversized DCB inflation at low pressure (<4 atm, 2.4 ± 1.2 atm, DCB/artery ratio 1.14 ± 0.22; LP group) were compared with 135 lesions (119 patients) treated by the standard DCB technique (7.1 ± 2.2 atm, DCB/artery ratio 1.03 ± 0.16; SP group). Results. Although the lesions in the LP group were more complex than those in the SP group (smaller reference diameter (2.38 mm vs. 2.57 mm, P = 0.011 ), longer lesions (11.7 mm vs. 10.5 mm, P = 0.10 ), and more frequent use of rotational atherectomy (45.0% vs. 28.1%, P = 0.003 ), there was no significant difference in the NHLBI type of dissections between the two groups (11.5%, 12.0%, 5.2% vs. 12.6%, 12.6%, 2.2% in type A, B, and C, P = 0.61 ), and no bailout stenting was required. In 125 well-matched lesion pairs after propensity score analysis, the cumulative incidence of target lesion revascularization at 3 years was 4.5% vs. 7.0%, respectively ( P = 0.60 ). Late lumen loss (−0.00 mm vs. −0.01 mm, P = 0.94 ) and restenosis rates (7.4% vs. 7.1%, P = 1.0 ) were similar in both of the groups. Conclusion. The application of oversized DCB at low pressure is effective and feasible for preventing late restenosis comparative to the standard technique of DCB.

scholarly journals Three-dimensional laparoscopic partial nephrectomy for renal hilar tumors: an empirical analysis of 290 patients

2020 ◽  
Author(s):  
Feiya Yang ◽  
Lianjie Mou ◽  
Nianzeng Xing
Keyword(s):  
Partial Nephrectomy ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Intraoperative Ultrasound ◽  
Operation Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Significant Difference ◽  
Group A

Abstract Objective To explore the feasibility of laparoscopic partial nephrectomy(LPN) in the treatment of renal hilar tumors. Methods Clinical data of 290 patients undergoing laparoscopic partial nephrectomy from January 2013 to August 2019 were retrospectively analyzed, including 27 patients with renal hilar tumors and 263 patients with non-hilar renal tumors. Perioperative data and follow-up results were compared between the two groups. Results Tumor size in Group A is smaller(2.97±0.88 vs 3.55±1.46,p<0.05), R.E.N.A.L. nephrometry score of Group A is higher(8.4±1.3 vs 6.5±1.7,p<0.01).The operation time, WIT and intraoperative blood loss in the Group A were slightly higher, but with no statistical difference (p>0.05). There was no significant difference between the two groups in intraoperative ultrasound rate, collection system repair rate, drainage time,postoperative hospital stay, and eGFR changes (p>0.05).The median follow-up period was 40 months. One patient with postoperative pathologic report of angiomyolipoma was found tumor recurrence and was currently undergoing regular reexamination. Conclusion Three-dimensional laparoscopic partial nephrectomy for renal hilar tumors is safe and feasible after detailed preoperative evaluation of the tumor and selection of appropriate surgical strategies.

scholarly journals An Insight into Histopathologic Examination as a Gold Standard for the Diagnosis of Chronic Apical Periodontitis

2018 ◽  
Vol 64 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Monica Monea ◽  
Anca Maria Pop ◽  
Veronica Grozescu ◽  
Alexandra Stoica ◽  
Simona Mocanu ◽  
...  
Keyword(s):  
Gold Standard ◽  
Standard Technique ◽  
Final Diagnosis ◽  
Apical Periodontitis ◽  
Histologic Examination ◽  
Chi Square ◽  
Histologic Diagnosis ◽  
Tissue Samples ◽  
Significant Difference ◽  
The Status

AbstractObjective: The purpose of our study was to determine the level of correlation between histopathologic results after surgery for chronic apical periodontitis and the radiographic and clinical diagnosis. The status of gold standard technique of histologic examination was evaluated in the diagnosis of apical radiolucency in necrotic teeth.Methods: Out of 154 patients with incorrect root fillings and apical radiolucency included in an endodontic retreatment protocol, 87 patients (108 teeth) were scheduled for apical surgery at 3-6 months control recall. Clinical and radiographic exams were completed prior to surgery and compared to the histological results of apical biopsies. The collected data were statistically analyzed with the SPSS version 20.0 and the Chi-square test was used to determine the associations between clinical and histologic diagnosis. A value of p <0.05 was considered statistically significant.Results: There was a statistically significant difference between the number of cases diagnosed as granulomas or cysts during clinical and radiological evaluation compared to histologic evaluation of tissue samples, with 40.9% to 75.9% and 54.2% to 16.8% respectively (p<0.05).Conclusions: The final diagnosis was obtained only after histologic examination of apical tissue samples, which means that the observations made based on radiologic investigations must be confirmed by biopsy.

663 QUANTITATIVE PERFUSION ASSESSMENT TO PREDICT ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yoshitaka Ishikawa ◽  
Christopher Breuler ◽  
Andrew C Chang ◽  
Jules Lin ◽  
Mark B Orringer ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Anastomotic Stricture ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Gastric Conduit ◽  
Fluorescence Angiography ◽  
Operative Care ◽  
Significant Difference ◽  
Perfusion Assessment ◽  
Mckeown Esophagectomy

Abstract   Impaired gastric conduit perfusion is a risk factor for anastomotic leak after esophagectomy. Most studies evaluating conduit perfusion have been qualitative with limited impact on post-operative care. The aim of this study is to evaluate the feasibility of intraoperative quantitative assessment of gastric conduit perfusion with indocyanine green (ICG) fluorescence angiography as a predictor for cervical esophagogastric anastomotic (CEGA) leak after esophagectomy. Methods ICG fluorescence angiography using the SPY elite® (Stryker, MI, USA) system was performed in patients who had undergone a transhiatal or McKeown esophagectomy CEGA from July 2015 through December 2020. Fluorescence angiography assessed Ingress (dye uptake) and Egress (dye exit). Ingress Index, Ingress Time, Egress Index, and Egress Time at two anatomic landmarks (tip of the conduit, and 5 cm from tip) were calculated from the measured curve of fluorescence (Figure). The collected data between the leak (L) group and the no-leak (NL) group were compared by both univariate and multivariable analyses to analyze risk factors potentially associated with CEGA leak. Results 304 patients were evaluated. There was no significant difference in patients' demographic and post-operative complications between the groups (L n = 73; NL n = 231), except for anastomotic stricture (42.5 vs 9.1%, p &lt; 0.01). 5 cm and Tip Ingress Index were significantly lower in L (35.0 vs 45.1% and 17.4 vs 25.7%, p &lt; 0.01). 5 cm Ingress Time was significantly higher in L (70.6 vs 56.8 sec, p &lt; 0.01). On multivariable analysis, these variables retained statistical significance, suggesting that these three variables can be used to predict future leak. Conclusion This study revealed that gastric conduit perfusion correlates with the incidence of CEGA leak. Intraoperative measurement of gastric conduit perfusion may be predictive for CEGA leak following esophagectomy. These variables can be easily collected intraoperatively with the SPY study and used to make clinical decisions which may avert CEGA leak.

Rigid versus flexible neuroendoscopy: a systematic review and meta-analysis of endoscopic third ventriculostomy for the management of pediatric hydrocephalus

2021 ◽  
pp. 1-11
Author(s):  
Daphne Li ◽  
Vijay M. Ravindra ◽  
Sandi K. Lam
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Statistical Significance ◽  
Flexible Endoscopy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Related Complication ◽  
Rigid Endoscopy ◽  
Pediatric Hydrocephalus ◽  
Significant Difference

OBJECTIVE Endoscopic third ventriculostomy (ETV), with or without choroid plexus cauterization (±CPC), is a technique used for the treatment of pediatric hydrocephalus. Rigid or flexible neuroendoscopy can be used, but few studies directly compare the two techniques. Here, the authors sought to compare these methods in treating pediatric hydrocephalus. METHODS A systematic MEDLINE search was conducted using combinations of keywords: “flexible,” “rigid,” “endoscope/endoscopic,” “ETV,” and “hydrocephalus.” Inclusion criteria were as follows: English-language studies with patients 2 years of age and younger who had undergone ETV±CPC using rigid or flexible endoscopy for hydrocephalus. The primary outcome was ETV success (i.e., without the need for further CSF diversion procedures). Secondary outcomes included ETV-related and other complications. Statistical significance was determined via independent t-tests and Mood’s median tests. RESULTS Forty-eight articles met the study inclusion criteria: 37 involving rigid endoscopy, 10 involving flexible endoscopy, and 1 propensity scored–matched comparison. A cumulative 560 patients had undergone 578 rigid ETV±CPC, and 661 patients had undergone 672 flexible ETV±CPC. The flexible endoscopy cohort had a significantly lower average age at the time of the procedure (0.33 vs 0.53 years, p = 0.001) and a lower preoperatively predicted ETV success score (median 40, IQR 32.5–57.5 vs 62.5, IQR 50–70; p = 0.033). Average ETV success rates in the rigid versus flexible groups were 54.98% and 59.65% (p = 0.63), respectively. ETV-related complication rates did not differ significantly at 0.63% for flexible endoscopy and 3.46% for rigid endoscopy (p = 0.30). There was no significant difference in ETV success or complication rate in comparing ETV, ETV+CPC, and ETV with other concurrent procedures. CONCLUSIONS Despite the lower expected ETV success scores for patients treated with flexible endoscopy, the authors found similar ETV success and complication rates for ETV±CPC with flexible versus rigid endoscopy, as reported in the literature. Further direct comparison between the techniques is necessary.

Influence of Comorbidity on Outcome after Pulmonary Resection in the Elderly

2007 ◽  
Vol 15 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Morris Beshay ◽  
Patrick Dorn ◽  
Hans-Beat Ris ◽  
Ralph A Schmid
Keyword(s):  
Pulmonary Resection ◽  
Preoperative Evaluation ◽  
Lung Resection ◽  
Survival Rates ◽  
Age Groups ◽  
The Elderly ◽  
Major Complications ◽  
Proper Patient Selection ◽  
Significant Difference ◽  
Group 3

The aim of this study was to determine the influence of comorbidity on outcome after pulmonary resection in patients over 75 years old. Three hundred and thirty-three patients with non-small-cell lung cancer operated on between 1998 and 2002 were divided into 3 age groups: < 60 years (group 1), 60–75 years (group 2), > 75 years (group 3). Overall operative mortality was 0.3%; 30-day mortality was 1%. There were more major complications with re-operation in groups 1 and 2, but minor complications occurred significantly more frequently in group 3 (36% vs 16%). Overall mean hospital stay was 12 days, with no significant difference among groups. Three-year survival rates were: 80%, 70%, and 65% in groups 1, 2, and 3, respectively, with no significant difference among groups. Age or the presence of comorbidity should not be considered contraindications for lung resection. With proper patient selection and careful preoperative evaluation, many major complications after pneumonectomy are avoidable.

scholarly journals Accuracy of two hand-held electronic devices for determination of blood β-hydroxybutyrate in dairy cows

2017 ◽  
Vol 18 (3) ◽  
pp. 439-445 ◽  
Author(s):  
Eliana FIORENTIN ◽  
Anderson TIECHER ◽  
Cristina MENEGAT ◽  
Clarice SOARES ◽  
Adelina AIRES ◽  
...  
Keyword(s):  
Dairy Cows ◽  
Standard Method ◽  
Electronic Devices ◽  
Correlation Coefficients ◽  
Standard Technique ◽  
Portable Devices ◽  
Predictive Values ◽  
Subclinical Ketosis ◽  
Significant Difference

SUMMARY The cowside determination of blood β-hydroxybutyrate (BHB) is an important tool for diagnosing subclinical ketosis in dairy cattle. Portable methods to measure BHB have been introduced in the past years. This study evaluated the accuracy of two hand-held electronic devices for blood determination of BHB in dairy cows at early postpartum. A total of 98 blood samples were collected from dairy cows in the first month of lactation and tested with FreeStyle Optium (FSO, Abbott) and KetoVet (KVE, TaiDoc) portable devices according to the manufacturer instructions. Spectrophotometric BHB analysis (Ranbut, Randox) was used as standard method. The incidence of subclinical ketosis was 37.7 % determined by the standard method, 40.8 % determined by the FSO system and 42.8 % detected with the KVE system. The sensitivity and specificity indexes were 88.1% and 98.4% for FSO and 78.7% and 92.4% for KVE, respectively. The Pearson´s correlation coefficients comparing the portable devices to the standard technique were 0.96 for FSO and 0.93 for KVE. No significant difference in BHB values was found between the two portable tests and the standard method. Predictive values (PV) were better using FSO (positive PV 97.3 %, negative PV 92.4%) than using KVE (positive PV 88.1 %, negative PV 85.9 %). Passing-Bablok regressions revealed good agreement between methods. Though FSO system had a better performance than KVE system, the results suggest that the two portable systems have good accuracy and are reliable for measuring BHB.

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