Antireflux System Research Articles

Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial.

Gastroesophageal reflux disease (GERD) is an issue after one anastomosis gastric bypass (OAGB) and modification of OAGB with adding an anti-reflux system may decrease the incidence of postoperative GERD. This study aimed to compare the efficacy of the anti-reflux mechanism to treat preoperative GERD and prevent de novo GERD. A prospective randomized clinical trial study was conducted on patients with a body mass index of 40 and more from August 2020 to February 2022. Patients undergoing one anastomosis gastric bypass with and without anti-reflux sutures (groups A and B, respectively). These patients had follow-ups for one year after the surgery. GERD symptoms were assessed in all the patients using the GERD symptom questionnaire. The mean age was 39.5 ± 9.8 years and 40.7 ± 10.2 years in groups A and B respectively. GERD symptoms remission occurred in 76.5% and 68.4% of patients in groups A and B, respectively. The incidence of de novo GERD symptoms was lower in group A, compared to group B (6.2% and 16.1% in groups A and B respectively), without any statistically significant difference (p-value: 0.239). GERD symptoms and de novo GERD after OAGB seems to be under-reported after OAGB. This study suggests that applying an anti-reflux suture can decrease de novo GERD symptoms.

Bowel in Chest Following Hiatal Hernia: A Rare Presentation

Organ displacement severity across the esophageal hiatus determines how severe a hiatal hernia is. Rare Type IV paraesophageal hernias entail the protrusion of additional abdominal organs in addition to the stomach. We discuss the case of a 13-year-old boy who experienced intestinal obstruction and had a recurring hiatal hernia. A paraesophageal hiatal hernia with colonic and small bowel herniation was identified through clinical examination and imaging. Surgery was used to strengthen the anti-reflux system, reduce the hernia contents, and fix the hernia defect. The patient’s postoperative course was successful. This instance emphasizes the significance of quick paraesophageal hernia diagnosis and care to avoid consequences. An early surgical intervention can enhance results and reduce possibly fatal consequences.

Novel biliary stenting with an antireflux system for distal biliary obstruction in a patient with a surgically altered anatomy.

Novel biliary stenting with an antireflux system for distal biliary obstruction in a patient with a surgically altered anatomy.

Iatrogenic Ureteral Injuries Associated with Gynecological and Surgical Procedures: Our Experience About 18 Cases and Literature Review.

AimTo describe the epidemiological aspects, etiology and outcome of iatrogenic ureteral injury repair at the urology division of Souro Teaching Hospital of Bobo Dioulasso (Burkina-Faso).Patients and MethodsThis was a retrospective descriptive study of consecutive patients with iatrogenic ureteric injuries who were referred and managed in the urology division of Souro Sanou Teaching Hospital (Bobo-Dioulasso) from January 2012 to December 2017. Variables studied were age, the time at the diagnosis, the causative event, the method of repair, and the outcome of the management.ResultsThe mean age was 37.72±3.5 years coming from the rural population in most cases. The mean time at the diagnosis was 15 days. The injuries were due to gynecologic surgeries with hysterectomy (66%) and caesarian section (33%). Ureteric reimplantation with anti-reflux system was performed in seventeen patients. The rate of treatment success was 94% and the postoperative course was uneventful for all the patients.ConclusionIatrogenic ureteric lesions at the department of urology of Sanou Sourou teaching hospital of Bobo Dioulasso were mainly caused by gynecologic and obstetric surgeries like hysterectomy and caesarian section.

14 Cases of Uretero-Vaginal Fistulain the Provincial Hospital of Abeche, Chad

Introduction: Urethro-Vaginal Fistula (UVF) is a communication between the ureter and the vagina. It is generally about an iatrogenic lesion happening in the decline of gynaeco-obstetrical pelvic surgery. Its main manifestation is the permanent leak of urines through the vagina with the notion of normal micturition conservation except in the case of bilateral lesion. The objective of this study was to describe the clinical, diagnostic, and therapeutic aspects. Patients et methods:It was about a retrospective and descriptive study focusing on the cases of Urethro-Vaginal Fistulas diagnosed and taken care of in the Provincial Hospital of Abeche from January 2011 to December 2016.The studied variables were sociodemographic, clinical, para clinical, therapeutic, and evolutionary. Results: During the study period, 14 cases of UVF have been diagnosed and treated.The average age of patients was 25.The average gestation is 3 and that of parity 2. The aetiology of the UVF: hysterectomy(n=5 that is 35,71%) and the caesarean section (n=9 that is 64,29%).The diagnosis was kept after a clinical and para clinical check-up mainly the examination through speculum, the examination through the blue of methylene, and the UIVwith negative profile photos. The ECBU has been positive in 4 cases (E. Coli), the presence of creatine was normal. The treatment consisted in urethro-vesicalre implantion with an anti-reflux device. The immediate post operating results were simple in 12 cases and the 2 other cases were marked by an E. Coli infection. Conclusion: UVF is a rare complication in gynaeco-obstetrical surgery. The reference treatment is the urethro-vesicalre implantation respecting the anti-reflux system.

Boari flap ureteroneocystostomy in an oncological patient

ObjectiveDemonstration of surgical steps of a Boari Flap ureteroneocystostomy in an oncological context. MethodsClinical case of a 66-year-old woman diagnosed with a left-pelvic recurrence of a high-grade serous ovarian carcinoma, involving the left ureter. After transection of 5cm of ureteral length, up to the level of the bifurcation of common iliac vessels, it was decided to perform a Boari Flap for ureteral reimplantation. ResultsThrough the tubularization of a bladder flap, the extension of the ureter to the bladder is possible. After mobilization and psoas fixation, the bladder is opened on its anterior surface, in a rhomboid incision, and a full thickness bladder flap is extended cranially and tubularized for anastomosis of the proximal ureteral segment. The ureter is reimplanted after creation of an anti-reflux system with a submucosal tunnel between the mucosa and the detrusor. To finish the procedure, the bladder is closed in two layers with a running monofilament absorbable suture. ConclusionsBoari Flap ureteroneocystostomy is an uncommon urinary reconstruction, useful to correct distal ureteric defects caused by traumatic, oncological or iatrogenic injuries [1]. The success rate of ureteral reimplantation can be higher than 85% [2]. This technique is suitable for anastomosis of lumbar ureteral segments, allowing the better correction of higher and more extensive defects than the Psoas-Hitch technique. The flap length should compensate the ureteric defect and enable a tension free anastomosis.

Intraocular Pressure Spikes after Aflibercept Intravitreal Injections

The objective of this study was to assess the intraocular pressure (IOP) as well as the anatomical modifications of the anterior segment following an aflibercept injection. Patients underwent an aflibercept intravitreal injection (IVI) (0.05 ml) with a 30.5-gauge needle and an antireflux system. IOP was assessed before injection (T0), immediately after (T1), and 5 min (T5), 15 min (T15), and 45 min (T45) after the IVI. Before the IVI and immediately after the T1 measurement, a PENTACAM® acquisition was used to evaluate the anterior chamber parameters (anterior chamber volume, depth and measure of the iridocorneal angle). At T0, IOP was 12.9 ± 1.3 mm Hg. IOP significantly increased after IVI (42.7 ± 3 mm Hg, p < 0.001). IOP returned to baseline at T45 (13.0 ± 1.2 mm Hg, p = 0.877). Anterior chamber volume decreased after IVI (160.6 vs. 168.3 mm³, p = 0.002). No significant changes were found for iridocorneal angle and anterior chamber depth. Aflibercept IVI causes an acute increase in IOP over a short period without iridocorneal angle closure.

Downstream Hepatic Arterial Blood Pressure Changes Caused by Deployment of the Surefire AntiReflux Expandable Tip

The purpose of this work was to evaluate blood pressure changes caused by deployment of the Surefire antireflux expandable tip. The pressure measurements are relevant because they imply changes in hepatoenteric arterial blood flow within this liver compartment during hepatic artery delivery of cytotoxic agents. After positioning the Surefire antireflux system in the targeted hepatic artery, blood pressure was obtained initially with the tip collapsed (or through a femoral artery sheath), then again after the tip was expanded before chemoembolization or yttrium 90 ((90)Y) radioembolization. Eighteen patients with liver malignancy underwent 29 procedures in 29 hepatic arteries (3 common hepatic, 22 lobar, 4 segmental). Systolic, diastolic, and mean blood pressure were all decreased by a mean of 29 mm Hg (p = 0.000004), 14 mm Hg (p = 0.0000004), and 22 mm Hg (p = 0.00000001), respectively. When the Surefire expandable tip is deployed to prevent retrograde reflux of agents, it also results in a significant decrease in blood pressure in the antegrade distribution, potentially resulting in hepatopedal blood flow in vessels that are difficult to embolize, such as the supraduodenal arteries.

Editorial Comment

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We are grateful for the helpful editorial comments agreeing on our views associated with urinary diversion surgery. Urinary reconstruction should match the needs and expectations of the individual patient, and most patients in turn adapt to whatever is expected of them. Patient participation with unbiased counseling before any treatment and the availability to choose between all available forms of treatment is the key to postoperative satisfaction. How Close Are We to Knowing Whether Orthotopic Bladder Replacement Surgery Is the New Gold Standard?—Evidence From a Systematic Review UpdateUrologyVol. 74Issue 6PreviewTo compare the clinical effectiveness and risk profile of the different types of surgeries using transposed intestinal segments in a systematic review update. Urinary diversion is designed to improve or replace the function of the diseased urinary bladder. Full-Text PDF Editorial CommentUrologyVol. 74Issue 6PreviewThe goal of any form of urinary diversion should be the control of urinary bladder disease and the preservation of a patient's quality of life (QoL). Safeguarding a patient's QoL is related both to the surgical urinary diversion form that is psychologically and socially acceptable and to the preservation of renal function.1 In fact, there are several reasons for deterioration of renal function that are generally diversion-related.2 In this sense, the incorporation of an antireflux system with urinary diversion or bladder replacement should protect the upper tract from regurgitation of the infected contents of the reservoir. Full-Text PDF

Altered ‘active’ antireflux mechanism in primary vesico‐ureteric reflux: a morphological and manometric study

To immunolocate c-kit-positive interstitial cells of Cajal (ICCs, known to be responsible for pacemaker activity in human ureters, coordinating ureteric motility) in the intramural ureter of patients with different grades of vesico-ureteric reflux (VUR), to assess the ureteric histology and correlate these findings with manometric patterns. The VU junction (VUJ) represents the boundary between the low-pressure of the upper and high pressure of the lower urinary tract, protecting the upper tract from VUR using active and passive antireflux mechanisms. The contraction of the longitudinal muscle coat of the VUJ possibly functions as an 'active' antireflux system, but previous manometric findings on refluxing ureteric units (RUs) have shown altered patterns. In all, 32 RU ends were stained using both picro-Mallory and Sirius Red techniques; in a parallel immunohistochemical procedure, using mast cell tryptase and CD117 antibodies (to identify ICCs), they were compared with eight control ureteric ends. Ureteric manometry of the VUJ was also done during ureteric reimplantation. The histochemical and immunohistochemical results in the RUs showed a replacement of the altered smooth muscle fascicles by collagenous stroma and significant loss of ICCs in RU ends, both correlated with the grade of VUR. Ureteric manometry showed significant impairment of basal and maximum pressure in RUs, correlated, respectively, with histological lesions and loss of ICCs. Deficiency of the longitudinal muscle coat probably leads to dysfunction and insufficiency of the ostial valve mechanism, with subsequent impairment of the active valve mechanism. Histological, histochemical and immunohistochemical changes support the alterations of ureteric peristalsis in RUs.

Technique of kidney transplantation in mice with anti-reflux urinary reconstruction

Experimental models of organ transplantation play a crucial role in establishing the principles of transplantation immunobiology. Murine transplant models of vascularized organs are particularly useful for immunobiological studies because there are more immunological tools available. However, the technique of kidney transplant in mice is very challenging. A difficult aspect of this model is urinary reconstruction, which is frequently associated to complications. In this article, the technique of mouse kidney transplantation using an anti-reflux system (modified extravesical ureteroneocystostomy) is described and illustrated for the first time. Although technically demanding, this procedure is feasible and may reduce the incidence of urine leakage and reflux.

A randomized study comparing an antireflux system with a direct ureteric anastomosis in patients with orthotopic ileal neobladders

To assess the benefit of an antireflux system in patients with orthotopic ileal neobladders, as there is controversy about whether reflux prevention offers any advantages. We conducted a randomized prospective study between January 2002 and March 2004, on 60 patients (53 men and seven women) with a mean (sd) age of 52.7 (7.3) years, who were candidates for orthotopic neobladders. Patients with comorbidities were excluded. Preoperative evaluation included intravenous urography (IVU), cystoscopic biopsy and radioisotope renography to evaluate the differential glomerular filtration rates (GFRs). Cases with normal kidneys and ureters, and with similar GFRs, were enrolled. Surgery comprised a standard radical cystectomy with pelvic lymphadenectomy. The ureters were randomized to either a direct anastomosis into a 5-cm ileal chimney on one side, or to be implanted using the antireflux serous-lined extramural tunnel on the contralateral side in the same patient. Regular follow-up included IVU and renography every 6 months in cancer-free patients. The mean (sd) follow-up was 23 (9.6) months. There was prolonged urinary leak from a refluxing ureter in one patient that was treated with a temporary percutaneous nephrostomy. Symptomatic pelvic collections required tube drainage in six cases. Six ureters developed early anastomotic strictures (one direct and five antirefluxing), and were treated with endoscopic ureterotomy in three and open revision in three. Serum creatinine levels were normal in all patients throughout the observation period. GFRs were similar in the two groups. The mean GFRs before surgery and at 6, 12, 18, and 24 months after cystectomy were: 55.1, 50.7, 49.4, 52.2 and 53.9 mL/min for the direct side; and 56.1, 53, 52.4, 53.2 and 50.4 mL/min for renal units with antirefluxing implantation. There was a significant deterioration of the GFRs due to anastomotic strictures, from 48.6 (6.7) mL/min before surgery to 31.8 (15.9) mL/min after the revision (P = 0.01). The antireflux procedures were associated with a higher incidence of anastomotic strictures than the direct methods and there was a significant deterioration of renal function after obstruction. The long-term follow-up data are awaited.

482: A Randomized Study Comparing an Antireflux System with a Direct Uretero-Intestinal Anastomosis in Patients with Orthotopic Ileal Neobladders

You have accessJournal of UrologyPodium, Sunday, May 22, 2005, 1:00 - 3:00pm1 Apr 2005482: A Randomized Study Comparing an Antireflux System with a Direct Uretero-Intestinal Anastomosis in Patients with Orthotopic Ileal Neobladders Atallah A. Shaaban, Mohamed Abdel-Latif, Ahmed Mosbah, and Ibrahim Eraky Atallah A. ShaabanAtallah A. Shaaban More articles by this author , Mohamed Abdel-LatifMohamed Abdel-Latif More articles by this author , Ahmed MosbahAhmed Mosbah More articles by this author , and Ibrahim ErakyIbrahim Eraky More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)34735-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "482: A Randomized Study Comparing an Antireflux System with a Direct Uretero-Intestinal Anastomosis in Patients with Orthotopic Ileal Neobladders." The Journal of Urology, 173(4S), p. 132 © 2016 by American Urological AssociationFiguresReferencesRelatedDetailsCited BySagalowsky A (2018) Editorial commentJournal of Urology, VOL. 175, NO. 4, (1393-1394), Online publication date: 1-Apr-2006. Volume 173Issue 4SApril 2005Page: 132 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Atallah A. Shaaban More articles by this author Mohamed Abdel-Latif More articles by this author Ahmed Mosbah More articles by this author Ibrahim Eraky More articles by this author Expand All Advertisement Loading ...

756A randomized study comparing an antireflux system with a direct uretero-intestinal anastomosis in

756A randomized study comparing an antireflux system with a direct uretero-intestinal anastomosis in

FISTULE URÉTÉRO-VAGINALE : TECHNIQUE DE LA SONDE URÉTÉRALE PERDUE DANS LE RÉTROPÉRITOINE POUR L’INDIVIDUALISATION DU SEGMENT URÉTÉRAL DISTAL

Introduction : The uretero – vaginal fistula are rare and mostly iatrogenic. The diagnosis is easy since all the signs are collected and lot of therapeutic modalities were described in the literature. Observation : it’s a patient of 40 years old who present urinary leak one week after an haemostatic hysterectomy for uterine rupture. She was surgically treated with uretero – ureteral anastomosis with easier individualization of the distal ureteral segment by using the technique of the loosed ureteral catheter in the retroperitoneum. Conclusion : This technique allows end to end uretero-ureterostomy conserving the physiologic antireflux system and avoiding the complications of the ureterovesical reimplantations.

Features of the Sinushunt® and its influence on the cerebrospinal fluid system

Objectives: A new cerebrospinal fluid (CSF) shunt system, Sinushunt®, has recently been introduced. CSF is shunted from the ventricles to the transverse sinus. The Sinushunt is not a classical differential...

Colpopromontoriosacropexy with Stratasis Bandage in Anterior Vaginal Prolapse in Kidney Transplanted Patients

Women with kidney transplant and anterior vaginal wall prolapse should be operated early. Infact the anatomical and functional alteration of pelvis, in this case, can cause urological diseases which can deteriorate antireflux system of kidney transplant. These women can be submitted to colpopromontoriosacropexy using a Stratasis bandage. Stratasis, is a biomaterial derived from submucosa of pig bowel. It is inert, not immunogenic, it does not cause sensitization or extra body reaction, it will be biotransformed, it is progressively colonised and substituted by tissue where it is placed. It is suitable to be used in transplanted patients, because of its early colonisation and rapid neo-vascularization, that means supply of nutritive substance and infection resistance. We operated with this technique two women with kidney transplanted six years before. They were 47 and 55 years old with III-IV degree cystocele. We made hysterectomy, adnexectomy and indirect colpopromontoriosacropexy with Stratasis bandage. Both patients have no complications, no urinary infections, no altered renal function, no changes in immunosuppressive therapy, bladder catheter was removed on sixth day. They were dismissed in eighth and fourteenth day. Patients have spontaneous and regular micturition, they are continent, post-micturition residual is less than 30 cc.

A novel antireflux uretero-ileal anastomosis for urinary diversion: an experimental study.

To assess a new antireflux valve technique in a dog model of urinary diversion, and thus provide a reliable and easily constructed antireflux system for an ileal reservoir. In five female beagle dogs, 3 cm of ileum were intussuscepted into the reservoir formed using the adjacent 10 cm of ileum. The intussuscepted ileum was sutured to the reservoir wall after stripping the mucosa of the reservoir in a trapezoidal zone opposite the similarly stripped mucosa of the intussuscepted ileum, to avoid dessusception. After the distal 4 cm of the ureters was united and pulled through the intussuscepted segment of ileum, the combined distal ureter was sutured to the labial edge of the intussuscepted segment. Finally, the reservoir was anastomosed to the bladder as an enterocystoplasty. Dogs were evaluated by ascending cystography and intravenous pyelography at 1 and 6 months. The valve and upper urinary tract were evaluated histopathologically at 6 months. In all dogs the antireflux system remained intact and prevented reflux. The intussuscepted ileum was firmly attached to the reservoir wall and the submucosa of each segment was united. The upper urinary tract was normal with no ureteric stenosis. Histopathologically, the ureter was surrounded by intact ileal serosa and showed no inflammation or scarring. The very short ileal segment required and the firm attachment of the constructed valve to the reservoir were the advantages of this practical and reliable new antireflux system.

Estenosis ureterales de las anastomosis urétero-ileales

Replacement plasty allows to perform oncology surgery while maintaining body image and preserving renal function. Enteroureteral anastomosis is a significant element in this procedure where the main responsible for the loss of renal function are stenosis, infection and reflux.1Our group has performed 206 orthotopical vesical replacements (November 1981 - November 1998), using a direct Wallace-type uretero-ileal anastomosis. An intussusception valve system was used as antireflux mechanism. The number of obstructions, rate of stenosis at the uretero-ileal junction and incidence of valve stenosis were all analyzed as part of the complications occurred over a follow-up period of 54 months (6-183).Findings included 6 stenosis at the uretero-intestinal junction and 2 at the intussusception valve. Two (3.8%) of the uretero-ileal stenosis were earlier and associated to fistula; one was treated with open surgery and one had a double J placed through antegrade percutaneous access. Of the remaining late four, only one was treated with a double J catheter while the other three had to be re-operated. Stenoses of the valvular system (1.2%) were solved with open surgery.From our experience, we believe that direct uretero-ileal implantation with scraping of the ureter is a safe technique with little risk for stenosis at the uretero-ileal junction. Intussusception was used a antireflux system in all cases.