Importance of the vessel distribution at splenic hilum for laparoscopic Warshaw procedure

The laparoscopic Warshaw procedure (LWP) is a considered to carry a risk of splenic infarction and perigastric varices formation. We retrospectively analyzed the clinical outcomes and relationship between the distribution of the splenic hilum vessels and splenic infarction in patients who underwent LWP from February 2007 to February 2017. A total of 19 patients underwent LWP, and the median follow-up duration was 78 months. The median operative time and blood loss were 295 min and 200 gr. Six patients with splenic partial infarction and 3 with gastric varices were detected, but they have not needed any treatments. According to the classification by Michels, the distribution of splenic vessels were divided as distributed type and magistral type at the splenic hilum. In our study, 16 patients were distributed type and 3 were magistral type. Three of the 16 patients developed splenic infarction in distributed type. In contrast, all of magistral patients showed splenic infarction. Although LWP is a safe procedure, there is a high risk of splenic infarction if the splenic vessel distribution is a magistral type. Understanding the type before surgery leads to the identification of an appropriate vascular dissection position and reduces postoperative complications.

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Clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt: a multicenter study

Endoscopy ◽

10.1055/a-0977-3022 ◽

2019 ◽

Vol 51 (10) ◽

pp. 936-940 ◽

Cited By ~ 3

Author(s):

Mingyan Zhang ◽

Ping Li ◽

Haijun Mou ◽

Yongjun Shi ◽

Biguang Tuo ◽

...

Keyword(s):

Gastric Varices ◽

Safe Procedure ◽

Technical Success ◽

Technical Success Rate ◽

Gastrorenal Shunt ◽

Contrast Enhanced ◽

Enhanced Computed Tomography ◽

Lost To Follow Up ◽

Contrast Enhanced Computed Tomography

Abstract Background The aim of this study was to evaluate the safety and efficacy of clip-assisted endoscopic cyanoacrylate injection for gastric varices with a gastrorenal shunt. Methods Records were reviewed of patients with gastric varices and concomitant gastrorenal shunts who underwent clip-assisted endoscopic cyanoacrylate injection at three tertiary centers between April 2016 and October 2018. The assessed outcomes were technical success rate, eradication of gastric varices, cyanoacrylate embolization, and all-cause rebleeding. Results A total of 61 patients were analyzed. The procedure was successful in all patients (100 %). Gastric varices were eradicated in 30 of 33 patients (90.9 %) according to contrast-enhanced computed tomography re-examination within 1 month after the procedure. No symptoms or signs of cyanoacrylate embolization related to the procedure were observed. Four patients (6.6 %) were lost to follow-up. All-cause rebleeding occurred in 13/57 patients (22.8 %) during a median follow-up period of 225 days (interquartile range 114 – 507 days). Conclusions Clip-assisted endoscopic cyanoacrylate injection appeared to be a safe procedure that was convenient and efficacious in the treatment of gastric varices with concomitant gastrorenal shunt.

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The Cervico-Parasternal Thoracotomy (CPT): A New Surgical Approach for the Resection of Cervicothoracic Neuroblastomas

Children ◽

10.3390/children8030229 ◽

2021 ◽

Vol 8 (3) ◽

pp. 229

Author(s):

Giuseppe Martucciello ◽

Federica Fati ◽

Stefano Avanzini ◽

Filippo Maria Senes ◽

Irene Paraboschi

Keyword(s):

Surgical Approach ◽

Operative Time ◽

Lateral View ◽

Thoracic Inlet ◽

Trap Door ◽

Postoperative Time ◽

Neurovascular Structures ◽

Median Operative Time ◽

Disease Free

Cervicothoracic neuroblastomas (NBs) pose unique surgical challenges due to the complexity of the neurovascular structures located in the thoracic inlet. To date, two main techniques have been reported to completely remove these tumours in children: the trans-manubrial and the trap-door approaches. Herein, the authors propose a third new surgical approach that allows a complete exposure of the posterior costovertebral space starting from the retro-clavicular space: Cervico-Parasternal Thoracotomy (CPT). The incision is made along the anterior margin of the sternocleidomastoid muscle until its sternal insertion, and then the incision proceeds vertically following the ipsilateral parasternal line. The major pectoralis muscle is detached, and the clavicle and the ribs are disarticulated from their sternal insertions. Following an accurate isolation of the major subclavian blood vessels and the brachial plexus roots, the tumour is then completely exposed and resected by switching from a frontal to a lateral view of the costo-vertebral space. By adopting this technique, five cervicothoracic NBs were completely resected in a median operative time of 370 min (range: 230–480 min). By proceeding in safety with the heart apart, neither vascular injuries nor nerve damages occurred, and all patients were safely discharged in a median postoperative time of 11 days (range: 7–14 days). At the last follow-up visit (median: 16 months, range: 13–21 months), all patients were alive and disease-free.

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Laparoscopic single port radical prostatectomy in the 2020: Why not? Our experience

Urologia Journal ◽

10.1177/0391560321993555 ◽

2021 ◽

pp. 039156032199355

Author(s):

Giuseppe Sortino ◽

Willy Giannubilo ◽

Manuel Di Biase ◽

Andrea Marconi ◽

Maurizio Diambrini ◽

...

Keyword(s):

Radical Prostatectomy ◽

Personal Experience ◽

Functional Outcomes ◽

Operative Time ◽

Safe Procedure ◽

Estimated Blood Loss ◽

High Risk Disease ◽

Oncological Results ◽

The Mean

Objectives: To analyze the feasibility, safety and advantages of Laparo-Endoscopic Single-site Surgery radical prostatectomy (LESS-RP) based on our personal experience. Patients and methods: Details of 520 patients were retrospectively analyzed, from 2009 to 2019. Extraperitoneal approach, with only two accesses (2.5 cm and 5 mm respectively) was used to perform radical prostatectomy. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. Results: The mean age was 66.6 ± 5.6 years. Mean PSA level was 9 ± 3.5 ng/ml. According to D’Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 116 (22.4%), 275 (52.8%), and 129 (24.8%) respectively. Mean operative time was 156 ± 43 min. Mean estimated blood loss was 214 ± 93 ml. Positive surgical margins (PSMs) were detected in 110 (21.2%) patients. PSM rates in pT2 and pT3 stages were 20.1% and 22.9%, respectively. The overall complication rate was 9.2%, based on the modified Clavien classification. The 12 months continence and potency rates were 90.9% and 49.1%, respectively. The biochemical recurrence rate was 6.8%, at the median follow-up time of 26.7 months (IQR 12–32). Conclusions: Our analyses show that LESS-RP is a safe procedure, if performed by surgeons with adequate experience and skills. Unlike the classic laparoscopic prostatectomy, this technique allows better aesthetic and psychological results, reduced postoperative pain, and a faster return to normal daily activity with the same functional and oncological results.

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The comparison of central hepatic segments resection versus extended hepatectomies outcomes in children with liver tumors

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021176-83 ◽

2021 ◽

Vol 26 (1) ◽

pp. 76-83

Author(s):

D. G. Akhaladze ◽

G. S. Rabaev ◽

N. G. Uskova ◽

N. N. Merkulov ◽

S. R. Talypov ◽

...

Keyword(s):

Operative Time ◽

Liver Tumors ◽

Future Liver Remnant ◽

Transfusion Rate ◽

Safe Procedure ◽

Liver Remnant ◽

Future Liver Remnant Volume ◽

Central Hepatectomy ◽

Liver Remnant Volume ◽

Median Operative Time

Aim. To analyze the safety and advantages of central resection in comparison with extended hepatectomies. Methods. From June 2017 to May 2020 29 central and extended liver resections for children were performed. Central hepatic resections were carried out in 8, extended hepatectomies – in 21 patients. Preoperative investigations, intraoperative and postoperative data in both groups were analyzed.Results. The main indication for surgery was hepatoblastoma. Future liver remnant volume was significantly higher in central resections group (р = 0.003). No difference in median operative time (р = 0.94), intraoperative blood loss (р = 0.078) and blood transfusion rate (р = 0.057) were found between groups. There were no postoperative complications difference. Also no difference in hospital stay length (р = 0.3) were found.Conclusion. In comparison with extended procedures, central liver resection has similar complication rate. Central hepatectomy is a safe procedure in children with liver tumors, which allows to preserve more healthy parenchyma.

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Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04877-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hang Liao ◽

Peng Xie ◽

Guizhou Zheng ◽

Houguang Miao ◽

Ningdao Li ◽

...

Keyword(s):

Operative Time ◽

Bodily Pain ◽

Clinical Results ◽

Spinal Deformities ◽

Effective Technique ◽

Estimated Blood Loss ◽

Sf 36 ◽

Scoliosis Correction ◽

Median Operative Time

Abstract Background To report on the technique and results of parallel endplate osteotomy (PEO) for severe rigid spinal deformity. Methods We retrospectively reviewed the clinical data of 36 patients with severe rigid spinal deformities who underwent PEO between July 2016 and December 2018 and who were followed up for at least 24 months. Results Following PEO, the kyphosis and scoliosis correction rates reached 77.4 ± 14.0% and 72.2 ± 18.2%, respectively. The median intraoperative estimated blood loss was 1500 mL and the median operative time was 6.8 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 62 ± 28, 51 ± 26, 49 ± 29, 35 ± 30, 53 ± 28, 45 ± 30, 32 ± 34 and 54 ± 18 at baseline to 81 ± 16, 66 ± 41, 72 ± 40, 64 ± 44, 75 ± 25, 71 ± 46, 66 ± 34 and 76 ± 28 at 12 months postoperatively, 82 ± 32, 67 ± 42, 81 ± 30, 71 ± 41, 80 ± 30, 74 ± 36, 68 ± 35 and 85 ± 33 at 18 months postoperatively, and 86 ± 21, 83 ± 33, 88 ± 26, 79 ± 39, 86 ± 36, 86 ± 48, 80 ± 47 and 91 ± 39 at 24 months postoperatively, respectively. Conclusions PEO is an effective technique for successful correction of spinal deformities. At the two-year follow-up visit, all patients achieved better clinical results based on the SF-36 scores.

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Ambulatory surgery of umbilical, epigastric and small incisional hernias: open preperitoneal flat mesh technique in local anaesthesia

Acta chirurgica iugoslavica ◽

10.2298/aci0601029z ◽

2006 ◽

Vol 53 (1) ◽

pp. 29-34 ◽

Cited By ~ 5

Author(s):

M. Zuvela ◽

M. Milicevic ◽

D. Galun ◽

N.N. Lekic ◽

P. Bulajic ◽

...

Keyword(s):

Retrospective Study ◽

Incisional Hernia ◽

Local Anaesthesia ◽

Umbilical Hernia ◽

Operative Time ◽

Ambulatory Surgery ◽

Superficial Infection ◽

Mesh Technique ◽

Median Operative Time

Introduction. The dilemma whether to use the mesh or non mesh technique in the management of umbilical, epigastric and small incisional hernia is slowly fading away. The open preperitoneal "flat mesh" technique performed as ambulatory surgery may be one of the solutions. The Aim. The aim of this retrospective study is to present the results of open preperitoneal "flat mesh" technique in the management of umbilical, epigastric and small incisional hernia within Material and methods. This study included 34 patients (11 of them with umbilical, 13 with epigastric and 8 of them with small incisional hernia) operated by one surgeon in the period January 2004 - January 2006. Results. The median operative time was 52 minutes for umbilical hernia?s, 43 minutes for epgastric and 54 minutes for incisional hernia?s. The ambulatory surgery was performed at 91% of patients. The median hospitalization was 4h for patients with umbilical hernia?s, 3,7h for patients with epigastric and, 7,7h for patients with small incisional hernia. The follow up is 10,5 months. Apart of one superficial infection other complications were absent. Conclusion. The open preperitoneal "flat mesh" technique performed in local anesthesia as an ambulatory surgery provides good results in the management of umbilical, epigastric and small incisional hernia.

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P106 PROPHYLACTIC MESH FOR PREVENTION OF INCISIONAL HERNIA IN HIGH-RISK PATIENTS: PVDF “VISIBLE” MESH BEHAVIOUR ON MRI

British Journal of Surgery ◽

10.1093/bjs/znab395.099 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Beatriz Carrasco Aguilera ◽

Marina da Silva Torres ◽

Jose Rodicio ◽

Ana Fernández del Valle ◽

Maria Moreno ◽

...

Keyword(s):

High Risk ◽

Incisional Hernia ◽

Gastrointestinal Surgery ◽

Safe Procedure ◽

Prophylactic Mesh ◽

Midline Laparotomy ◽

Linea Alba ◽

High Risk Patients ◽

Risk Patients

Abstract Aim According to the guidelines, prophylactic mesh placement appears to be an effective, safe procedure in high-risk patients for the prevention of incisional hernia (IH) after midline laparotomy, without its use being standardized. Knowing its radiological behaviour can resolve doubts about its use. Material and Methods This was a prospective observational cohort study. The included patients needed to have more than one risk factor for IH (age> 60 years old, Body Mass Index > 30kg/m2, diabetes, chronic bronchopathy, heart disease, smoking, kidney disease, neoplasia, liver disease, immunosuppression or an emergency operation). Follow-up included 6-week and 12-month postoperative magnetic resonance imaging (MRI). If MRI was not performed, we used the follow-up computed tomography (CT). Results Between July 2016 and March 2021, 54 patients were enrolled in the study. Surgery was emergent in 14.8% of cases, clean-contaminated in 87% and upper gastrointestinal surgery in 51.9%. A total of 43 MRI and 3 CT at 6-week and 30 MRI and 2 CT at 12-month were carried out. The median of the mesh area were 150.7 vs 150,1cm2 respectively. 91% of cases had the mesh lined to the fascia at 12 months. The bridging in the linea alba was zero in 61% at 6-weeks and 24% at 12-month follow-up, mean 9 vs 19mm (p = 0.001). Conclusions The use of imaging tests to know the postoperative behaviour of a Polyvinylidenfluorid (PVDF) “visible” mesh shows us that there is no mesh contraction at one year or detachment of the fascia, however we observe a significant tendency in the separation of the linea alba.

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Effectiveness of Thoracoscopic Truncal Vagotomy in the Treatment of Marginal Ulcers after Laparoscopic Roux-en-Y Gastric Bypass

The American Surgeon ◽

10.1177/000313481207800619 ◽

2012 ◽

Vol 78 (6) ◽

pp. 663-668 ◽

Cited By ~ 7

Author(s):

John Hunter ◽

Richard D. Stahl ◽

Manasi Kakade ◽

Igal Breitman ◽

Jayleen Grams ◽

...

Keyword(s):

Gastric Bypass ◽

Chart Review ◽

Operative Time ◽

Telephone Interview ◽

Marginal Ulcer ◽

Symptomatic Improvement ◽

Truncal Vagotomy ◽

Peptic Ulcers ◽

Median Operative Time

Marginal ulcer is a significant complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). Most marginal ulcers resolve with medical management, but nonhealing ulcers may require revision of the gastrojejunostomy, a procedure with significant morbidity and mortality. Traditionally, surgical therapy for refractory peptic ulcers includes a vagotomy. The current study evaluates the effectiveness of thoracoscopic truncal vagotomy (TTV) in the management of refractory marginal ulcers. All patients at two institutions with an intractable marginal ulcer after LRYGB treated with TTV between 2003 and 2010 were reviewed. Data were collected from chart review and telephone interview. Seventeen patients (mean age, 39 ± 13 years; 16 females) were diagnosed with marginal ulceration a median of 18 months after LRYGB and proceeded to TTV at a mean of 39 ± 43 weeks (range, 1 to 114 weeks) after the diagnosis. The median operative time was 89 ± 65 minutes (range, 45 to 318 minutes). Four patients had a complication (sympathetic contralateral pleural effusion, pneumothorax, operative bleeding, and readmission for emesis). Eleven patients had follow-up of 3 months to 6 years (median, 7 months). Nine patients (82%) had symptomatic improvement and/or endoscopic resolution, whereas two (18%) did not. No patient had endoscopic evidence of persistent or recurrent marginal ulcer. TTV achieves symptomatic improvement and/or endoscopic resolution of intractable marginal ulcers in over 80 per cent of patients status post gastric bypass and therefore offers a less morbid alternative to revision of the gastrojejunostomy.

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The Feasibility, Technique, and Medium-Term Follow-Up of Laparoscopic Transvesical Diverticulectomy

Urologia Internationalis ◽

10.1159/000510242 ◽

2020 ◽

Vol 104 (11-12) ◽

pp. 923-927

Author(s):

Klaus Eredics ◽

Michael Rauchenwald ◽

Lukas Lusuardi ◽

Thomas Kunit ◽

Hans Christoph Klingler ◽

...

Keyword(s):

Operative Time ◽

Medium Term ◽

Ureter Injury ◽

Day Range ◽

Valuable Procedure ◽

Median Diameter ◽

Transurethral Catheter ◽

Bladder Diverticula ◽

Median Operative Time

Background: To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [BJU Int. 2009;103(3):412–24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up. Methods: Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32–85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique. Results: The median operative time was 297 min (range 83–488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40–110 mm). The transurethral catheter was removed in most patients on day 7 (range 1–26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4–18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed. Conclusion: The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.

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Holmium Laser Enucleation of the Prostate With Virtual Basket Mode: Faster and Better Control on Bleeding

10.21203/rs.3.rs-55897/v1 ◽

2020 ◽

Author(s):

Giorgio Bozzini ◽

Matteo Maltagliati ◽

Umberto Besana ◽

Lorenzo Berti ◽

Alberto Calori ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Holmium Laser ◽

Safe Procedure ◽

Significant Difference ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Irrigation Volume

Abstract BACKGROUND: To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate with Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH).METHODS: This prospective randomized study enrolled consecutive patients with BPH to HoLEP (n = 100) or VB-HoLEP (n =100). We evaluated all patients preoperatively with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We evaluated also the patients at 3, 6 and 12 months after surgery with the use of maximum flow rate (Qmax), postvoid residual urine volume (PVR) and International Prostate Symptom Score (IPSS).RESULTS: We didn’t see significant difference in preoperative parameters between patients in each study arm. Compared with HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs 1.12 g/dL, P = .003) and had a more rapid operative time (57.33±29.71 vs 42.99±18.51 minutes, P = 0.04). HoLEP and VB-HoLEP had same catheterization time (2.2 vs 1.9 days, P = 0.45), irrigation volume (33.3 vs 31.7 L, P = 0.69), and hospital stay (2.8 vs 2.7 days, P = 0.21). During the follow-up of subsequent 12 months, we didn’t demonstrate a significant difference in IPSS, Qmax, PVR, and QOLS.CONCLUSION: HoLEP and VB-HoLEP both are efficient a safe procedure for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and to allow a faster procedure. However, procedures did not differ significantly in catheterization time, hospital stay, operation time and irrigation volume. No differences were demonstrated in QOLF, IPSS, Qmax and PVR through the post-surgery 12 months of follow-up.TRIAL REGISTRATION: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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