Transoral Laser-Assisted Diverticulectomy: Swallow Study Results after Complete Endoscopic Pouch Excision for Zenker’s Diverticulum

2021 ◽  
pp. 000348942110125
Author(s):  
Ryan A. McMillan ◽  
Andrew J. Bowen ◽  
Michael L. Wells ◽  
Dale C. Ekbom
Keyword(s):  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Recurrence Rates ◽  
Zenker's Diverticulum ◽  
Pouch Size ◽  
Study Results ◽  
Significant Difference ◽  
Pouch Excision ◽  
Subjective Outcomes

Objective: Transoral endoscopic laser-assisted diverticulotomy (TELD) with diverticulectomy and diverticuloplasty (TELD + DD) for the management of Zenker’s diverticulum (ZD) has been utilized by our institution since 2016 in attempts to reduce residual pouch size. This technique involves complete endoscopic pouch excision with partial advancement of mucosal flaps. Our study compares the subjective outcomes, objective outcomes, and complication rates between TELD and TELD + DD. Methods: A retrospective cohort study was performed on patients who underwent TELD or TELD + DD by a single surgeon at a tertiary academic center (2013-2019). Videofluoroscopic swallow studies (VFSS) with esophagram, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and 3 month follow-up visits. A single blinded reviewer recorded height, width, and depth of pre and postoperative pouches with volumetric analysis performed assuming an ellipsoid shape. Comorbidities, complications, postoperative course, and recurrence were recorded. Results: Of the 75 patients that met criteria, 27 underwent TELD + DD and 48 underwent TELD. Eighteen TELD + DD and 37 TELD had both pre and post-operative VFSS. TELD + DD and TELD had a 96 ± 7% and 87 ± 16% reduction in pouch volume, respectively ( t-test; P = .01). Complications (TELD + DD 7%, TELD 17%, fisher’s exact; P = .31) and final subjective outcomes after adjusting for initial were not significantly different between methods (EAT-10 with TELD + DD ∆ + 1.3, P = .18; RSI ∆ + 1.4, P = .29; FOSS ∆-0.02, P = .91). One short-term recurrence was reported with TELD. Conclusion: Use of TELD + DD is associated with a statistically significantly decreased residual pouch size with no significant difference in short-term subjective outcomes. Complication rates and short-term recurrence rates are comparable. Long-term recurrence rates will require further studies to characterize. Level of Evidence: Level 3.

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.

Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications

2017 ◽  
Vol 83 (7) ◽  
pp. 696-698 ◽  
Author(s):  
Thomas S. Easterday ◽  
Joshuaw Moore ◽  
Meredith H. Redden ◽  
David V. Feliciano ◽  
Vernon J. Henderson ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Percutaneous Tracheostomy ◽  
Trauma Patients ◽  
Complication Rates ◽  
Short Term ◽  
Significant Difference ◽  
Urban Level ◽  
Level I ◽  
Bronchoscopic Guidance

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

Proton radiotherapy for prostate cancer in the Medicare population: Patterns of care and comparison of early toxicity with IMRT.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4651-4651
Author(s):  
James B. Yu ◽  
Pamela R. Soulos ◽  
Laura D. Cramer ◽  
Kenneth B Roberts ◽  
Jeph Herrin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Post Treatment ◽  
Complication Rates ◽  
Proton Radiotherapy ◽  
Short Term ◽  
Significant Difference ◽  
Patient Reported ◽  
One Year

4651 Background: Proton radiotherapy (PRT) is a costly treatment used for prostate cancer despite little evidence supporting its use. We examined patterns of PRT use in the Medicare program and assessed the short-term toxicity of PRT vs. intensity modulated radiation therapy (IMRT). Methods: Using national Medicare claims from 2008-2009, we identified a sample of prostate cancer patients ages 66-94 who had received PRT or IMRT. We used multivariable logistic regression to identify patient and regional factors associated with receipt of PRT. We searched claims for procedure and diagnosis codes indicative of treatment-related complications and grouped the complications into genitourinary (GU), gastrointestinal (GI), and other complications. To compare the effect of PRT and IMRT on short-term toxicity, we used a Mahalanobis distance approach to match each PRT patient to two IMRT patients, achieving balanced distribution of clinical and sociodemographic characteristics. We compared six-month and one-year outcomes between the two treatment groups using conditional logistic regression. Results: We identified 27,647 men; 421 (2%) received PRT and 27,226 (98%) received IMRT. Patients who received PRT were widely geographically distributed, with some patients traveling >500 miles for treatment. PRT patients were younger, healthier, and of higher socioeconomic status. Although PRT was associated with a significant reduction in GU complications at six-months compared with IMRT (6.1% vs. 12.0%, OR 0.60 [95% CI 0.38-0.96], p=0.03), at one-year post-treatment there was no longer any difference in cumulative complication rates (18.9% vs. 21.9%, OR 0.96 [95% CI 0.61-1.53], p=0.88). There was no significant difference in GI or other complications at six-months or one-year post-treatment. Conclusions: Although PRT remains a scarcely used treatment, some prostate cancer patients traveled great distances for treatment. While PRT was associated with a reduction in six-month GU toxicity, there were no differences in toxicity at one-year. Further study on longer-term effects and other clinical and patient-reported outcomes is needed to inform the widespread application of PRT.

A comparison of performance of Shepard and Sheehy collar button ventilation tubes

1991 ◽  
Vol 105 (11) ◽  
pp. 896-898 ◽  
Author(s):  
Judith M. Heaton ◽  
Brian J. G. Bingham ◽  
Jonathan Osborne
Keyword(s):  
Otitis Media With Effusion ◽  
Complication Rates ◽  
Middle Ear Effusion ◽  
Recurrence Rates ◽  
Tube Extrusion ◽  
Increased Risk ◽  
Significant Difference ◽  
Ventilation Tubes ◽  
Ear Effusion

AbstractThis study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rate associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 percent of those in whom at least on tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.

scholarly journals Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Mackenzie N. Abraham ◽  
Steven L. Raymond ◽  
Russell B. Hawkins ◽  
Atif Iqbal ◽  
Shawn D. Larson ◽  
...  
Keyword(s):  
Young Adults ◽  
Older Patients ◽  
Pilonidal Disease ◽  
Wound Complication ◽  
Wound Complications ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Significant Difference ◽  
Secondary Healing ◽  
Age And Sex

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: a retrospective multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Chetan Mittal ◽  
David L. Diehl ◽  
Peter V. Draganov ◽  
Laith H. Jamil ◽  
Ammara Khalid ◽  
...  
Keyword(s):  
Adverse Events ◽  
Practice Patterns ◽  
Clinical Success ◽  
Zenker’S Diverticulum ◽  
Success Rates ◽  
Zenker's Diverticulum ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Endoscopic Myotomy ◽  
Needle Knife

Abstract Background Flexible endoscopic myotomy has been increasingly performed for Zenker’s diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker’s diverticulum. Methods Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker’s diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events. Results 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P  = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 – 20, and ≤ 10 procedures. Conclusions Flexible endoscopic myotomy is an effective therapy for Zenker’s diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife.

scholarly journals Feasibility of short term drainage for diagnostic thoracoscopy

2016 ◽  
Vol 71 (2) ◽  
Author(s):  
D.P. Breen ◽  
S. Mallawathantri ◽  
A. Fraticelli ◽  
L. Greillier ◽  
P. Astoul
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Economic Benefits ◽  
Optimal Time ◽  
Chest Drain ◽  
Complication Rates ◽  
Short Term ◽  
Drainage Time ◽  
Drain Removal ◽  
Significant Difference

Background and Aim. Thoracoscopy is a diagnostic tool superior to other available techniques for the assessment of pleural effusions. There are numerous publications that describe the technique in detail but there is very little published on the optimal time of chest drain removal post procedure. Our aim was to retrospectively study all cases of diagnostic thoracoscopy and to ascertain the time of chest drain removal, length of hospital stay and associated complications. Methods. All patients who underwent thoracoscopy during a 6-year period were identified from a computerised database. Patients who received talc for pleurodesis were excluded as they required longer drainage time. A review of the remaining patients’ charts and radiology was performed to ascertain the predefined outcomes. Results. 124 patients had a diagnostic thoracoscopy. The time to chest drain removal was documented as less than four hours, four to 24 hours, 24 to 48 hours and greater than 48 hours in 66 (53.2%), 29 (23.4%), 12 (9.7%) and 17 (13.7%) of patients respectively. The median length of stay for all patients was one day (interquartile range, 1-4 days). There was a statistically significant difference in overall length of hospital stay between the early (48 hours) chest drain removal groups, p=0.0028. The overall complication rate was 15.9%. There was no statistical difference in complication rates between the two groups. Conclusion. This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

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

scholarly journals Evaluation of Treatment of Herniated Lumbar Disc Sciatica by Epidural Corticosteroid Injection

10.3823/2620 ◽  
2020 ◽  
Vol 13 ◽  
Author(s):  
Quang-Tri LE ◽  
Minh-Hoang Nguyen
Keyword(s):  
Lumbar Disc ◽  
Epidural Injection ◽  
Military Hospital ◽  
Complication Rates ◽  
Methylprednisolone Acetate ◽  
Hydrocortisone Acetate ◽  
Vas Score ◽  
Study Results ◽  
Significant Difference ◽  
Herniated Lumbar Disc

Background: Medical facilities in Vietnam both use Methylprednisolone acetate and Hydrocortisone acetate in treatment with different administrations. This study aimed to evaluate of effects and side-effects of epidural injection of Methylprednisolone acetate and Hydrocortisone acetate in the treatment of herniated lumbar disc sciatica. Methods and findings: Cross-sectional descriptive study on 80 herniated lumbar disc sciatica patients treated at Department of Orthopedic, 7A Military Hospital, Hochiminh City, VietNam. The patients were divided into two groups in coupling fashion based on the VAS score of pain. Study results showed that both corticosteroid drugs (Methylprednisolone acetate and Hydrocortisone acetate) yielded good outcomes on all investigated parameters and there was no significant difference between the two medications (p < 0.05); administration of Methylprednisolone acetate reduced VAS score of 1.98 ± 1.33 points and Hydrocortisone acetate reduced of 2.13 ± 1.17 points. Lasegue test score in Methylprednisolone acetate administered patients raised from 74.630 ± 18.820 to 80.750 ± 15.870 and in Hydrocortisone acetate patients from 71.250 ± 10.110 to 81.630 ± 8.350). Treatment methods were safe, and there was no difference in complication rates between the two groups. The direct and indirect cost of Hydrocortisone acetate administration was three times higher than Methylprednisolone acetate. Conclusion: It was safe and effective to administrate both Methylprednisolone acetate and Hydrocortisone acetate in the treatment of herniated lumbar disc sciatica. Methylprednisolone acetate administration was more economical than Hydrocortisone acetate. Keywords: Sciatica, epidural injection, Methylprednisolone acetate, Hydrocortisone acetate

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