Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage of walled-off pancreatic necrosis (WOPN)

Abstract: Introduction: The endoscopic treatment of walled-off pancreatic necrosis (WOPN) as well as other minimally invasive methods have been evolving since last years. The aim of this study is evaluation of efficiency and safety of endoscopic necrosectomy under fluoroscopy done during the transmural drainage in patients with symptomatic WOPN. Material and methods: The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. Results: Endoscopic necrosectomy was performed under fluoroscopic guidance during transmural drainage in 24/114 (21,05%) patients.The mean amount of endoscopic procedures in each patient was 8,88 (3-27). The active drainage was continued averagely for 40,1 (11-96) days. The avarage number of necrosectomy procedures during continued drainage was 6,54 (1-24) per patient. Additional percutaneous drainage was applied in just two patients. The complications of endotherapy were present in 9/24 (37,5%) patients. The therapeutic success was reached in 23/24 (95,83%) patients. The mean time of observation was 35 [18-78] months. The recurrence of pancreatic fluid collection was stated in 4 patients during the observation time. The mean time between the end of endotherapy and recurrence of fluid collection was 19 [16-22] months. In three patients recurrent fluid collections were treated endoscopically and in one patient were treated surgically. Long-term success of endoscopic treatment of WOPN was reached in 22/24 (91,67%) patients. Conclusions: Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage is successful and safe method of minimally invasive treatment in selected patients with walled-off pancreatic necrosis.

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Description Of Minimally Invasive Methods Of Treatment Of Walled-Off Pancreatic Necrosis (WOPN)- The Use Of „Step-Up Approach” In Patient With Pancreatic Necrosis

Polish Journal of Surgery ◽

10.1515/pjs-2015-0080 ◽

2015 ◽

Vol 87 (8) ◽

Cited By ~ 1

Author(s):

Mateusz Jagielski ◽

Marian Smoczyński ◽

Michał Studniarek ◽

Krystian Adrych

Keyword(s):

Minimally Invasive ◽

Endoscopic Treatment ◽

Percutaneous Drainage ◽

Pancreatic Necrosis ◽

Clinical Effects ◽

Fluoroscopic Guidance ◽

Endoscopic Necrosectomy ◽

Percutaneous Access ◽

Methods Of Treatment ◽

Minimally Invasive Methods

AbstractThe study presents description of treatment of patients with walled-off pancreatic necrosis (WOPN). The strategy of treatment was to extend access to necrotic areas (“step-up approach”). Applied endoscopic transmural access (transgastric) and percutaneous access (transperitoneal). The endoscopic necrosectomy under fluoroscopic guidance was repeated four times during active transluminal drainage. Endoscopic treatment with percutaneous drainage gave very beneficial clinical effects.

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Surgical Management of Necrotizing Pancreatitis

10.5772/intechopen.96044 ◽

2021 ◽

Author(s):

Dane Thompson ◽

Siavash Bolourani ◽

Matthew Giangola

Keyword(s):

Pancreatic Necrosis ◽

Necrotizing Pancreatitis ◽

Standard Of Care ◽

Nutrition Intervention ◽

Morbid Condition ◽

Endoscopic Necrosectomy ◽

Transmural Drainage ◽

Percutaneous Endoscopic Necrosectomy ◽

Invasive Techniques ◽

First Line Treatment

Pancreatic necrosis is a highly morbid condition. It is most commonly associated with severe, acute pancreatitis, but can also be caused by trauma or chronic pancreatitis. Once diagnosed, management of pancreatic necrosis begins with supportive care, with an emphasis on early, and preferably, enteral nutrition. Intervention for necrosis, sterile or infected, is dictated by patient symptoms and response to conservative management. When possible, intervention should be delayed to allow the necrotic collection to form a capsule. First-line treatment for necrosis is with percutaneous drainage or endoscopic, transmural drainage. These strategies can be effective as monotherapy, but the need for repeated interventions, or for progression to more invasive interventions, is not uncommon. Necrosectomy may be performed using a previously established drainage tract, as in percutaneous endoscopic necrosectomy (PEN), video-assisted retroperitoneal debridement (VARD), and direct endoscopic necrosectomy (DEN). Although outcomes for these minimally-invasive techniques are better than for traditional necrosectomy, both laparoscopic and open techniques remain important for patients with extensive disease that cannot otherwise be adequately treated. This is especially true when pancreatic necrosis is complicated by disconnected pancreatic duct syndrome (DPDS), where necrosectomy remains standard of care.

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Current Surgical Management of Infected Pancreatic Necrosis

The American Surgeon ◽

10.1177/000313481007601016 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1096-1099 ◽

Cited By ~ 3

Author(s):

Brendan Boland ◽

Steven Colquhoun ◽

Vijay Menon ◽

Amanda Kim ◽

Simon Lo ◽

...

Keyword(s):

Surgical Approach ◽

Pancreatic Necrosis ◽

Infected Pancreatic Necrosis ◽

Challenging Problem ◽

Surgical Service ◽

Single Procedure ◽

Pancreatic Debridement ◽

Single Intervention ◽

The Mean ◽

Mean Time

Infected pancreatic necrosis (IPN) continues to be a challenging problem for the surgeon. We reviewed the experience on a hepatobiliary surgical service with patients who required operative intervention for IPN with emphasis on surgical approach, timing of surgery, and complications. Between 2002 and 2008, 21 patients underwent surgery for IPN. The initial surgical approach in these 21 patients included either direct pancreatic debridement (DPD, n = 13) or transgastric debridement using cyst-gastrostomy (CG, n = 8). Fifteen patients (71%) required only a single procedure, whereas three (14%) required two procedures and three (14%) required three procedures. The mean time from onset of pancreatitis to operation was 77 days. Patients requiring a single intervention had a longer interval from onset of pancreatitis to surgery compared with those requiring multiple interventions. When comparing CG and DPD groups, there was a longer interval from onset of pancreatitis to debridement, a lower chance of needing multiple debridements, and fewer pancreatic fistulae in the CG group. Overall survival was 95 per cent. Our results demonstrate that CG can be successfully used in select patients with IPN. Patients undergoing CG are less likely to require repeat surgical debridement and to develop pancreatic fistulae compared with patients undergoing DPD.

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Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts

Gastroenterology Research and Practice ◽

10.1155/2016/1249064 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Hyeong Seok Nam ◽

Hyung Wook Kim ◽

Dae Hwan Kang ◽

Cheol Woong Choi ◽

Su Bum Park ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Complete Resolution ◽

Symptomatic Improvement ◽

Lesion Size ◽

Endoscopic Drainage ◽

Fluoroscopic Guidance ◽

The Mean ◽

Fluid Collections ◽

Mean Time

Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance.Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted.Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n=13) and pelvic abscesses (n=4). The median lesion size was 7.1 cm (range: 2.8–13.0 cm), and the mean time spent per procedure was26.2±9.8minutes (range: 16–50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution.Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.

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Process optimized minimally invasive total hip replacement

Orthopedic Reviews ◽

10.4081/or.2012.e3 ◽

2012 ◽

Vol 3 (2) ◽

pp. 3 ◽

Cited By ~ 4

Author(s):

Philipp Gebel ◽

Markus Oszwald ◽

Bernd Ishaque ◽

Gaffar Ahmed ◽

Recha Blessing ◽

...

Keyword(s):

Minimally Invasive ◽

Total Hip Replacement ◽

Hip Replacement ◽

Direct Anterior Approach ◽

Operation Technique ◽

Complication Rates ◽

Leg Length ◽

Total Hip ◽

The Mean ◽

Mean Time

The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA) in total hip replacement (THR) in combination with the leg positioner (Rotex- Table) and a modified retractor system (Condor). We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS). All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years), with a mean BMI of 26.5 (17 to 43). The mean time of surgery was 80 min. (55 to 130 min). The blood loss showed an average of 511.5 mL (200 to 1000 mL). No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points) 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

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Ultrasonography-Guided Percutaneous Nephrolithotomy for the Treatment of Urolithiasis in Patients with Scoliosis

International Surgery ◽

10.9738/cc93.1 ◽

2012 ◽

Vol 97 (2) ◽

pp. 182-188 ◽

Cited By ~ 3

Author(s):

Hongyan Li ◽

Zhuo Zhang ◽

Hai Li ◽

Yuanyuan Xing ◽

Gang Zhang ◽

...

Keyword(s):

Minimally Invasive ◽

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Single Session ◽

Minimally Invasive Percutaneous Nephrolithotomy ◽

The Mean ◽

Ultrasonographic Guidance ◽

Mean Time ◽

Treatment Of Urolithiasis

Abstract We examined the surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) in scoliotic patients with complicating urolithiasis. Two patients with scoliosis were hospitalized for MPNCL due to upper tract urolithiasis. Calyx puncture was performed in the prone position under ultrasonographic guidance. The renal access route was established using a set of 8F to 16F dilators, and a transpyelic ballistic lithotriptor was used to fragment the calculi. The stone burdens in the 2 patients were 410 mm2 and 500 mm2. The entire operative time was 40 to 70 minutes, and the mean time of establishing percutaneous access was 20 minutes. The calculi were completely removed by single-session pneumatic lithotripsy. The 2 patients recovered from MPCNL uneventfully, and the follow-up radiologic examinations identified no stone residual or recurrence. MPCNL is a minimally invasive modality that is effective and safe for the treatment of urolithiasis in patients with scoliosis.

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Experience with a Minimally Invasive Approach to Combined Valve Surgery and Coronary Artery Bypass Grafting through Bilateral Thoracotomies

The Heart Surgery Forum ◽

10.1532/hsf98.20121126 ◽

2013 ◽

Vol 16 (3) ◽

pp. 125 ◽

Cited By ~ 3

Author(s):

Pieter J. S. Smit ◽

Masood A. Shariff ◽

John P. Nabagiez ◽

Muhammad A. Khan ◽

Scott M. Sadel ◽

...

Keyword(s):

Coronary Artery ◽

Minimally Invasive ◽

Artery Bypass ◽

Median Sternotomy ◽

Valve Surgery ◽

Invasive Approach ◽

Invasive Group ◽

The Mean ◽

Artery Disease ◽

Mean Time

Background: Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive valve surgery (MIVS) have been used independently to manage occlusive coronary artery disease and valvular diseases, respectively. We present 12 patients who underwent combined MICS-CABG and MIVS via bilateral mini-thoracotomies.Methods: We retrospectively reviewed 116 consecutive valve/CABG operations by a single surgeon and compared the outcomes obtained via sternotomy with those obtained via bilateral minithoracotomies.Results: Six patients in the MIVS group underwent aortic valve replacement (sternotomy group, n = 70), 3 patients underwent mitral valve repair (sternotomy group, n = 9), and 3 underwent mitral valve replacement (sternotomy group, n = 25). The minimally invasive valve surgeries were combined with MICS-CABG for single- (n = 2), double- (n = 9), and triple-vessel (n = 1) coronary artery disease in a single operation. The mean SD duration of cardiopulmonary bypass was 164 ± 44.6 minutes (mean time via sternotomy, 152 ± 50.5 minutes; P = .4146), and the mean aortic cross-clamp time was 87.8 ± 22.1 minutes (mean time via sternotomy, 105 ± 39.8 minutes; P = .1455). The use of perioperative blood transfusions averaged to 2.3 ± 5.6 units (mean usage via sternotomy, 2.7 ± 4.9 units; P = .8326). There were no conversions to sternotomy in the minimally invasive group. Patients in the minimally invasive group were extubated earlier (24 ± 11 hours; sternotomy group, 40 ± 61 hours; P = .3684) and discharged earlier (7 ± 4 days) than patients who underwent median sternotomy (9 ± 10 days; P = .4027).Conclusion: MICS-CABG combined with MIVS via bilateral minithoracotomies yielded short-term results comparable to those for CABG and valve repair via median sternotomy. There were no operative mortalities or reoperations. The possible advantages of the minimally invasive approach included earlier extubation and earlier discharge from the hospital. Combined CABG and valve surgery can be safely performed via bilateral thoracotomies.

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The Development of Endoscopic Techniques for Treatment of Walled-Off Pancreatic Necrosis: A Single-Center Experience

Gastroenterology Research and Practice ◽

10.1155/2018/8149410 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Mateusz Jagielski ◽

Marian Smoczyński ◽

Anna Jabłońska ◽

Krystian Adrych

Keyword(s):

Endoscopic Treatment ◽

Pancreatic Necrosis ◽

Single Center ◽

Therapeutic Success ◽

Endoscopic Necrosectomy ◽

Endoscopic Techniques ◽

Single Center Experience ◽

Analysis Of Results ◽

Therapeutic Possibilities

Background. Endotherapy is a common method of treatment in patients with symptomatic walled-off pancreatic necrosis (WOPN). The aim of this study is to indicate the potential therapeutic possibilities created by the combination of several new endoscopic techniques and the evaluation of their efficacy in the treatment of WOPN. Methods. The retrospective analysis of results and complications in the group of 101 patients, who underwent endoscopic treatment of symptomatic WOPN between years 2011 and 2015. Results. Endoscopic treatment was started in 101 patients (71 men, 30 women; mean age 50.97 years) with symptomatic WOPN. Single transluminal gateway technique (SGT) was used in 93/101 (92.08%) patients. SGT in combination with multiple transluminal gateway technique (MTGT) was exploited in 4/93 (4.30%) patients, while in combination with single transluminal gateway transcystic multiple drainage (SGTMD) in 22/93 (23.66%) patients. Transpapillary access was used in 11/101 (10.89%) patients. 20/101 (19.80%) patients underwent percutaneous drainage. Fluoroscopy-guided endoscopic necrosectomy was performed in 19/101 (18.81%) patients. The combinations of endoscopic techniques depended on the extent of necrosis. Procedure-related complications occurred in 16/101 (15.84%) patients. The mortality rate was 0.99% (1/101 patient). Therapeutic success was achieved in 99/101 (98.02%) patients. The long-term success of endoscopic treatment was achieved in 97/101 (96.04%) patients with symptomatic WOPN. Conclusions. Application of new endoscopic techniques in the treatment of the patients with symptomatic WOPN significantly improves the efficiency of endotherapy with an acceptable amount of complications.

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Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016–2019

Journal of Fungi ◽

10.3390/jof8010049 ◽

2022 ◽

Vol 8 (1) ◽

pp. 49

Author(s):

Chi-Jung Wu ◽

Cong-Tat Cia ◽

Hsuan-Chen Wang ◽

Chang-Wen Chen ◽

Wei-Chieh Lin ◽

...

Keyword(s):

Medical Center ◽

Pulmonary Aspergillosis ◽

Microbiological Characteristics ◽

Single Center Study ◽

All Cause Mortality ◽

Southern Taiwan ◽

The Mean ◽

Antifungal Use ◽

Mean Time ◽

Culture Positive

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

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Catheter systems for intrathecal drug delivery

Journal of Neurosurgery ◽

10.3171/jns.1995.83.2.0215 ◽

1995 ◽

Vol 83 (2) ◽

pp. 215-217 ◽

Cited By ~ 75

Author(s):

Richard D. Penn ◽

Michelle M. York ◽

Judith A. Paice

Keyword(s):

Medical Center ◽

Intrathecal Catheter ◽

Content Type ◽

Steady Rate ◽

Catheter Complications ◽

The Mean ◽

Thin Walled ◽

A Prospective Study ◽

Mean Time ◽

Drug Pump

✓ A prospective study of intrathecal catheter reliability was performed at Rush-Presbyterian-St. Luke's Medical Center. All 102 patients who had baclofen administered chronically for spasticity via an implanted drug pump were included. Sixty percent of the patients had no catheter complications; the remaining patients had one to five complications over their course of treatment. Survival analysis demonstrated a steady rate of malfunction up to 80 months, with the mean time to first failure recorded at 20 months. Kinks, holes, breaks, dislodgments, and disconnections were the most common complications. On the basis of their research the authors conclude that the thin-walled silastic catheter does not perform well and that larger, thick-walled catheters should be used.

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