Minimally invasive endoscopic therapy for the management of Boerhaave’s syndrome

Introduction Boerhaave’s syndrome represents the most lethal of all gastrointestinal perforations. In 2009 a treatment algorithm was published based on current level 4 evidence indicating that all septic patients should be treated surgically, early presentations without sepsis endoscopically and delayed presentations without sepsis conservatively. No provision was made for septic patients unfit for surgical intervention. Using a case series, we demonstrate how minimally invasive endoscopic therapies can be used successfully to manage such a cohort. Methods Between September 2008 and January 2010, five patients presented to Wishaw General Hospital with Boerhaave’s syndrome, all with an associated septic profile and none fit for surgery. They were managed using minimally invasive endoscopic therapies including endoscopic placement of oesophageal stents, elimination of mediastinal/pleural contamination using video assisted thorascopic lavage, management of subsequent collections using sinus tract endoscopy and minilaparotomy with transhiatal endoscopic drainage, and closure of oesophagocutaneous fistulas using the Surgisis® (Cook Surgical, Bloomington, IN, US) anal fistula plug sited endoscopically with a rendezvous technique. Results Oesophageal re-epithelialisation and resolution of sepsis was achieved in all five cases on days 50, 50, 51, 59 and 103. Four patients are alive today. The fifth died on day 109 in hospital as a consequence of co-morbidity. Two patients required oesophageal dilatation for benign oesophageal strictures. Conclusions Minimally invasive endoscopic therapy can be used successfully to achieve oesophageal re-epithelialisation and resolution of sepsis in patients unfit for surgical intervention. It offers a feasible treatment for patients not accounted for in today’s literature and expands on currently described endoscopic therapies.

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Minimally Invasive Approach in Boerhaave's Syndrome: Case Series and Systematic Review

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2020.0751 ◽

2021 ◽

Author(s):

Oliver Pickering ◽

Philip H. Pucher ◽

Henry De'Ath ◽

Mahmoud Abuawwad ◽

Jamie Kelly ◽

...

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Case Series ◽

Boerhaave’S Syndrome ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Boerhaave's Syndrome

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Minimally invasive endoscopic therapy for the management of Boerhaave's syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960049315 ◽

2013 ◽

Vol 95 (8) ◽

pp. 552-556

Author(s):

JH Darrien ◽

H Kasem

Keyword(s):

Minimally Invasive ◽

Endoscopic Therapy ◽

Boerhaave’S Syndrome ◽

Boerhaave's Syndrome

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Minimally invasive endoscopic therapy for the management of Boerhaave’s syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021678754 ◽

2014 ◽

Vol 96 (3) ◽

pp. 253-254 ◽

Cited By ~ 2

Author(s):

B Dent ◽

A Immanuel ◽

SM Griffin

Keyword(s):

Minimally Invasive ◽

Endoscopic Therapy ◽

Boerhaave’S Syndrome ◽

Boerhaave's Syndrome

Darrien JH, Kasem H Minimally invasive endoscopic therapy for the management of Boerhaave’s syndrome. Ann R Coll Surg Engl 2013; 95: 552–556 doi 10.1308/003588413X13629960049315

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Successful closure of gastrocutaneous fistulas using the Surgisis® anal fistula plug

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021677755 ◽

2014 ◽

Vol 96 (4) ◽

pp. 271-274 ◽

Cited By ~ 8

Author(s):

JH Darrien ◽

H Kasem

Keyword(s):

Minimally Invasive ◽

Anastomotic Leak ◽

Anal Fistula ◽

Local Anaesthesia ◽

Surgical Intervention ◽

Fistula Plug ◽

Rendezvous Technique ◽

Anal Fistula Plug ◽

Upper Gastrointestinal

Introduction Gastrocutaneous fistulas remain an uncommon complication of upper gastrointestinal surgery. Less common but equally problematic are gastrocutaneous fistulas secondary to non-healing gastrostomies. Both are associated with considerable morbidity and mortality. Surgical repair remains the gold standard of care. For those unfit for surgical intervention, results from conservative management can be disappointing. We describe a case series of seven patients with gastrocutaneous fistulas who were unfit for surgical intervention. These patients were managed successfully in a minimally invasive manner using the Surgisis® (Cook Surgical, Bloomington, IN, US) anal fistula plug. Methods Between September 2008 and January 2009, seven patients with gastrocutaneous fistulas presented to Wishaw General Hospital. Four gastrocutaneous fistulas represented non-healing gastrostomies, two followed an anastomotic leak after an oesophagectomy and one following an anastomotic leak after a distal gastrectomy. All patients had poor nutritional reserve with no other identifiable reason for failure to heal. All were deemed unfit for surgical intervention. Five gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula plug positioned directly into the fistula tract under local anaesthesia and two gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula positioned endoscopically using a rendezvous technique. Results For the five patients with gastrocutaneous fistulas closed directly under local anaesthesia, oral alimentation was reinstated immediately. Fistula output ceased on day 12 with complete epithelialisation occurring at a median of day 26. For the two gastrocutaneous fistulas closed endoscopically using the rendezvous technique, oral alimentation was reinstated on day 5 with immediate cessation of fistula output. Follow-up upper gastrointestinal endoscopy confirmed re-epithelialisation at eight weeks. In none of the cases has there been fistula recurrence (range of follow-up duration: 30–59 months). Conclusions Surgisis® anal fistula plugs can be used safely and effectively to close gastrocutaneous fistulas in a minimally invasive manner in patients unfit for surgical intervention.

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Facial schwannoma: results of a large case series and review

The Journal of Laryngology & Otology ◽

10.1017/s0022215107000667 ◽

2008 ◽

Vol 122 (11) ◽

pp. 1139-1150 ◽

Cited By ~ 65

Author(s):

B McMonagle ◽

A Al-Sanosi ◽

G Croxson ◽

P Fagan

Keyword(s):

Facial Nerve ◽

Current Literature ◽

Clinical Observation ◽

Surgical Intervention ◽

Treatment Algorithm ◽

Case Series ◽

Tertiary Referral ◽

Management Algorithm ◽

Facial Function ◽

Facial Rehabilitation

AbstractObjectives and hypothesis:To report a series of 53 cases of facial schwannoma, to review the current literature, addressing contentious issues, and to present a management algorithm.Study design:Retrospective case review combined with review of current literature.Materials and methods:A review of the case notes of 53 patients with intracranial and intratemporal facial schwannoma, from two tertiary referral centres, was undertaken. This represents the largest series of facial schwannomas with clinical correlations in the literature. Data relating to epidemiological, clinical and management details were tabulated and compared with other large series. A review of the current literature was performed, and a management algorithm presented.Results:There were 23 (43 per cent) female and 30 (57 per cent) male patients. Patients' ages at presentation ranged from five to 84 years, with a mean of 49 years. Twenty-five (47 per cent) of the tumours were present on the left side and 28 (53 per cent) on the right side. Hearing loss was the most common presenting symptom, being present in 31/53 (58 per cent) patients, followed by facial weakness in 27/53 (51 per cent). Two patients (4 per cent) were completely asymptomatic, and their facial neuromas were diagnosed incidentally. The schwannoma extended along more than one segment of the facial nerve in 39 patients (74 per cent), with the mean number of segments involved being 2.5. A conservative approach of clinical observation was undertaken in 20 patients (38 per cent). Thirty-three patients (62 per cent) underwent surgery, with a total of 36 procedures. The translabyrinthine approach was most common, being utilised in 17 of the 36 procedures. Two patients underwent revision surgery for residual or recurrent disease on three occasions. There was total removal of tumour in 21 cases; the remainder had subtotal or no removal with drainage or decompression of the tumours. Twenty-one nerve reconstructions were performed, and 18 facial rehabilitation procedures were performed on 14 patients.Discussion:The results of this case series are similar to those of other reported series. The diagnosis of facial schwannoma is now generally made pre-operatively, due to improved imaging techniques and heightened awareness. Clinical assessment of facial function and imaging form the mainstays of surveillance for these tumours. These tumours are managed via clinical observation or surgical intervention; the latter can range from simple procedures (such as drainage of cystic components) to aggressive tumour removal and facial nerve reconstruction. Facial rehabilitation procedures may also be applied. The timing of intervention is contentious; surgical intervention is indicated when facial function deteriorates to a House–Brackmann grade IV level.Conclusion:Facial schwannomas are rare lesions, and reported series are generally small. Due to the complex management issues involved, these tumours are best managed in a tertiary referral setting. Observation is preferred until facial function deteriorates to a House–Brackmann grade III level, at which time surgery is considered. When facial function deteriorates to House–Brackmann grade IV, surgical intervention is indicated. We advocate surgical management based on the treatment algorithm described.

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Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis

The American Journal of Sports Medicine ◽

10.1177/0363546511417096 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2429-2435 ◽

Cited By ~ 20

Author(s):

Cheng-Li Lin ◽

Jung-Shun Lee ◽

Wei-Ren Su ◽

Li-Chieh Kuo ◽

Ta-Wei Tai ◽

...

Keyword(s):

Minimally Invasive ◽

Grip Strength ◽

Surgical Intervention ◽

Current Trend ◽

Case Series ◽

Lateral Epicondylitis ◽

Extensor Tendon ◽

Level Of Evidence ◽

Vas Score

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition ( P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly ( P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

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