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World Journal of Surgical Oncology Aug 2023Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage...
BACKGROUND
Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients.
METHODS
This is retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage catheter, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated.
RESULTS
Sixty-four patients were included in the study. Insertion of the transnasal abscess drainage catheter, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients, while 35 patients received transnasal abscess drainage, 13 received percutaneous abscess drainage, and 16 received transnasal drainage plus percutaneous abscess drainage. Immediately after placement of the tube, the mean volume of drainage was 180 mL (range, 10-850 mL); the amount steadily decreased from then on. The clinical success rate was 84.3% (54/64). Median time to fistula healing was 58 days (range, 7-357 days).
CONCLUSIONS
Transnasal insertion of transnasal abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.
Topics: Humans; Abscess; Anastomosis, Surgical; Fistula; Gastrectomy; Anastomotic Leak; Retrospective Studies; Drainage
PubMed: 37528403
DOI: 10.1186/s12957-023-03105-7 -
Case Reports in Gastrointestinal... 2021Fistulae between the colon or the small intestine and the uterus are extremely rare as the uterus is a thick, muscular organ. Here, we present the case of a 74-year-old...
Fistulae between the colon or the small intestine and the uterus are extremely rare as the uterus is a thick, muscular organ. Here, we present the case of a 74-year-old female presenting to our surgical department because of fecal vaginal discharge for the past few months, which proved to be caused by a combined colouterine and jejunouterine fistula due to chronic diverticulitis. Total abdominal hysterectomy with bilateral oophorectomy with en bloc resection of part of the jejunum and the sigmoid colon and primary anastomoses were performed. This case represents an unusual type of diverticulitis complication and aims to point out the diagnostic and therapeutic issues of such a rare medical condition.
PubMed: 33868734
DOI: 10.1155/2021/5543505 -
Head & Neck Jun 2024It remains unclear whether a tubed fasciocutaneous or jejunal free flap (FCFF and JFF) is preferable for reconstruction of circumferential pharyngolaryngoesophageal...
BACKGROUND
It remains unclear whether a tubed fasciocutaneous or jejunal free flap (FCFF and JFF) is preferable for reconstruction of circumferential pharyngolaryngoesophageal defects.
METHODS
All consecutive patients with circumferential pharyngolaryngoesophageal defects reconstructed with an FCFF or JFF between 2000 and 2022 were included. Outcomes of interest were rates of fistulas, strictures, and donor-site complications.
RESULTS
In total, 112 patients were included (35 FCFFs and 77 JFFs). Fistula and stricture rates were significantly lower following JFF compared to FCFF reconstructions, with 12% versus 34% (p = 0.008) and 29% versus 49% (p = 0.04), respectively. Severe donor-site complications leading to surgical intervention or ICU admittance only occurred after JFF reconstructions (18%, p = 0.007).
CONCLUSIONS
The high fistula and stricture rates in FCFF reconstructions and the rate of severe abdominal complications in JFF reconstructions illustrate inherent procedure-specific advantages and disadvantages. Relative pros and cons should be carefully weighed when tailoring treatments to the individual needs of patients.
Topics: Humans; Male; Free Tissue Flaps; Female; Jejunum; Middle Aged; Plastic Surgery Procedures; Aged; Hypopharyngeal Neoplasms; Postoperative Complications; Cohort Studies; Retrospective Studies; Hypopharynx; Adult; Fascia; Treatment Outcome
PubMed: 38294120
DOI: 10.1002/hed.27667 -
International Journal of Surgery Case... 2018Postoperative duodenal-cutaneous fistula represents a rare and very complex problem. In most cases operative management becomes necessary, but only after local and...
INTRODUCTION
Postoperative duodenal-cutaneous fistula represents a rare and very complex problem. In most cases operative management becomes necessary, but only after local and systemic stabilization and sepsis control.
CASE PRESENTATION
A 39-year-old man was admitted for surgical management of laparostomy and pyloro-duodenostomy of the first (DI) and second (DII) duodenal segments with one year of evolution, as a complication of several surgical interventions. The patient had been previously submitted to surgical interventions in another institution for: 1- lower gastrointestinal haemorrhage: treated with total colectomy; 2- upper gastrointestinal haemorrhage: performed a pyloroduodenotomy and pyloroplasty; 3- evisceration: abdominal wall closure; 4- biliary peritonitis due to pyloroplasty dehiscence: submitted to laparotomy with placement of a gastrostomy tube and pyloroduodenostomy tube; 5- intestinal haemorrhage through the pyloroduodenostomy tube: inconclusive exploratory laparotomy plus laparostomy; 6- gastrointestinal haemorrhage and shock: submitted to jejunal segmental resection (haemorrhagic mucous nodule); 7- several complications related to drainage, fistulae and celiostomy.
DISCUSSION
After initial medical treatment for local and systemic stabilization during four months, the following surgical procedures were performed: antrectomy; duodenectomy of DI and the suprapapillary part of DII; T-L gastrojejunostomy; duodenojejunostomy (DII and DIII) L-L at 40 cm of the gastrojejunal anastomosis; T-L jejunojejunostomy; abdominoplasty with a mesh and fibrin glue application; primary cutaneous closure. A multitubular drain was positioned near the duodeno-jejunal anastomosis and a suction drain was positioned in the subcutaneous space.
CONCLUSION
The patient was discharged at the 60th postoperative day, asymptomatic and with a weight gain of 10 kg.
PubMed: 29894924
DOI: 10.1016/j.ijscr.2018.05.020 -
Journal of Inflammation Research 2023Necrotizing pancreatitis (NP) complicated by gastrointestinal fistula is challenging and understudied. As the treatment of necrotizing pancreatitis changed to a step-up...
PURPOSE
Necrotizing pancreatitis (NP) complicated by gastrointestinal fistula is challenging and understudied. As the treatment of necrotizing pancreatitis changed to a step-up strategy, we attempted to evaluate the incidence, risk factors, clinical outcomes and treatment of gastrointestinal fistulas in patients receiving a step-up approach.
METHODS
Clinical data from 1274 patients with NP from 2014-2022 were retrospectively analyzed. Multivariable logistic regression analysis was conducted to identify risk factors and propensity score matching (PSM) to explore clinical outcomes in patients with gastrointestinal fistulas.
RESULTS
Gastrointestinal fistulas occurred in 8.01% (102/1274) of patients. Of these, 10 were gastric fistulas, 52 were duodenal fistulas, 14 were jejunal or ileal fistulas and 41 were colonic fistulas. Low albumin on admission (OR, 0.936), higher CTSI (OR, 1.143) and invasive intervention prior to diagnosis of gastrointestinal fistula (OR, 5.84) were independent risk factors for the occurrence of gastrointestinal fistula, and early enteral nutrition (OR, 0.191) was a protective factor. Patients who developed a gastrointestinal fistula were in a worse condition on admission and had a poorer clinical outcome (p<0.05). After PSM, both groups of patients had similar baseline information and clinical characteristics at admission. The development of gastrointestinal fistulas resulted in new-onset persistent organ failure, increased open surgery, prolonged parenteral nutrition and hospitalization, but not increased mortality. The majority of patients received only conservative treatment and minimally invasive interventions, with 7 patients (11.3%) receiving surgery for upper gastrointestinal fistulas and 11 patients (26.9%) for colonic fistulas.
CONCLUSION
Gastrointestinal fistulas occurred in 8.01% of NP patients. Independent risk factors were low albumin, high CTSI and early intervention, while early enteral nutrition was a protective factor. After PSM, gastrointestinal fistulas resulted in an increased proportion of NP patients receiving open surgery and prolonged hospitalization. The majority of patients with gastrointestinal fistulas treated with step-up therapy could avoid surgery.
PubMed: 38026251
DOI: 10.2147/JIR.S433682 -
Surgical Endoscopy May 2023Postoperative pancreatic fistula (POPF) is often associated with significant morbidity and mortality after the Whipple operation. Patient-related factors associated with...
BACKGROUND
Postoperative pancreatic fistula (POPF) is often associated with significant morbidity and mortality after the Whipple operation. Patient-related factors associated with POPF include soft pancreatic texture and a small main pancreatic duct (MPD). The traditional duct-to-mucosa anastomosis was modified to be easily performed. The aim of the study was to evaluate the simplified pancreaticojejunostomy (PJ) method in the prevention of POPF after minimally invasive pancreaticoduodenectomy (PD).
METHODS
Ninety-eight patients who underwent laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD) with a simplified PJ procedure containing only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer in our center were retrospectively studied. Demographics and clinical short-term safety were assessed.
RESULTS
All LPD and RPD procedures were successfully performed. The median time of PJ was 17 min, and the median blood loss was 60 mL, with only one patient requiring transfusion. Four patients (4.1%) suffered from clinically relevant POPF (CR-POPF), including four grade B cases and no grade C cases. For patients with an MPD diameter of 3 mm or less, POPF was noted in two (4%) of the fifty patients, with all cases being grade B. Of the patients with a soft pancreas, only two (4.5%) patients suffered from grade B POPF. One patient (1.0%) experienced a 90-day mortality. Neither the main pancreatic diameter nor pancreatic texture had an impact on postoperative outcomes.
CONCLUSIONS
Our technique is a simple, safe and efficient alternative to prevent POPF after LPD and RPD. This method is suitable for almost all pancreatic conditions, including cases with a small main pancreatic duct and soft pancreas, and has the potential to become the preferred procedure in low-volume pancreatic surgery centers. Our modified duct-to-mucosa PJ, which contains only two duct-to-mucosa sutures and four penetrating-sutures to anastomose the pancreatic parenchyma and jejunal seromuscular layer, is ideal for small MPD and soft pancreas when performing minimally invasive PD and has a low rate of POPF. PJ pancreaticojejunostomy, MPD main pancreatic diameter, PD pancreaticoduodenectomy, POPF postoperative pancreatic fistula.
Topics: Humans; Pancreaticojejunostomy; Pancreaticoduodenectomy; Pancreatic Fistula; Retrospective Studies; Pancreas; Pancreatic Ducts; Anastomosis, Surgical; Postoperative Complications; Mucous Membrane
PubMed: 36624217
DOI: 10.1007/s00464-022-09830-6 -
Pancreatology : Official Journal of the... 2016Pancreatic fistula represents the most important complication in terms of clinical management and costs after pancreaticoduodenectomy. A lot of studies have investigated...
PURPOSE
Pancreatic fistula represents the most important complication in terms of clinical management and costs after pancreaticoduodenectomy. A lot of studies have investigated several techniques in order to reduce pancreatic fistula, but data on the effect of sutures material on pancreatic fistula are not available. The analysis investigated the role of suture material in influencing pancreatic fistula rate and severity.
METHODS
Results from 130 consecutive pancreaticoduodenectomy with pancreaticojejunostomy performed between March 2013 and September 2014 were prospectively collected and analyzed. In 65 cases pancreaticojejunostomy was performed with absorbable sutures, in the other 65 cases using non-absorbable sutures (polyester, silk and polybutester).
RESULTS
Pancreaticojejunostomy with non-absorbable sutures had the same incidence of pancreatic fistula, but less severe and with less episodes of post-operative bleeding if compared with absorbable sutures. A sub-analysis was carried out comparing polydioxanone with polyester: the latter was associated with a lower pancreatic fistula rate (11.9% vs. 31.7%; p = 0,01) and less severe pancreatic anastomosis dehiscence (grade C - 0% vs. 30%; p = 0.05). Univariate and multivariate analysis confirmed that hard pancreatic texture, pancreatic ductal adenocarcinoma at final histology and the use of polyester for pancreaticojejunostomy were associated with a lower pancreatic fistula rate (p < 0.05).
CONCLUSION
Further studies are needed to investigate the effects of pancreatic juice and bile on different sutures and pancreatic tissue response to different materials. However, pancreaticojejunostomy performed with polyester sutures is safe and feasible and is associated to a lower incidence of pancreatic fistula with less severe clinical impact.
Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Female; Humans; Jejunum; Male; Middle Aged; Pancreas; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Polydioxanone; Polyesters; Postoperative Complications; Retrospective Studies; Silk; Sutures
PubMed: 26712241
DOI: 10.1016/j.pan.2015.11.004 -
The Journal of Craniofacial SurgeryFistula formation after free jejunal transplantation is relatively common; however, treating esophago-jejunal anastomosis fistulas is difficult. Herein, the authors...
Fistula formation after free jejunal transplantation is relatively common; however, treating esophago-jejunal anastomosis fistulas is difficult. Herein, the authors report a case of esophago-jejunal anastomosis fistula adjacent to the permanent tracheostoma after free jejunal transplantation that was closed using negative pressure wound therapy (NPWT). A 70-year-old man underwent total pharyngo-laryngo-cervical esophagectomy and free jejunal transplantation for hypopharyngeal cancer. After reconstruction, an esophago-jejunal anastomosis fistula developed on the permanent tracheostoma margin. The fistula was sutured, but it recurred. Therefore, NPWT was performed to close the fistula via the bridge method and balloon compression using a tracheal cannula. NPWT requires the maintenance of local negative pressure. However, esophago-jejunal anastomosis fistula formation after free jejunal transplantation makes this difficult because of the unevenness of the permanent tracheostoma and moist surface of the tracheal mucosa. NPWT performed using the bridge method and balloon compression is an effective option for fistula treatment.
Topics: Aged; Anastomosis, Surgical; Cutaneous Fistula; Humans; Jejunum; Male; Neck; Negative-Pressure Wound Therapy
PubMed: 34224456
DOI: 10.1097/SCS.0000000000007763 -
Plastic and Reconstructive Surgery.... Aug 2017Free jejunal transfer has a high success rate, but if vascular thrombosis occurs, the salvage of failing flap with reanastomosis is difficult. This study described a...
BACKGROUND
Free jejunal transfer has a high success rate, but if vascular thrombosis occurs, the salvage of failing flap with reanastomosis is difficult. This study described a combined deltopectoral (DP) and pectoralis major musculocutaneous (PMMC) flap 2-step technique for cervical esophageal reconstruction after free-jejunal-flap necrosis.
METHODS
In step 1, the detection of free jejunal flap with the subsequent debridement of necrotic and infected tissue was followed by the construction of external fistula on the pharyngeal side with the hole in cervical skin and the construction of another external fistula on the esophageal side and tracheal stoma with a single or double DP flap. In step 2, after the primary healing of all wounds was confirmed, a wide hinge flap was elevated for reconstructing the posterior wall or full circumferential defect of cervical esophagus. PMMC flap harvested from either the left or right anterior chest wall was used for reconstructing the cervical surface defect or anterior pharyngeal wall.
RESULTS
This technique was used for cervical esophageal reconstruction after free-jejunal-flap necrosis in 5 patients. Step 1 surgery was performed at an average of 10 days after primary-free-jejunal flap transfer. Oral intake was resumed in all cases at an average of 117 days after step 2 surgery. No complications including esophageal stricture were found during a 6-month follow-up period.
CONCLUSIONS
Combined DP and PMMC flap technique was useful for cervical esophageal reconstruction after free-jejunal-flap necrosis and applicable to patients with the late detection of jejunal necrosis and surgical-site infection.
PubMed: 28894663
DOI: 10.1097/GOX.0000000000001444 -
Revista de La Facultad de Ciencias... Dec 2020Bouveret syndrome consists of an obstruction of the gastric outlet due to the impaction of a gallstone in the duodenal bulb after migration through a cholecystoduodenal...
INTRODUCTION
Bouveret syndrome consists of an obstruction of the gastric outlet due to the impaction of a gallstone in the duodenal bulb after migration through a cholecystoduodenal fistula.
CLINICAL CASE
Patient with diffuse colicky abdominal pain, diarrhea and yellowish vomiting. The imaging tests carried out reveal significant gastric and duodenal dilation with the presence of gas at the gallbladder level with the existence of a cholecystoduodenal fistula with a rounded intraluminal image in the proximal jejunum compatible with migrated lithiasis. The patient underwent emergency surgery through an enterotomy with removal of the calculus and its closure. Discussion:
DISCUSSION
Bouveret's syndrome is a rare gallstone ileus condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnosis and treatment strategies are required for optimal management and results, with endoscopic treatment or open surgery being the two treatments available for resolution of the condition.
CONCLUSION
Bouveret syndrome is a life-threatening condition with gastric outlet obstruction caused by large gallstones. In most cases, a CT scan is required for diagnosis, and although in some cases percutaneous and endoscopic treatments can be successful as first-line treatment, most patients require surgery to remove stones.
Topics: Gallstones; Humans; Ileus; Intestinal Fistula; Syndrome
PubMed: 33351368
DOI: 10.31053/1853.0605.v77.n4.30300