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Chirurgia (Bucharest, Romania : 1990) Aug 2021Small bowel injuries are infrequent after blunt trauma and typically affect fixed segment. Untimely management of such injuries, results in high-output entero-cutaneous...
Small bowel injuries are infrequent after blunt trauma and typically affect fixed segment. Untimely management of such injuries, results in high-output entero-cutaneous fistula which increases morbidity and mortality. Treatment of duodeno-jejunal flexure transection has been traditionally done by pyloric exclusion with gastrojejunostomy, but more recent evidence suggests that end-to-end anastomosis or primary closure may be equally effective in which duodeno-jejunal anastomosis is protected via an external tube duodenostomy. The objective of the study is to provide a modification to the technique of management of duodeno-jejunal flexure injury, avoiding external tube duodenostomy. Material and Patients admitted from July 1, 2015 to June 1, 2018 were identified and examined for duodeno-jejunal flexure transection. Non-accidental injury cases were excluded. In the study period, a total of 10 patients were admitted with duodeno-jejunal flexure transection. All cases were admitted 24 hours after the injury and presented with shock. After fluid resuscitation and investigations, they were taken for urgent laparotomy. The whole of duodenum was mobilised, the transected ends were debrided and end-to-end duodenojejunal anastomosis was performed in two-layer fashion. An 18-French Nasojejunal (NJ) tube was placed beyond the anastomosis, and an 18-French nasogastric (NG) tube was placed in the stomach for gastric decompression. A feeding jejunostomy was performed in all cases. Both NG and NJ tubes were removed after bowel movements started and FJ was removed on first follow up. There was no incidence of duodenum related complications, and all were doing well on follow up. Placing the nasojejunal and nasogastric tube eliminates the need for duodenostomy and gastrostomy, respectively. This method protects the duodeno-jejunal anastomosis and decreases the incidence of duodenum-related complications.
Topics: Duodenostomy; Duodenum; Gastric Bypass; Humans; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 34463243
DOI: 10.21614/chirurgia.116.eC.2282 -
Annals of Medicine and Surgery (2012) Jul 2021Peptic ulcer perforation (PUP) is one of the most common critical surgical emergencies. The omentum flap is commonly used to cover a PUP. However, the omentum cannot be...
INTRODUCTION
Peptic ulcer perforation (PUP) is one of the most common critical surgical emergencies. The omentum flap is commonly used to cover a PUP. However, the omentum cannot be used in cases of severe peritonitis or previous surgical removal. This is the first study conducted in Vietnam that was designed to analyse the outcomes of patients with PUPs who were treated using the falciform ligament.
METHOD
In this study, we retrospectively identified 40 consecutive patients who were treated for PUP at a single high-volume centre in Vietnam from February 2018 to February 2021. Peptic ulcer perforation was measured during diagnostic evaluation based on preoperative imaging, such as X-ray, and CT scan. Patients who had malignancy, laparoscopic surgery, omentopexy and nonoperative treatment were excluded from this research.
RESULTS
Forty patients were included; the mean age of the patients was 66.3 years (range 33-99 years), and some patients had comorbid disease (57.5%), hypertension (30%), diabetes (10%), cirrhosis (7.5%), and chronic renal failure (7.5%). The PUPs were located in the duodenum (80%), or the pyloric (15%) and prepyloric (5%) regions. The procedures used to treat the patients included duodenostomy (32.5%), gastrojejunostomy (37.5%), and antrum resection (2.5%). The average operative time was 88.6 min (45-180 min), hospital stay was 9.6 days (2-35 days), and oral intake was started at 4.1 days (3-8 days); additionally, the 30-day mortality (17.5%) and incidences of pneumonia (25%), multiorgan failure (15%), acute liver failure (5%), wound infection (7.5%), and ulcer peptic fistula (0%) were assessed. Univariate tests showed that an ASA ≥ III and comorbidities, such as pulmonary complications, liver failure and multiorgan failure, were associated with mortality. The multivariate test showed that multiorgan failure was the only factor related to mortality.
CONCLUSION
The falciform ligament can be efficiently used for the closure of a PUP. Although there were no instances of complication with a reperforated peptic ulcer, the mortality rate was slightly highly related to severe comorbidities and postoperative multiorgan failure.
PubMed: 34188907
DOI: 10.1016/j.amsu.2021.102477 -
Surgical Endoscopy Apr 2022Laboratory skills training is an essential step before conducting minimally invasive surgery in clinical practice. Our main aim was to develop an animal model for...
BACKGROUND
Laboratory skills training is an essential step before conducting minimally invasive surgery in clinical practice. Our main aim was to develop an animal model for training in clinically highly challenging laparoscopic duodenal atresia repair that could be useful in establishing a minimum number of repetitions to indicate safe performance of similar interventions on humans.
MATERIALS AND METHODS
A rabbit model of laparoscopic duodenum atresia surgery involving a diamond-shaped duodeno-duodenostomy was designed. This approach was tested in two groups of surgeons: in a beginner group without any previous clinical laparoscopic experience (but having undergone previous standardized dry-lab training, n = 8) and in an advanced group comprising pediatric surgery fellows with previous clinical experience of laparoscopy (n = 7). Each participant performed eight interventions. Surgical time, expert assessment using the Global Operative Assessment of Laparoscopic Skills (GOALS) score, anastomosis quality (leakage) and results from participant feedback questionnaires were analyzed.
RESULTS
Participants in both groups successfully completed all eight surgeries. The surgical time gradually improved in both groups, but it was typically shorter in the advanced group than in the beginner group. The leakage rate was significantly lower in the advanced group in the first two interventions, and it reached its optimal level after five operations in both groups. The GOALS and participant feedback scores showed gradual increases, evident even after the fifth surgery.
CONCLUSIONS
Our data confirm the feasibility of this advanced pediatric laparoscopic model. Surgical time, anastomosis quality, GOALS score and self-assessment parameters adequately quantify technical improvement among the participants. Anastomosis quality reaches its optimal value after the fifth operation even in novice, but uniformly trained surgeons. A minimum number of wet-lab operations can be determined before surgery can be safely conducted in a clinical setting, where the development of further non-technical skills is also required.
Topics: Animals; Child; Clinical Competence; Duodenal Obstruction; Humans; Intestinal Atresia; Laparoscopy; Rabbits
PubMed: 33999254
DOI: 10.1007/s00464-021-08530-x -
Journal of Indian Association of... 2021Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation of the extrahepatic and/or intrahepatic bile ducts. CDC excision with...
Choledochal cysts (CDC) are rare biliary tract anomalies characterized by congenital dilatation of the extrahepatic and/or intrahepatic bile ducts. CDC excision with hepatico-enterostomy is the preferred surgery in modern era. Perioperative blood loss in a case of laparoscopic choledochal cyst excision (LCCE) is usually minimal and managed by conservative treatment such as blood transfusion and correction of coagulation factors. Massive hemorrhage in LCCE is rare and reported intraoperatively or within the first 3 postoperative days. Hereby, we present an unusual case of arterio-duodenal fistula, post LCCE presenting as delayed massive upper gastrointestinal bleeding in a male child and its successful endovascular management.
PubMed: 33953516
DOI: 10.4103/jiaps.JIAPS_56_20 -
Fetal and Pediatric Pathology Aug 2022The presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. A male neonate presented with clinical signs and symptoms of duodenal...
The presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. A male neonate presented with clinical signs and symptoms of duodenal obstruction. At exploration, an annular pancreas was found as the causative factor and he underwent a Kimura's duodeno-duodenostomy. A pedicled cyst was attached to the stomach's greater curvature, was excised, and histologically was a mesothelial-lined cyst with ectopic liver, complete with bile ducts, in the cyst wall. Ectopic liver tissue may be clinically silent and found within the wall of a mesothelial cyst. Long-term complications of this ectopic tissue are not known.
Topics: Cysts; Duodenal Obstruction; Duodenostomy; Humans; Infant, Newborn; Liver; Male; Pancreas
PubMed: 33945385
DOI: 10.1080/15513815.2021.1919809 -
Vascular and Endovascular Surgery Oct 2021Primary aortoenteric fistula (AEF) is an uncommon but life-threatening condition. We present a case of primary AEF in an octogenarian with previous endovascular aortic...
Primary aortoenteric fistula (AEF) is an uncommon but life-threatening condition. We present a case of primary AEF in an octogenarian with previous endovascular aortic repair, type II endoleak and end stage liver and renal disease. He was successfully treated with accessory renal artery ligation, duodenojejunostomy, aneurysm sac debridement and irrigation and closure of the aneurysm sac over a drain. The patient made an excellent recovery and was discharged on POD #7, with no complications noted after over a year of follow up. This approach may represent a valuable option to manage primary AEF versus open endograft explant, particularly in severely ill patients.
Topics: Aged, 80 and over; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Debridement; Duodenal Diseases; Duodenostomy; Embolization, Therapeutic; End Stage Liver Disease; Endoleak; Endovascular Procedures; Humans; Intestinal Fistula; Jejunostomy; Kidney Failure, Chronic; Ligation; Male; Renal Artery; Treatment Outcome; Vascular Fistula
PubMed: 33779400
DOI: 10.1177/15385744211004649 -
The Turkish Journal of Gastroenterology... Dec 2020
Topics: Adult; Duodenostomy; Enteral Nutrition; Female; Humans; Intestinal Obstruction; Jejunal Diseases; Jejunal Neoplasms; Ovarian Neoplasms; Ultrasonography, Interventional
PubMed: 33626014
DOI: 10.5152/tjg.2020.2001 -
Pain Research & Management 2021Smoking is clinically associated with high postoperative pain scores and increased perioperative analgesic requirements. However, the association between the duration of...
Smoking is clinically associated with high postoperative pain scores and increased perioperative analgesic requirements. However, the association between the duration of smoking cessation and postoperative opioid requirements remains unclear. Therefore, this study aimed to evaluate the association between the duration of smoking cessation and postoperative opioid requirements. We retrospectively analyzed the data of 144 male patients who received intravenous patient-controlled analgesia (IV PCA) after laparoscopic distal gastrectomy with gastroduodenostomy. All patients were divided into three groups: G0, nonsmoker; G1, smoker who quit smoking within 1 month preoperatively; G2, smoker who quit smoking over 1 month preoperatively. Analgesic use, pain intensity, and IV PCA side effects were assessed up to postoperative day 2. As the duration of smoking cessation increased, the amount of postoperative opioid consumption decreased ( = -0.08; 95% confidence interval (CI), -0.11 to -0.04; < 0.001). The total postoperative opioid requirements in G1 were significantly higher than those in G0 and G2 (G0, 75.5 ± 15.9 mg; G1, 94.6 ± 20.5 mg; and G2, 79.9 ± 19.4 mg ( < 0.001)). A multivariate regression analysis revealed that G1 was independently associated with increased postoperative opioid requirements ( = 12.80; 95% CI, 5.81-19.80; < 0.001). Consequently, male patients who had ceased smoking within 1 month of undergoing a laparoscopic distal gastrectomy with gastroduodenostomy had higher postoperative opioid use than patients who had ceased smoking for more than 1 month and nonsmokers.
Topics: Analgesics, Opioid; Duodenostomy; Gastrectomy; Gastroenterostomy; Humans; Laparoscopy; Male; Middle Aged; Pain, Postoperative; Retrospective Studies; Smokers; Smoking Cessation
PubMed: 33574973
DOI: 10.1155/2021/1541748 -
Annals of Medicine and Surgery (2012) Feb 2021Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the...
BACKGROUND
Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the minimally invasive surgery approach, which should have promised rapid recovery. This study aimed to evaluate the management of BDI following cholecystectomy procedure in Cipto Mangunkusumo Hospital, Jakarta, as a tertiary hospital.
METHOD
Descriptive retrospective cross-sectional design was used on open and laparoscopic cholecystectomy performed between January 2008 and December 2018. This study is reported in line with STROCSS 2019 Criteria.
RESULT
A total of 24 patients with BDI were included, with female preponderance (62,5%) with a median age 45 (21-58) years. Sixteen post-laparoscopy cases were classified according to Strasberg classification; 6 cases were type E3, 2 cases each of type E1 and E2, and one case each of Strasberg C and D. The remaining 4 were Strasberg A. Eight post-open cases were classified based on Bismuth criteria: 4 cases of Bismuth I, 1 case of Bismuth II, and 3 cases of Bismuth III. Five cases were presented with massive biloma, 7 with jaundice, and 10 cases with biliary-pancreatic fluid production through the surgical drain. The average time of problem recognition to patient's admission was 19 (7-152) days and admission to surgery was 14 days. Roux-en-Y hepaticojejunostomy was performed in 18 cases, choledocho-duodenostomy in 2 cases, and primary ligation cystic duct in 4 cases. Post-operative follow-up showed 2 patients had recurrent cholangitis, 2 superficial surgical site infection, and 2 relaparotomy due to bile anastomosis leakage and burst abdomen. The median length of hospital stay was 38 (14-53) days with zero hospital mortality. No stricture detected in long term follow-up.
CONCLUSION
Common bile duct was the most frequent site of BDI, and Roux-en-Y hepaticojejunostomy reconstruction performed by HPB surgeons on high volume center results in a good outcome.
PubMed: 33537132
DOI: 10.1016/j.amsu.2021.01.012 -
Radiology Case Reports Apr 2021Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding...
Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding intolerance that share similar symptoms with other intestinal obstructions. We reported a case of 11-month-old female infant with a history of nonbilious vomiting after coughing as much as 6 times per day 1 day before admission. The patient had an incorrect provisional diagnosis of hypertrophic pyloric stenosis based on ultrasound. Later on, an upper gastrointestinal series showed dilatation of the second part of the duodenum which was successfully treated by a duodenostomy during laparotomy procedure. It is suggested that treating an intestinal obstruction needs a further investigation when the symptoms were continuously repeated.
PubMed: 33537107
DOI: 10.1016/j.radcr.2021.01.019