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Diagnostics (Basel, Switzerland) Oct 2023Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our...
Lumen-apposing metal stents (LAMSs) in ultrasonography-guided gallbladder drainage (EUS-GBD) have become increasingly important for high-risk surgical patients. Our study aims to evaluate the technical and clinical success, safety, and feasibility of endoscopic ultrasonography-guided gallbladder drainage using a new dedicated LAMS. This is a retrospective multicenter study that included all consecutive patients not suitable for surgery who were referred to a tertiary center for EUS-GBD using a new dedicated electrocautery LAMS for acute cholecystitis at eight different centers. : Our study included 54 patients with a mean age of 76.48 years (standard deviation: 12.6 years). Out of the 54 endoscopic gallbladder drainages performed, 24 (44.4%) were cholecysto-gastrostomy, and 30 (55.4%) were cholecysto-duodenostomy. The technical success of LAMS placement was 100%, and clinical success was achieved in 23 out of 30 patients (76.67%). Adverse events were observed in two patients (5.6%). Patients were discharged after a median of 5 days post-stenting. : EUS-GBD represents a valuable option for high-surgical-risk patients with acute cholecystitis. This new dedicated LAMS has demonstrated a high rate of technical and clinical success, along with a high level of safety.
PubMed: 37958236
DOI: 10.3390/diagnostics13213341 -
Journal of Indian Association of... 2022This study aims to determine the sequelae of corrosive ingestion in children.
AIM
This study aims to determine the sequelae of corrosive ingestion in children.
METHODS
A retrospective study was conducted in the Department of Pediatric Surgery at a Tertiary Center. The children presenting between January 2015 and December 2020 with a history of ingestion of caustic agents were included in the study.
RESULTS
A total of 26 children were included in the study. The children with suicidal attempts were significantly older than those who ingested the corrosive agents accidentally (14.2 ± 1.9 years vs. 6 ± 3.3 years; < 0.01; Student's -test). Sixteen (62%) children had esophageal strictures, 8 (31%) had pyloric strictures, and a child (4%) had both esophageal and gastric strictures. Eight (31%) children required an initial feeding jejunostomy and 6 (23%) required a feeding gastrostomy as they had significant weight loss on presentation. Eleven (65%) esophageal strictures responded to the dilatation regimen and are symptom-free on follow-up. Three (18%) children with esophageal stricture underwent esophageal replacement. Eight (31%) children had a pyloric stricture and all of them were treated with a modified Billroth I gastro-duodenostomy. The children who presented after 2 months were found to have a significantly increased need for esophageal replacement (3/9 vs. 0/17; = 0.03; Fischer's exact test).
CONCLUSION
The corrosive ingestion in children is associated with higher morbidity. The sequelae include esophageal and antro-pyloric strictures. A feeding gastrostomy or jejunostomy was required in more than half of the patients. The children presenting after 2 months of ingestion were associated with an increased need for esophageal replacement.
PubMed: 36238332
DOI: 10.4103/jiaps.jiaps_133_21 -
World Journal of Gastroenterology Aug 2019In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the... (Review)
Review
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (., luminal biliary stents) have been adapted to the new trans-luminal EUS-guided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and EC-LAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cholestasis; Common Bile Duct Neoplasms; Drainage; Electrocoagulation; Endosonography; Humans; Neoplasm Invasiveness; Pancreatic Neoplasms; Self Expandable Metallic Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 31413524
DOI: 10.3748/wjg.v25.i29.3857 -
BMC Gastroenterology Feb 2022The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
BACKGROUND
The purpose of this study was to investigate the diagnosis and treatment experience of traumatic duodenal ruptures in children.
METHODS
Clinical data were collected from four children suffering from a traumatic duodenal rupture who were admitted to and treated by our hospital from January 2012 to December 2020. The early diagnosis and treatment, surgical plan, postoperative management, complications, and prognosis of each child were analyzed. The key points and difficulties of the diagnosis and treatment for this type of injury are summarized.
RESULTS
One child had an extreme infection caused by drug-resistant bacteria, which resulted in severe complications, including wound infection, dehiscence, and an intestinal fistula. One child developed an anastomotic stenosis after the duodenostomy, which improved following an endoscopic balloon dilatation. The other two children had no relevant complications after their operations. All four patients were cured and discharged from hospital. The average hospital stay was 48.25 ± 26.89 days. The follow-up period was 0.5 to 1 year. No other complications occurred, and all children had a positive prognosis.
CONCLUSIONS
The early identification of a duodenal rupture is essential, and surgical exploration should be carried out proactively. The principles of damage-control surgery should be followed as much as possible during the operation. Multidisciplinary cooperation and management are both important to reduce the occurrence of postoperative complications and improve cure rates.
Topics: Anastomosis, Surgical; Child; Dilatation; Duodenal Diseases; Duodenum; Humans; Postoperative Complications; Retrospective Studies
PubMed: 35151250
DOI: 10.1186/s12876-022-02136-w -
Canadian Journal of Surgery. Journal... Feb 2010Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons... (Review)
Review
Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.
Topics: Choledochal Cyst; Duodenostomy; Enterostomy; Female; Hepatic Duct, Common; Humans; Pancreatitis; Pregnancy; Pregnancy Complications
PubMed: 20100414
DOI: No ID Found -
Annals of the Royal College of Surgeons... Sep 2017Introduction Cholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but...
Introduction Cholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but its acceptance remains debated because of the risk of reflux cholangitis and sump syndrome. The aim of this study was to assess the current features and outcomes of patient undergoing CDD. Patients and methods We retrospectively analysed the surgical results of consecutive 130 patients treated by CDD between 1991 and 2013 and excluded five cases with a malignant disorder. Indications for surgery included endoscopic management where stones were difficult or failed to pass and primary common bile duct stones with choledochal dilatation. Incidences of reflux cholangitis, stone recurrence, pancreatitis or sump syndrome were investigated and the data between end-to-side and side-to-side CDD were compared. Results Reflux cholangitis and stone recurrence was 1.6% (2/125) and 0% (0/125) of cases by CDD. There is no therapeutic-related pancreatitis in CDD. Sump syndrome was not also observed in side-to-side CDD. Conclusions This study is a first comparative study between end-to-side and side-to-side CDD. The surgical outcomes for CDD treatment of choledocholithiasis were acceptable. The incidence of reflux cholangitis, stone recurrence, pancreatitis and sump syndrome was very low.
Topics: Aged; Cholangitis; Choledochostomy; Cholelithiasis; Duodenostomy; Female; Humans; Male; Middle Aged; Operative Time; Pancreatitis; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 28853605
DOI: 10.1308/rcsann.2017.0082 -
The Journal of International Medical... Jan 2020Congenital duodenal obstruction is typically treated by duodenoduodenostomy. Tapering of the dilated segment has been indicated to reduce duodenal dysmotility. The...
OBJECTIVE
Congenital duodenal obstruction is typically treated by duodenoduodenostomy. Tapering of the dilated segment has been indicated to reduce duodenal dysmotility. The purpose of this study was to review the outcomes between these two approaches.
METHODS
We retrospectively reviewed cases of duodenal obstruction repair performed at a quaternary care referral pediatric hospital from 2007 to 2017. The length of stay, time to full enteral feeding, and complications were compared between patients who underwent duodenoduodenostomy with and without tapering duodenoplasty (n=4 and n=35, respectively).
RESULTS
Both groups had similar times to initial enteral feeding (7 days) and full enteral feeding (14 vs. 15 days). Among the 35 patients who underwent duodenoduodenostomy alone, 6 (17%) required a return to the operating room; in contrast, no patients who underwent tapering required a return to the operating room. Of those who returned to the operating room, two underwent tapering at that time because of duodenal dilation and feeding intolerance.
CONCLUSIONS
Although limited by the small sample size, this study suggests that patients undergoing tapering duodenoplasty may have a slightly shorter time to full enteral feeding and a lower rate of complications than patients undergoing duodenoduodenostomy alone.
Topics: Duodenal Obstruction; Duodenostomy; Duodenum; Female; Humans; Infant, Newborn; Male; Postoperative Complications; Prognosis; Retrospective Studies
PubMed: 31353994
DOI: 10.1177/0300060519862109 -
California Medicine Mar 1956Four hundred consecutive cases in which subtotal gastrectomy was done for duodenal and gastric ulcer were reviewed. The mortality rate was 3.5 per cent. There were 57...
Four hundred consecutive cases in which subtotal gastrectomy was done for duodenal and gastric ulcer were reviewed. The mortality rate was 3.5 per cent. There were 57 complications, an incidence of 14 per cent. Of the fatal complications, duodenal stump disruption was the most common and serious-11 cases and 7 deaths. The other fatal complications included various types of obstruction, pulmonary embolus, hemorrhagic pancreatitis and separation of the abdominal incision. Of the nonfatal complications, obstruction of the stoma, anastomotic bleeding, pneumonia, venous thrombosis and wound infection were the most common. Catheter duodenostomy is helpful in the closure of a difficult duodenal stump. Where this was done in the present series there were no fatalities. Electrolyte balance, correction of protein deficiencies, blood replacement and the judicious use of antibiotics are important prophylactic factors against postoperative complications.
Topics: Anti-Bacterial Agents; Death; Duodenostomy; Duodenum; Gastrectomy; Gastrointestinal Hemorrhage; Humans; Incidence; Pancreatitis; Peptic Ulcer; Postoperative Complications; Pulmonary Embolism; Replantation; Stomach Ulcer
PubMed: 13304670
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2009The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive...
BACKGROUND
The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive operative repair of severe duodenal injuries.
METHODS
Sixty-seven patients who underwent surgery for duodenal injuries were evaluated. Management of duodenal injury was classified as primary repair and tube decompression.
RESULTS
Fifty-nine patients were injured by a penetrating mechanism, and eight were injured by blunt mechanism. The most common injury site was in the second portion of the duodenum. There were no significant differences between the two groups with respect to morbidity and mortality rate. In 35 patients without morbidity, the mean length of hospital stay was 18.53+/-1.85 days in the tube duodenostomy group and 11.45+/-1.92 days in the primary repair group, and the difference was statistically significant. In the 32 patients with morbidity, the mean length of hospital stay was 47.05+/-10.46 days in the tube duodenostomy group and 49.86+/-10.86 days in primary repair group, but there was no statistically significant difference between the groups.
CONCLUSION
Primary repair is suitable in the vast majority of duodenal injuries; tube duodenostomy increases the length of hospital stay and does not improve clinical outcome.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Duodenostomy; Duodenum; Female; Hematoma; Humans; Lacerations; Length of Stay; Male; Middle Aged; Trauma Severity Indices; Treatment Outcome; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 19779988
DOI: No ID Found -
International Journal of Surgery Case... 2020Due to the risk of malignancy, the established management of choledochal cysts mandates bile duct excision and biliary reconstruction. While the reconstructive procedure...
OBJECTIVE
Due to the risk of malignancy, the established management of choledochal cysts mandates bile duct excision and biliary reconstruction. While the reconstructive procedure of choice for most surgeons has traditionally been hepatico-jejunostomy, this may not be feasible in selected cases due to immobility or inadequacy of the jejunum. The following case will outline the management of a 32-year-old woman with short bowel syndrome, who was diagnosed with choledocholithiasis and a type 1 choledochal cyst.
METHOD AND MATERIALS
As a child, our patient suffered midgut volvulus secondary to malrotation which resulted in extensive bowel resection and developed short bowel syndrome. She presented with recurrent bouts of cholangitis. Imaging of her biliary tree confirmed common duct stones extending into the branched hepatic ducts, as well as a fusiform dilatation of the common bile duct, that appeared consistent with a type 1 choledochal cyst. Laparoscopic excision of the cyst with reconstruction using a hepatico-duodenostomy was planned.
RESULTS
The patient underwent successful laparoscopic cholecystectomy, CBD clearance with excision of the bile duct and reconstruction with hepatico-duodenostomy. Recovery was uneventful and she is asymptomatic on subsequent follow-up. Histology is consistent with a markedly dilated bile duct rather than a choledochal cyst.
CONCLUSIONS
This case illustrates the dilemma of diagnosis and treatment of a dilated bile duct mimicking a choledochal cyst in the setting of short bowel syndrome and the feasibility of a laparoscopic approach in such cases. Also, it demonstrates that hepatico-duodenostomy may be a safe alternative in cases with limited material for conduit.
PubMed: 32145565
DOI: 10.1016/j.ijscr.2020.02.061