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Revista Espanola de Enfermedades... May 2019Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with...
Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with development of a fistulous tract to the skin without prior biliary surgery or trauma. We report the case of an octogenarian woman with debilitating comorbidities and consequently immunosuppression who presented with spontaneous external biliary fistula and a history of ERCP three months before, a procedure that was carried out with no apparent immediate complications.
Topics: Aged, 80 and over; Biliary Fistula; Cutaneous Fistula; Female; Gallbladder Diseases; Humans
PubMed: 30912668
DOI: 10.17235/reed.2019.5882/2018 -
The New England Journal of Medicine Feb 2004Infliximab, a monoclonal antibody against tumor necrosis factor, is an effective maintenance therapy for patients with Crohn's disease without fistulas. It is not known... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Infliximab, a monoclonal antibody against tumor necrosis factor, is an effective maintenance therapy for patients with Crohn's disease without fistulas. It is not known whether infliximab is an effective maintenance therapy for patients with fistulas.
METHODS
We performed a multicenter, double-blind, randomized, placebo-controlled trial to evaluate the efficacy of infliximab maintenance therapy in 306 adult patients with Crohn's disease and one or more draining abdominal or perianal fistulas of at least three months' duration. Patients received 5 mg of infliximab per kilogram of body weight intravenously on weeks 0, 2, and 6. A total of 195 patients who had a response at weeks 10 and 14 and 87 patients who had no response were then randomly assigned to receive placebo or 5 mg of infliximab per kilogram every eight weeks and to be followed to week 54. The primary analysis was the time to the loss of response among patients who had a response at week 14 and underwent randomization.
RESULTS
The time to loss of response was significantly longer for patients who received infliximab maintenance therapy than for those who received placebo maintenance (more than 40 weeks vs. 14 weeks, P<0.001). At week 54, 19 percent of patients in the placebo maintenance group had a complete absence of draining fistulas, as compared with 36 percent of patients in the infliximab maintenance group (P=0.009).
CONCLUSIONS
Patients with fistulizing Crohn's disease who have a response to induction therapy with infliximab have an increased likelihood of a sustained response over a 54-week period if infliximab treatment is continued every 8 weeks.
Topics: Adult; Aged; Antibodies, Monoclonal; Crohn Disease; Cutaneous Fistula; Double-Blind Method; Drug Tolerance; Female; Gastrointestinal Agents; Humans; Infliximab; Infusions, Intravenous; Intestinal Fistula; Male; Middle Aged; Rectal Fistula; Recurrence; Remission Induction; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 14985485
DOI: 10.1056/NEJMoa030815 -
The Laryngoscope May 2021A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study...
OBJECTIVE
A paucity of data exists regarding surgical outcomes for patients undergoing total laryngectomy for a dysfunctional larynx. Herein, we present the largest study evaluating the method of closure on postoperative fistula rate and swallowing ability.
METHOD
We performed a retrospective review of patients undergoing total laryngectomy for a dysfunctional larynx after primary radiation or chemoradiation therapy for laryngeal carcinoma from 1998 to 2020. Demographic information, operative details, length of hospitalization, fistula formation, method of fistula treatment, and need for enteral feeding 6 months after surgery were analyzed.
RESULTS
A total of 268 patients were included. Flaps were performed in 140 (52.2%) patients, including radial forearm free flaps (RFFF), pectoralis flaps, and supraclavicular flaps. Sixty-four (23.9%) patients developed postoperative fistulas. There was no significant difference in the fistula rate between flap and primary closure methods (P = .06). However, among patients who had a flap, RFFF had a significantly lower fistula rate (P = .02). Significantly more patients who had initial closure with a pectoralis flap required an additional flap for fistula repair than those who underwent RFFF or primary closure (P < .05). Last, whereas 87 patients (32.5%) required an enteral feeding tube 6 months after surgery, significantly fewer patients who underwent RFFF were feeding tube-dependent (P = < .0001).
CONCLUSION
Herein, we present the largest study of outcomes after total laryngectomy for dysfunctional larynx. Postoperative fistula rates are high, 23%; however, the majority of patients, 67%, will not require long-term enteral support. The RFFF is an excellent option demonstrating the lowest rates of postoperative fistula and enteral feeding tube dependence.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:E1510-E1513, 2021.
Topics: Aged; Aged, 80 and over; Carcinoma; Chemoradiotherapy; Cutaneous Fistula; Enteral Nutrition; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Larynx; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Radiation Injuries; Plastic Surgery Procedures; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 33037821
DOI: 10.1002/lary.29154 -
Brazilian Journal of Otorhinolaryngology 2020Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with... (Review)
Review
INTRODUCTION
Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy.
OBJECTIVE
Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors.
METHODS
We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed.
RESULTS
We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p=0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p=0.03) and large pharyngostomes (64.3% versus 0%, p=0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p=0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p=0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes.
CONCLUSIONS
Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.
Topics: Adult; Aged; Aged, 80 and over; Cutaneous Fistula; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Retrospective Studies; Risk Factors; Severity of Illness Index; Surgical Flaps
PubMed: 30683565
DOI: 10.1016/j.bjorl.2018.11.007 -
Annals of Palliative Medicine Sep 2023Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols... (Review)
Review
Pharyngocutaneous fistula is a serious complication after head and neck reconstruction and concurrent chemoradiotherapy, yet no consensus or practical protocols regarding the surgical timing and specific procedures could be found in the current literature. The authors aimed to review their clinical experience in surgical management and develop an algorithmic approach accordingly. A retrospective review of all hypopharyngeal cancer patients who developed pharyngocutaneous fistula during 2017 to 2021 at E-Da Hospital was conducted. Seventeen patients developed pharyngocutaneous fistula in all 321 pharyngeal cancer admissions during this period. Three patients received interventions at acute stage (≤2 weeks), with two direct repairs Three patients received interventions at acute stage (≤2 weeks), with two direct repairs and one regional flap coverage then negative pressure wound therapy. Nine received interventions at subacute stages (2 weeks to 3 months), with 4 resolved after debridement and direct repair yet another 4 underwent regional flap reconstruction and 1 free flap reconstruction. Five chronic fistula (>3 months) received secondary reconstructions utilizing a double-layered repair of local turn-over flaps for the internal mucosal opening and another flap harvest (four regional flaps and one free flap) to cover the outer skin defect. All patients after the palliative surgery achieved complete remission of fistula at follow follow-up. Different conservative and surgical approaches should be adopted according to the acute, subacute, and chronic stages of pharyngocutaneous fistula after palliative head and neck reconstructions.
Topics: Humans; Cutaneous Fistula; Head and Neck Neoplasms; Pharyngeal Diseases; Plastic Surgery Procedures; Postoperative Complications; Retrospective Studies; Surgical Flaps
PubMed: 37691332
DOI: 10.21037/apm-22-1475 -
International Journal of Nanomedicine 2022Pharyngocutaneous fistula is the most common complication after total laryngectomy and is difficult to heal. Although conservative treatment and surgical repair are... (Review)
Review
Pharyngocutaneous fistula is the most common complication after total laryngectomy and is difficult to heal. Although conservative treatment and surgical repair are effective, they often take longer and additional trips to the operating room, which undoubtedly increases the financial burden on patients. Especially in combination with diseases such as diabetes and hypertension, which affect the efficacy of surgery. Adding growth factors into the repair material can promote fibroblast proliferation, angiogenesis, and accelerate wound healing. A substantial number of studies have shown that a type of nanoscale extracellular vesicle, called exosomes, facilitates organization repair by promoting blood vessel production, protein polysaccharides, and collagen deposition, thereby representing a new type of cellular therapy. At present, there is little research on the application of exosomes in pharyngocutaneous fistula regeneration after total laryngectomy. In this review, we summarize the biological characteristics of exosomes and their application in biomedical science, and highlight their application prospects in pharyngocutaneous fistula regeneration after total laryngectomy.
Topics: Cutaneous Fistula; Exosomes; Humans; Laryngeal Neoplasms; Laryngectomy; Pharyngeal Diseases
PubMed: 36118178
DOI: 10.2147/IJN.S372042 -
Surgical Endoscopy Mar 2023Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1-2%. Most of gastro-cutaneous fistulae do not... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1-2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically.
METHODS
This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I-II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively.
RESULTS
Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4-7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1 week was significantly higher in SG than EG (p < 0.001). No mortality reported in EG, while 2 patients died in SG (p = 0.48).
CONCLUSION
Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients.
Topics: Female; Humans; Adult; Middle Aged; Gastric Fistula; Cutaneous Fistula; Prospective Studies; Obesity, Morbid; Laparoscopy; Anastomotic Leak; Gastrectomy; Gastric Bypass; Treatment Outcome; Retrospective Studies
PubMed: 36326931
DOI: 10.1007/s00464-022-09748-z -
Archives of Gynecology and Obstetrics Oct 2021Fistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost... (Review)
Review
BACKGROUND
Fistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost invariably significant associated morbidity and impact on a patient's quality of life. Imaging may aid in the diagnosis of pelvic fistulas and is essential to identify any associated pathology, define the course of the fistula, and aid in pre-surgical planning.
PURPOSE
This article aims to review the wide array of clinical and imaging presentations of fistulas in the pelvis, with a focus on the radiologists' role in managing this challenging entity.
METHODS
This article will review each classification type of fistula.
RESULTS
Pelvic fistula is a devastating condition that causes significant morbidity and evaluation can be challenging.
CONCLUSIONS
Imaging, and particularly MRI, plays a vital role in the diagnosis, characterizing the course of a fistula and demonstrating associated complications, which are essential to guide treatment decisions.
Topics: Abdomen; Aged; Cutaneous Fistula; Female; Fistula; Humans; Magnetic Resonance Imaging; Middle Aged; Pelvis; Quality of Life; Urinary Fistula; Vaginal Fistula
PubMed: 34286358
DOI: 10.1007/s00404-021-06144-1 -
TheScientificWorldJournal 2011In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are... (Review)
Review
In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.
Topics: Age Factors; Circumcision, Male; Constriction, Pathologic; Cutaneous Fistula; Hemorrhage; Humans; Male; Penile Diseases; Penis; Postoperative Complications
PubMed: 22235177
DOI: 10.1100/2011/373829