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Annals of Medicine and Surgery (2012) Dec 2022Indocyanine green (ICG) can be injected into the human bloodstream and it allows us to show stomach vascularity in real time. The aim of our study is to observe the...
BACKGROUND
Indocyanine green (ICG) can be injected into the human bloodstream and it allows us to show stomach vascularity in real time. The aim of our study is to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic Roux-en-Y Gastric Bypass (RYGB in our center and how the perfusion of the gastro-jejunal anastomosis affects the onset of fistula.
MATERIALS AND METHODS
30 consecutive patients underwent RYGB with ICG fluorescence angiography at our center from January 2020 to December 2021.5 ml of ICG were then injected intravenously to identify the blood supply of the stomach and the gastro-jejunal anastomosis. The UIN for ClinicalTrial.gov Protocol Registration and Results System is: NCT05476159 for the Organization UFoggia.
RESULTS
In the RYGB tested with ICG, we all have adequate perfusion but despite this a methylene blue test was positive and allowed us to reinforce the suture of the gastro-jejunal anastomosis.
CONCLUSION
Intraoperative ICG testing during laparoscopic RYGB may be helpful in determining which patients are at an increased risk for leakage but multiple factors concur to the pathophysiology and the incidence of gastric fistula not only the perfusion.
PubMed: 36536736
DOI: 10.1016/j.amsu.2022.104939 -
International Urology and Nephrology May 2021Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and... (Review)
Review
PURPOSE
Define factors for proper diagnosis and treatment of small intestinal injury during procedures with percutaneous renal access, thus optimizing favorable outcomes and avoiding complications and death during conservative or surgical approaches.
MATERIALS AND METHODS
Bibliographic review of case reports available in the literature and presentation of data from an additional case have been carried out.
RESULTS
Percutaneous nephrolithotripsy was the procedure that most frequently caused injury of the small intestine. Time for diagnosis of the lesion took up to 5 days after the intraoperative phase. When occurring in the intraoperative phase, perforation was identified by direct endoscopic visualization; a catheter was then placed inside the intestinal lumen and a conservative approach to the derived fistula was adopted, which led to successful outcomes in all cases. Abdominal pain was the most common symptom in cases diagnosed during the postoperative phase (75%). In the presence of signs of peritonitis, surgical intervention was performed, with favorable evolution in all cases.
CONCLUSIONS
Conservative management of small intestine injuries is possible when there is no peritoneal contamination. Its success factors include intraoperative diagnosis and non-transfixing lesions, which is more common in duodenal involvement. Laparotomy to clean the cavity associated with a corrective approach (enterorrhaphy or enterectomy with primary anastomosis) was successfully indicated in cases of late diagnosis with signs of peritonitis, a situation that is most commonly found in transfixing lesions of ileum and jejunum.
Topics: Humans; Intestine, Small; Intraoperative Complications; Kidney; Urologic Surgical Procedures
PubMed: 33385286
DOI: 10.1007/s11255-020-02726-1 -
Pediatric Surgery International Jul 2020Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes...
BACKGROUND
Esophageal replacement is a challenge to the therapeutic skills of surgeons and a technically demanding operation in the pediatric age group. Various conduits and routes have been described in the literature, each with their specific advantages and disadvantages. We carried out this retrospective study to share our experience of esophageal replacement.
METHODOLOGY
This study was conducted at the department of pediatric surgery The Children's Hospital and The Institute of Child Health, Lahore. The records of patients treated for esophageal replacement were reviewed. The patients under follow-up were called for clinical evaluation and assessed of long terms complications if any.
RESULTS
A total of 93 patients with esophageal replacement were included in the study. Esophageal replacement was done with gastric transposition in 84 cases (90%), colon interposition in 7 cases (7.5%) including one case of redo colonic interposition, and jejunal interposition in 2 cases (2%). Routes of esophageal replacement were trans-hiatal in 71 (76%), retrosternal in 13 (14%), and trans-hiatal with thoracotomy in 9 (10%) patients. Postoperatively, all of the conduits maintained viability. Wound infection was seen in 10 (11%), wound dehiscence in 5 (5%), anastomotic leak in 9 (10%), anastomotic stenosis in 12 (13%), fistula formation in 4 (4%), aortic injury 1 (1%), dumping syndrome 8 (9%), reflux 18 (19%), dysphagia 15 (16%) and death occurred in 12 patients (13%).
CONCLUSION
There are problems with esophageal replacement in developing countries. In this context, gastric conduit appeared as the best conduit for esophageal replacement, using the trans-hiatal route for replacement, in the authors' experience.
Topics: Adolescent; Afghanistan; Child; Child, Preschool; Colon; Esophagus; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Jejunum; Male; Postoperative Complications; Retrospective Studies; Stomach
PubMed: 32236666
DOI: 10.1007/s00383-020-04649-5 -
Pancreas Mar 2022Endoscopic ultrasound/endosonography-guided pancreaticogastrostomy (EUS-PGS) is a useful alternative when endoscopic retrograde pancreatography is difficult. Recently,...
OBJECTIVES
Endoscopic ultrasound/endosonography-guided pancreaticogastrostomy (EUS-PGS) is a useful alternative when endoscopic retrograde pancreatography is difficult. Recently, many procedures, including peroral pancreatoscopy (POPS), have been performed through the mature fistula (MF) created by EUS-PGS. We evaluate the efficacy and safety of POPS to diagnose and treat pancreatic ductal stricture/pancreato-jejunal anastomotic stricture (PDS/PJAS) through the MF.
METHODS
Twenty patients underwent EUS-PGS; 13 of these underwent POPS through the MF at Juntendo University Hospital. All patients were studied retrospectively in terms of technical and clinical success rates and adverse events (AEs).
RESULTS
The technical and clinical success rates of EUS-PGS were 95% and 100%. The early and late AEs rates were 20% and 15%. The technical success rate of POPS was 100%, with one AE. Biopsy of PDS/PJAS under POPS guidance revealed recurrent/residual intrapapillary mucinous adenoma (3 patients) and benign fibrotic stricture (10 patients). In the latter patients, multiple plastic stents were placed to dilate PDS/PJAS. Four patients with improvement of PDS/PJAS were stent free, but the remaining patients were not yet.
CONCLUSIONS
Endoscopic ultrasound/endosonography-guided pancreaticogastrostomy and various procedures (including POPS) performed through the MF are feasible and effective and can diagnose and treat PDS/PJAS with acceptable AEs rates.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Constriction, Pathologic; Drainage; Endosonography; Fistula; Humans; Pancreatic Ducts; Retrospective Studies; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35584379
DOI: 10.1097/MPA.0000000000002003 -
Annals of Surgery Open : Perspectives... Jun 2022Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients' outcome. Our reasoning that active...
BACKGROUND
Pancreatic leak after pancreaticoduodenectomy and gut restoration via a single jejunal loop remains the crucial predictor of patients' outcome. Our reasoning that active pancreatic enzymes may be more disruptive to the pancreatojejunostomy prompted us to explore a Roux-en-Y configuration for the gut restoration, anticipating diversion of bile salts away from the pancreatic stump. Our study aims at comparing two techniques regarding the severity of postoperative pancreatic fistula (POPF) and patients' outcome.
METHODS
The files of 415 pancreaticoduodenectomy patients were retrospectively reviewed. Based on gut restoration, the patients were divided into: cohort A (n = 105), with gut restoration via a single jejunal loop, cohort B (n = 140) via a Roux-en-Y technique assigning the draining of pancreatic stump to the short limb and gastrojejunostomy and bile (hepaticojejunostomy) flow to long limb, and cohort C (n = 170) granting the short limb to the gastric and pancreatic anastomosis, whereas hepaticojejunostomy was performed to the long limp. The POPF-related morbidity and mortality were analyzed.
RESULTS
Overall POPF in cohort A versus cohorts B and C was 19% versus 12.1% and 9.4%, respectively ( = 0.01 A vs B + C). POPF-related morbidity in cohort A versus cohorts B and C was 10.5% versus 7.3% and 6.3%, respectively ( = 0.03 A vs B+C). POPF-related total hospital mortality in cohorts A versus B and C was 1.9% versus 0.8% and 0.59%, respectively ( = 0.02 A vs B+C).
CONCLUSION
Roux-en-Y configuration showed lower incidence and severity of POPF. Irrespective of technical skill, creating a gastrojejunostomy close to pancreatojejunostomy renders the pancreatic enzymes less active by leaping the bile salts away from the pancreatic duct and providing a lower pH.
PubMed: 37601609
DOI: 10.1097/AS9.0000000000000161 -
BMJ Case Reports Jun 2024Bouveret's syndrome is an uncommon cause of gastric outlet obstruction caused by the impaction of large gallstones in the duodenal lumen. The gallstones pass into the...
Bouveret's syndrome is an uncommon cause of gastric outlet obstruction caused by the impaction of large gallstones in the duodenal lumen. The gallstones pass into the duodenal lumen through a cholecystogastric or a cholecystoduodenal fistula. Endoscopic retrieval with or without lithotripsy is the first line of management, often with variable success. We present a case of a woman in her 70s who presented with signs of gastric outlet obstruction and was diagnosed with Bouveret's syndrome with a 5 cm diameter gallstone in the third part of her duodenum. Following several unsuccessful attempts of endoscopic extraction, she underwent successful jejunal enterotomy with fragmentation and extraction of the calculus using an Allis tissue holding forceps. Postoperative recovery was uneventful.
Topics: Humans; Female; Gastric Outlet Obstruction; Gallstones; Aged; Syndrome
PubMed: 38890110
DOI: 10.1136/bcr-2024-261232 -
Frontiers in Surgery 2022Abdominal cocoon is a unique peritoneal disease that is frequently misdiagnosed. The occurrence of the abdominal cocoon with a jejuno-ileo-colonic fistula has not been...
INTRODUCTION
Abdominal cocoon is a unique peritoneal disease that is frequently misdiagnosed. The occurrence of the abdominal cocoon with a jejuno-ileo-colonic fistula has not been previously reported.
CASE PRESENTATION
We admitted a 41-year-old female patient with an abdominal cocoon and a jejuno-ileo-colonic fistula. She was admitted to our hospital for the following reasons: "the menstrual cycle is prolonged for half a year, and fatigue, palpitations, and shortness of breath for 2 months". On the morning of the 4th day of admission, the patient experienced sudden, severe, and intolerable abdominal pain after defecating. An emergency abdominal CT examination revealed intestinal obstruction. Surgery was performed, and the small intestine and colon were observed to be conglutinated and twisted into a mass surrounded by a fibrous membrane, and an enteroenteric fistula was observed between the jejunum, ileum, and sigmoid colon. We successfully relieved the intestinal obstruction and performed adhesiolysis. The patient was discharged from our hospital on the 6th postoperative day, then she recovered and was discharged from Feicheng People's Hospital after another 11 days of conservative treatment, and she recovered well-during the 2-month follow-up period.
CONCLUSION
Abdominal cocoon coexisting with a jejuno-ileo-colonic fistula is very rare. During the process of abdominal cocoon treatment, the patient's medical history should be understood in detail before the operation, and the abdominal organs should be carefully evaluated during the operation to avoid missed diagnoses.
PubMed: 35574535
DOI: 10.3389/fsurg.2022.856583 -
Cureus Jan 2023Cholecysto-antral fistula and gallstone ileus are rare complications of a common disease, gallbladder stone (GBS). This fistula is developed as a prolonged complication...
Cholecysto-antral fistula and gallstone ileus are rare complications of a common disease, gallbladder stone (GBS). This fistula is developed as a prolonged complication of cholelithiasis in which the gallbladder adheres to the adjacent antrum, and a stone erodes through the wall. Among the variety of cholecystoenteric fistulae, the cholecystoduodenal fistula occurs more commonly than the cholesysto-antral fistula. In this scientific study, we present a 98-year-old male patient who came to ER with a complaint of abdominal pain, vomiting, and constipation for five days. He was vitally stable and had normal laboratory results. The plain abdominal X-ray showed dilated loops with excessive gases. His computed tomography (CT) abdomen with contrast showed small bowel obstruction secondary to an impacted gallstone at the distal jejunum, fistulous communication between the gall bladder and the antrum, and pneumobilia. Our management included endoscopic retrieval of a single gallstone from the second part of the duodenum followed by open surgical enterolithotomy, partial cholecystectomy, and closing of the fistula. Despite our case sharing many aspects with the available literature, our case, to our knowledge, is the first case of ileus gallstone occurring in a 98-year-old patient. Cholecysto-antral fistula has not been widely published in the literature. The offending gallstone presented along with the radiological Mercedes Benz sign which does not present in all cases of GBS. Typically, the obstructing GBS stops at the terminal ileum, but in our case, it was dislodged in the distal jejunum with no previous biliary symptoms. Finally, we were able to remove another single GBS from the second part of the duodenum during the preoperative upper endoscopy. The clinical diagnosis may be missed due to the vague presentation of symptoms; hence imaging, especially of the CT abdomen is crucial in establishing the diagnosis, moreover, performing an upper endoscopy could have diagnostic and therapeutic benefits. In cases like this, the main surgical intervention should be to address the bowel obstruction, and cholecystectomy with fistula closure may be added if the patient's condition is stable with minimal inflammation and adhesion.
PubMed: 36779134
DOI: 10.7759/cureus.33580 -
Anticancer Research Aug 2021This study evaluated the incidence of perioperative complications in jejunal flap compared with the free tissue flap approach. (Clinical Trial)
Clinical Trial
BACKGROUND/AIM
This study evaluated the incidence of perioperative complications in jejunal flap compared with the free tissue flap approach.
PATIENTS AND METHODS
This study included 75 patients who underwent free flap reconstruction for hypopharyngeal carcinoma. The primary outcome was the incidence of pharyngocutaneous fistula, and the secondary outcomes were perioperative complications.
RESULTS
Pharyngocutaneous fistula developed in 7% of patients who underwent jejunal flap procedures and 6% of patients who underwent free tissue flap procedure. Flap sampling site complications occurred in 23% of patients who underwent jejunal flap procedures and in none of the patients who underwent free tissue flap procedure.
CONCLUSION
No significant difference was observed in the incidence of pharyngocutaneous fistula between the two groups (p=0.99), but complications at the flap sampling site were significantly more common in jejunal flap procedures than in free tissue flap procedures (p=0.03). Free tissue flap procedures are potential reconstruction methods superior to jejunal flap methods.
Topics: Aged; Aged, 80 and over; Cutaneous Fistula; Dermatologic Surgical Procedures; Female; Humans; Hypopharyngeal Neoplasms; Jejunum; Male; Middle Aged; Postoperative Complications; Skin; Surgical Flaps
PubMed: 34281870
DOI: 10.21873/anticanres.15203 -
Cureus Jun 2023Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we...
Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we present the case of a 41-year-old patient who previously underwent gastrojejunostomy for superior mesenteric artery syndrome and developed a peptic jejunal ulcer, leading to a uretero-jejunal fistula and finally causing acute pyelonephritis. The patient was managed with a multidisciplinary approach including medical therapy and endoscopic and radiologic interventions.
PubMed: 37492813
DOI: 10.7759/cureus.40824