Morpho-functional follow-up of modified Indiana Pouch

— Between November ‘90 and August ‘94, 55 patients underwent modified Indiana Pouch. Our modifications include the isolation of 20 cm of right colon, the creation of a 15 cm long ileal patch, taeniotomies of partial detubularized cecum, Le Duc ureterocolic anastomosis and umbilical stomal positioning. An orthotopic reservoir was constructed in 2 young exstrophic patients. The ileal limb was anastomosed to the introitus vaginalis in a female and by an original, staged operation to the epispadic urethral plate in a male. The continence rate was 91%. The mean pouch capacity was 500 ± 40 cc, the filling pressure was 10 ± 2 cm H2O and the ileocecal valve resistance was 85 ± 6 cm H2O. 12 late complications were reported (4 stomal stenoses, 3 parastomal hernias, 1 severe ureteral stenosis, 2 high pressure pouches, 2 decompensated reservoirs). No ureteral reflux renal function decrease, metabolic acidosis or vitamin B12 reduction was observed. We conclude that modified Indiana Pouch is a reliable, reproducible, easy-to-perform technique with an acceptable complication rate. On the other hand it has to be reserved for compliant patients.

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Results and Lessons Learned on Robotic Assisted Kidney Transplantation

BioMed Research International ◽

10.1155/2020/8687907 ◽

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.

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Initial experience with 10 cases of Indiana pouch continent urinary diversion

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v34i1.1166 ◽

1970 ◽

Vol 34 (1) ◽

pp. 21-25

Author(s):

S.M. Mahbub Alam ◽

Md. Muzharul Hoq ◽

Monwarul Hoque ◽

Mizanur Rahman

Keyword(s):

Urinary Diversion ◽

Metabolic Abnormalities ◽

Continent Urinary Diversion ◽

Ascending Colon ◽

Indiana Pouch ◽

Full Capacity ◽

The Mean ◽

Continence Rate ◽

One Year

Indiana pouch continent urinary diversion provides patient control over elimination of urine with periods of dryness. This allows emptying of urine from the pouch by catheter at convenient intervals avoiding major metabolic abnormalities with satisfactory renal function. Detubularization of the ascending colon and caecum with tapering of the terminal ileum and tunneled tenial implants of the ureters have resulted continent cutaneous urinary reservoir. In total 10 patients were included and follow-up period was for a period of 6 months to 5 years. One year after surgery overall day and night continence rate was in 70% patients, some leakage at day and night in 30% cases and no patient developed day or night incontinence. The mean capacity of the pouch was 530 ml at 12-18 months. Pouch pressure at full capacity was 16 cm H20 at 18 months.Â Indiana pouch provides better attention for urinary diversion in developing countries as it is well accepted, economically more suitable and relatively easy to construct, with good results in terms of continence and reduced complications with satisfactory renal function.Keywords: Indiana pouch; urinary diversionDOI: 10.3329/bmrcb.v34i1.1166Bangladesh Med Res Counc Bull 2008; 34: 21-25

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

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2014/745790 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 8

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.

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

ISRN Gastroenterology ◽

10.5402/2011/467258 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 15

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.

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

The American Surgeon ◽

10.1177/000313481107701026 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1386-1389 ◽

Cited By ~ 2

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.

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

Acta chirurgica iugoslavica ◽

10.2298/aci0704073i ◽

2007 ◽

Vol 54 (4) ◽

pp. 73-77 ◽

Cited By ~ 4

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.

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

Journal of Endovascular Therapy ◽

10.1177/1526602820962484 ◽

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.

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

10.53350/pjmhs211582043 ◽

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

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Late Results of Subtalar Distraction Fusion

Foot & Ankle International ◽

10.1177/107110079801900402 ◽

1998 ◽

Vol 19 (4) ◽

pp. 197-202 ◽

Cited By ~ 51

Author(s):

Douglas C. Burton ◽

Bradford W. Olney ◽

Greg A. Horton

Keyword(s):

Late Results ◽

Late Complications ◽

Average Score ◽

Lateral Ankle ◽

Heel Height ◽

Satisfactory Outcome ◽

Declination Angle ◽

The Mean ◽

Calcaneus Fractures

Between 1990 and 1994, 15 subtalar distraction fusions were performed on 14 patients for sequelae of calcaneus fractures. Twelve patients (13 feet) were available for a minimum 2-year follow-up and constituted the composition of this study. All patients complained of lateral ankle pain and had CT evidence of calcaneofibular abutment and radiographic evidence of loss of heel height preoperatively. The average age at time of surgery was 56 years (range, 23–81 years), and the average follow-up was 47 months (range, 25–75 months). The only change in surgical technique from that previously described was the use of a bone spreader rather than a femoral distractor for distraction of the subtalar joint. The average preoperative talocalcaneal angle improved from 27° (range, 19–37°) to 33° (range, 23–45°) postoperatively ( P < 0.003). The mean talar declination angle improved from 11° (range, 6–18°) to 16° (range, 7–27°) postoperatively ( P < 0.003). The mean heel height increased from 71 mm (range, 60–83 mm) to 76 mm (range, 63–91 mm) postoperatively ( P < 0.0001). All patients completed the AOFAS Ankle-Hindfoot scale at latest follow-up, and the average score was 76.1 (range, 57–94). Eleven of 13 outcomes were rated as very satisfactory or satisfactory. Twelve of 13 said they would ‘definitely yes’ do surgery again. We have found that subtalar distraction fusion for late complications of calcaneus fracture in a carefully selected population can provide a consistent and satisfactory outcome.

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Comparison of complications after Ahmed versus Baerveldt implant in glaucoma patients: one year follow-up

International Journal of Ophthalmology ◽

10.18240/ijo.2020.12.10 ◽

2020 ◽

Vol 13 (12) ◽

pp. 1908-1914

Author(s):

Sara Listyani Koentjoro ◽

Iwan Soebijantoro ◽

Vira Wardhana Istiantoro ◽

Emma Rusmayani ◽

Rini Sulastiwaty ◽

...

Keyword(s):

Success Rate ◽

Late Complications ◽

Early Complications ◽

Glaucoma Medication ◽

Group 13 ◽

The Mean ◽

One Year ◽

Baerveldt Implant ◽

Glaucoma Implants

AIM: To compare surgical results of the Ahmed and Baerveldt implant procedures in glaucoma patients at 1y follow-up at Jakarta Eye Center (JEC) Eye Hospitals. METHODS: This cohort retrospective study was conducted on glaucoma patients aged ≥18y who had undergone Ahmed and Baerveldt implant surgery. Intraocular pressure (IOP), visual acuity, glaucoma medication, success rate, early and late postoperative complications, and the number of resurgeries were analyzed. RESULTS: A total of 351 eyes in the Ahmed group and 94 eyes in the Baerveldt group were included in this study. At 1y follow-up, the mean IOP was found to be significantly lower in the Baerveldt group (13±4.47 mm Hg) compared to the Ahmed group (15.02±5.73 mm Hg; P=0.025). Glaucoma medication was required in both the Ahmed and Baerveldt groups (58.92% vs 71.67%). Comparable success rate was found in both groups. The Ahmed group revealed a complete and qualified success of 86.82%, and failure of 13.17%. Similarly, the Baerveldt group showed complete and qualified success in 87.75% and failure in 12.25% cases. In the Ahmed group, 11.97% early complications, 26.06% late complications and 9.97% resurgeries were observed. In comparison, in the Baerveldt group, 23.40% early complications, 30.95% late complications and 11.70% resurgeries were observed. CONCLUSION: Both groups of glaucoma implants show significant IOP reduction, however, the Baerveldt implant group demonstrates greater IOP reduction with more failure rates and complications than the Ahmed implant group.

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