scholarly journals Thoracoscopy for Esophageal Diverticula After Esophageal Atresia With Tracheo-Esophageal Fistula

2021 ◽  
Vol 9 ◽  
Author(s):  
Zhao Yong ◽  
Wang Dingding ◽  
Hua Kaiyun ◽  
Gu Yichao ◽  
Zhang Yanan ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Operation Time ◽  
Esophageal Stenosis ◽  
Good Growth ◽  
Recurrent Pneumonia ◽  
Esophageal Anastomosis

Background: Esophageal diverticulum (ED) is an extremely rare complication of congenital esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) surgery. We aimed to investigate feasible methods for the treatment of this rare complication.Methods: We retrospectively reviewed all patients with EA/TEF at Beijing Children's Hospital from January 2015 to September 2019. The clinicopathological features of patients with ED after EA/TEF surgery were recorded. Follow-up was routinely performed after surgery until December 2020.Results: Among 198 patients with EA/TEF, ED only occurred in four patients (2.02%; one male, three female). The four patients had varying complications after the initial operation, including anastomotic leakage (3/4), esophageal stenosis (3/4), and recurrence of TEF (1/4). The main clinical symptoms of ED included recurrent pneumonia (4/4), coughing (4/4), and dysphagia (3/4). All ED cases occurred near the esophageal anastomosis. Patients' age at the time of diverticulum repair was 6.6–16.8 months. All patients underwent thoracoscopic esophageal diverticulectomy (operation time: 1.5–3.5 h). Anastomotic leakage occurred in one patient and spontaneously healed after 2 weeks. The other three patients had no peri-operative complications. All patients were routinely followed up after surgery for 14–36 months. During the follow-up period, all patients could eat orally, had good growth and weight gain, and showed no ED recurrence or anastomotic leakage on esophagogram.Conclusions: ED is a rare complication after EA/TEF surgery and is a clear indication for diverticulectomy. During the midterm follow-up, thoracoscopic esophageal diverticulectomy was safe and effective for ED after EA/TEF surgery.

Thoracoscopic surgery for recurrent tracheoesophageal fistula after esophageal atresia repair

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
Kaiyun Hua ◽  
Shen Yang ◽  
Yanan Zhang ◽  
Yong Zhao ◽  
Yichao Gu ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Thoracoscopic Surgery ◽  
Operation Time ◽  
Oral Feeding ◽  
Uneventful Recovery ◽  
Severe Malnutrition ◽  
Z Score

Summary We aimed to investigate the safety, feasibility, and outcomes of thoracoscopic surgery for recurrent tracheoesophageal fistula (rTEF) after esophageal atresia repair. The medical records and follow-up data of 31 patients who underwent thoracoscopic surgery for rTEF at a single institution were collected and reviewed. In total, 31 patients were enrolled with a median age of 7 months (range: 3–30 months) and a median weight of 6,000 g (range: 4,000–12,000 g) before reoperation. The median operation time for the entire series was 2.9 hours (range: 1.5–7.5 hours), and the median total hospitalization duration after surgery was 19 days (range: 11–104 days). One patient died of anastomotic leakage, a second rTEF, severe malnutrition, and thoracic infection; the mortality rate was 3.23% (1/31). Nine patients (9/31, 29.03%) had an uneventful recovery, and the incidences of postoperative anastomotic leakage, anastomotic stricture, and second rTEF were 25.81%, 61.29%, and 9.68%, respectively. After a median follow-up of 12 months (range: 3–24 months), 26 survivors resumed full oral feeding, 2 were tube fed, 2 required a combination of methods, and 4 patients experienced severe respiratory complications. In total, 9 patients had pathological gastroesophageal reflux, and 2 patients eventually underwent Nissen fundoplication. Of the 30 survivors with growth chart data, the median weight for age Z-score, height for age Z-score, and weight for height Z-score were − 0.46 (range: −5.1 to 2.8), 0.75 (range: −2.7 to 4.7), and − 1.14 (range: −6.8 to 3.0), respectively. Thoracoscopic surgical repair for rTEF is safe, feasible, and effective with acceptable mortality and morbidity.

DOZ047.47: Flourish device for treatment of esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
Bethany J Slater ◽  
Mario Zaritzky
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis ◽  
Distal Portion ◽  
Contrast Study ◽  
Anastomotic Leaks ◽  
Magnetic Device ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Cook Medical

Abstract Esophageal atresia (EA) is usually repaired soon after birth. However, there are conditions in which early repair is not possible including prematurity, a large distance between the ends, failed attempt at primary anastomosis, and postoperative complications. Cases in which the ends of the esophagus are not able to be brought together without significant tension, or long-gap esophageal atresia (LGEA), remain a challenge to manage. A variety of techniques have been used to establish esophageal continuity consisting of extensive mobilization, myotomies, esophageal flaps, and traction of the segments. The use of magnets is a nonsurgical alternative for esophageal anastomosis. There have been a few series demonstrating initial success and accomplishment of magnamosis in EA patients. A prospective, single-arm, observational study is currently enrolling patients to evaluate the safety and benefit of the Flourish Device (Cook Medical), a catheter-based, magnetic device used to lengthen the atretic esophageal ends and create an anastomosis. The primary outcomes include stricture requiring dilation or surgery, anastomotic leaks or other adverse events with follow-up for two years. The distance of the esophageal gap is measured with metal probes. All patients require a mature gastrostomy and atretic segments < 4 cm apart. The proximal catheter has a suction port and the distal portion has a channel for feeds. Placement is done under fluoroscopy with anesthesia or sedation. Daily chest radiographs are obtained until union of the magnets occur. Successful anastomosis is identified by saliva in the gastrostomy catheter, feeds in the esophageal catheter, or with a contrast study. One day after confirmation, the magnets may be removed. When the catheters are aligned, the magnets attract. Once the magnets have connected, the tissue between them sloughs off while the outer rim heals establishing the anastomosis. The Flourish device may be particularly useful in patients in whom additional operations are not ideal such as those with congenital anomalies or who have undergone previous operations or complications.

scholarly journals Fluoroscopy guided stent placement for the treatment of malignant afferent loop obstruction

2021 ◽  
Author(s):  
Chaoyang Wang ◽  
Xiaoyi Duan ◽  
Lequn Wei ◽  
Tong Wang ◽  
Huanzhang Niu
Keyword(s):  
Tumor Progression ◽  
Stent Placement ◽  
Clinical Symptoms ◽  
Operation Time ◽  
The Other ◽  
Efficacy And Safety ◽  
Safe Method ◽  
Afferent Loop ◽  
Afferent Loop Obstruction

Abstract BACKGROUND & AIM: To evaluate the efficacy and safety of fluoroscopy guided stent placement for the treatment of malignant afferent loop obstruction (ALO). METHODS 12 patients with malignant ALO in whom fluoroscopy guided stent placement had been performed were analyzed retrospectively. The operation time, clinical efficacy, complications and postoperative hospitalization were observed. Follow-up was scheduled at 1 and 3 months after the operation, and every 3 months thereafter, or when the patients developed clinical symptoms related to ALO. RESULTS Stent placement was performed successfully in 11 patients with an average time of 37.9 ± 12.2 min. For the other one patient, we adopted transnasal drainage tube implantation in afferent loop instead of stent placement. All the patients had an obvious relief of clinical symptoms, and no serious complications occurred. During the follow-up, 1 patient had restenosis 12 months later as the tumor grew across the stent mesh. 7 patients died of tumor progression at 3, 4.5, 5, 7, 8, 11 and 15 months after the operation. CONCLUSION Fluoroscopy guided stent placement is an effective and safe method for the treatment of malignant ALO.

DOZ047.66: Thoracoscopic posterior tracheopexy during primary esophageal atresia repair

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S H A J Tytgat ◽  
D C van der Zee ◽  
J W Verweij ◽  
E S van Tuyll van Serooskerken ◽  
M Y A Lindeboom
Keyword(s):  
Esophageal Atresia ◽  
Respiratory Symptoms ◽  
Wide Spectrum ◽  
New Approach ◽  
Esophageal Anastomosis ◽  
Life Threatening ◽  
Syncytial Virus ◽  
The Right ◽  
Tracheal Collapse

Abstract Background Esophageal atresia (EA) is usually accompanied by some form of tracheomalacia. During the early phases in life, excessive dynamic collapse of the trachea can cause a wide spectrum of symptoms ranging from mild complaints to apparent life-threatening events (ALTE’s). Therapeutic strategies for severe tracheomalacia include aortopexy to lift the anterior weakened cartilaginous rings or posterior tracheopexy of the floppy membranous tracheal intrusion. Earlier we have introduced a new approach in which the posterior tracheopexy is performed directly during primary thoracoscopic correction of EA. Methods In the period 2017–2018, all consecutive EA patients (27) underwent a rigid tracheobronchoscopic evaluation during induction of anesthesia prior to the thoracoscopic EA repair. Tracheomalacia was diagnosed in 11 patients. During the subsequent thoracoscopic procedure, the posterior tracheal membrane was fixed to the anterior longitudinal spinal ligament with nonabsorbable sutures. The esophageal ends were then mobilized toward the right hemithorax and anastomosed. Results On preoperative RTB, six patients had a severe (66–99%) mid tracheal collapse and five patients had a moderate (33–66%) collapse. Thoracoscopic posterior tracheopexy with on to three sutures was possible in all 11 patients, prior to the formation of the esophageal anastomosis. Median time per suture was 6 minutes (range: 4–12 minutes). All operative procedures were uneventful. A median follow-up of 10 months (range: 2–22 months) revealed that eight patients recovered without any respiratory symptoms, one patient had respiratory symptoms caused by a suture granuloma that was removed by bronchoscopy, one patient had a respiratory syncytial virus bronchiolitis and one patient had a rhinovirus infection. None of the patients experienced any ALTE’s. Conclusion Eleven patients have been treated by thoracoscopic posterior tracheopexy during primary EA repair. This technique could prevent potentially deleterious sequelae of moderate to severe tracheomalacia that may complicate the lives of EA patients. Also, a second, sometimes complex surgical procedure can be prevented as the posterior tracheopexy is performed during the primary thoracoscopic EA correction.

scholarly journals Comparison of the effect of two internal fixation methods for proximal clavicle fractures

2020 ◽  
Vol 66 (5) ◽  
pp. 654-658
Author(s):  
Haining Xu ◽  
Yan Nie ◽  
Lifang Han ◽  
Liang Li ◽  
Haitao Sui
Keyword(s):  
Blood Loss ◽  
Internal Fixation ◽  
Fracture Healing ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Healing Time ◽  
Fixation Methods ◽  
Plate Group ◽  
Clavicle Fractures

SUMMARY OBJECTIVE To compare the effect of two internal fixation methods in the treatment of proximal clavicle fractures. METHODS Fifty patients with proximal clavicle fractures received surgical treatment. They were divided into a clavicular T-plate group and a double mini-plates group. The duration of the operation, blood loss during the operation, fracture healing time, and incision infection were evaluated between the two groups. RESULTS Operation time (t=2.063, P=0.058), intraoperative bleeding (t=1.979, P=0.062), and fracture healing time (t=1.082, P=0.066) were not statistically significant in the two groups. The patients were followed up for 12-18 months; one patient in the T-plate group had early removal of nails, but no clinical symptoms. At the 2-month follow-up, the ASES score in the double mini-plates group was significantly better than in the T-plate group (P<0.001); but at the 6-month follow-up, 1-week before removal of internal fixation and the final follow-up, the two groups had no significant differences (P>0.05). CONCLUSIONS Both internal fixations have similar clinical results in the duration of operation, blood loss during the operation, and fracture healing time. The double mini-plates fixation presents advantages by reducing complications and speeding fracture healing; thus it is a more effective method to treat proximal clavicle fractures.

scholarly journals Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

2020 ◽  
Author(s):  
Shengliang Zhao ◽  
Zhengxia Pan ◽  
Yonggang Li ◽  
Yong An ◽  
Lu Zhao ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Open Surgery ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Diaphragmatic Eventration ◽  
Diaphragmatic Plication ◽  
Paradoxical Movement ◽  
First Choice

Abstract Backgrounds: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

scholarly journals Endoscopic TLIF with Unilateral Pedicle Screw and Contralateral Translaminar Facet Screw Fixation : Technical Note and Early Outcomes

2021 ◽  
Author(s):  
qingchen liang ◽  
fenglong sun ◽  
hongqing wang
Keyword(s):  
Back Pain ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Disc Height ◽  
Leg Pain ◽  
Vas Score ◽  
Degenerative Lumbar Diseases ◽  
Time In Bed ◽  
The Mean

Abstract Study Design: Retrospective study.Objective：To evaluate outcomes and safety of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) for degenerative lumbar diseases.Summary of Background Data：There is no report about Endo-TLIF using unilateral pedicle screws and contralateral translaminar facet joint screw (UPS and TFS) fixation.Purpose: This paper evaluated the efficacy and safety of Endo-TLIF using UPS and TFS fixation in degenerative lumbar diseases.Methods:From August, 2018 to December, 2019, 21 patients with degenerative lumbar diseases were treated with Endo-TLIF. Clinical symptoms were evaluated at 1 month, 3 months, and the last follow-up after surgery. Outcomes were assessed by using the VAS back pain VAS leg pain, Oswestry disability index (ODI). Dural Sac Cross-sectional Area (DSCA), Foraminal Height (FH), Anterior Disc Height (ADH), Posterior Disc Height (PDH) and Lumbar Lordosis (LL).Results:The mean age of the cases was 62.9 years. The mean operation time was 198.7 min, the blood loss was 86.7 mL, and the length of incision was 5.7 cm. The mean time in bed was 34.3 hours, and the mean length of hospital stay was 15.1 days. The ODI scores improved from 64.1 to 13.3 (P < 0.05), the VAS score of back pain improved from 5.8 to 1.7 (P < 0.05), and the VAS score of leg pain improved from 6.2 to 1.6 (P < 0.05). ADH increased from 1.3 cm to 1.6 cm (P < 0.05), PDH increased from 0.7 cm to 1.0 cm (P < 0.05), FH increased from 1.7 cm to 2.0 cm (P < 0.05), and DSCA increased from 147 mm2 to 40 mm2 (P < 0.05). No serious complications occurred during the follow-up period.Conclusions:Endo-TLIF with UPS and TFS can improve the clinical symptoms of patients with degenerative lumbar diseases. The early curative effect was satisfactory.

scholarly journals Nicolau Syndrome due to Penicillin Injection: A Report of 3 Cases without Long-Term Complication

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Sara Memarian ◽  
Behdad Gharib ◽  
Mohammd Gharagozlou ◽  
Hosein Alimadadi ◽  
Zahra Ahmadinejad ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Sympathetic Nerve ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Mechanical Injury ◽  
Benzathine Penicillin ◽  
Sympathetic Nerve Stimulation ◽  
Nicolau Syndrome

Nicolau syndrome (NS) or livedo-like dermatitis is a rare complication of injection of various medications such as penicillin. The pathophysiology of this events is not clear, but some hypotheses are suggested, such as sympathetic nerve stimulation, embolic occlusion, inflammation, or mechanical injury. In this paper we report 3 cases of NS following benzathine penicillin. Clinical symptoms improved in 2 cases during 2-month follow-up, but one of them had a residual necrosis in the distal phalanges of the toes.

Percutaneous embolization of renal arteriovenous fistula

VASA ◽  
2005 ◽  
Vol 34 (3) ◽  
pp. 207-210 ◽  
Author(s):  
Sendi ◽  
Toia ◽  
Nussbaumer
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Abdominal Discomfort ◽  
Renal Arteriovenous Fistula ◽  
Percutaneous Embolization ◽  
Arterial Access ◽  
Number Of Publications ◽  
Occluding Balloon

Acquired renal arteriovenous fistula is a rare complication following a nephrectomy and its diagnosis may be made many years after the intervention. The closure of the fistula is advisable in most cases, since it represents a risk for heart failure and rupture of the vessel. There are an increasing number of publications describing different techniques of occlusion. The case of a 70-year-old woman with abdominal discomfort due to a large renal arteriovenous fistula, 45 years after nephrectomy, is presented and current literature is reviewed. Percutaneous embolization was performed by placing an occluding balloon through the draining vein followed by the release of nine coils through arterial access. One day after successful occlusion of the fistula, clinical symptoms disappeared.

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