Continuous Suction Research Articles

Negative-pressure box under continuous suction for shielding against aerosols produced by patients with COVID-19 during abdominal ultrasound-guided intervention

The American Institute of Ultrasound in Medicine states that ultrasound providers must be safeguarded from COVID-19 transmission [1American Institute of Ultrasound in MedicineGuidelines for cleaning and preparing external- and internal-use ultrasound transducers and equipment between patients as well as safe handling and use of ultrasound coupling gel.Updated Statement March. 2020; 27 (Available at)https://www.aium.org/officialStatements/57Google Scholar, 2American Institute of Ultrasound in Medicine. Quick guide on COVID-19 protections-patient and ultrasound provider protection. Available at: https://aium.s3.amazonaws.com/covid19/Covid19_Quick_Guide_PUPP.pdf.Google Scholar, 3Chiu PWY Ng SC Inoue H et al.Practice of endoscopy during COVID-19 pandemic: position statements of the Asian Pacific Society for Digestive Endoscopy (APSDE-COVID statements).Gut. 2020; 69: 991-996Crossref PubMed Scopus (209) Google Scholar, 4Bertroche JT Pipkorn P Zolkind P et al.Negative-pressure aerosol cover for COVID-19 tracheostomy.JAMA Otolaryngol Head Neck Surg. 2020; (https://doi.org/Epub ahead of print])https://doi.org/10.1001/jamaoto.2020.1081Crossref PubMed Scopus (34) Google Scholar]. Additionally, ultrasound examinations should be postponed to prioritize urgent procedures involving percutaneoushepato-biliary drainage and ablation of hepatocellular carcinoma. However, novel means for shielding against patient-generated aerosols remain undeveloped. A negative-pressure room should be prepared to turn off aerosol circulation when performing interventions for patients with COVID-19. However, such facilities are uncommon in ultrasonography units. We herein describe the use of a negative-pressure box under continuous suction for shielding against COVID-19 during ultrasound interventions (Fig. 1A) (Video S1). The prepared materials included a transparent vinyl bag, kitchen rack, and binder clips (Fig. 1B). Written informed consent was obtained. First, the box was created by clipping the bag inside the rack. Next, a suction tube was inserted into the openside of the box, resulting in a negative-pressure box. An oxygen-insufflated nasal tube was simultaneously inserted into the upper side of the box to maintain patient respiration (Fig. 2A). After the right arm was raised outside the box via a suitable hole, the openside was wrapped with a clean disposable cloth on the mid-body. The upper body was almost completely shielded by the box (Fig. 2B). This method can be an alternative means for minimizing virus transmission during urgent abdominal ultrasound-guided interventions. None declared. We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of the manuscript. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI4MWIyYjgxZjhmZTg0ZjdhM2YyMzMyNTUzNzE5YjBhMiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc0ODI0NTM4fQ.LhwxSAp7bc3GCG_InWo3LjVsGihkjAejsgR1_WJUtc9vU3PKYDmBc0V4NxxMJVkVMSNXBN-P3D67ecR9YnWLZ8onm04h66SE5nI6w-INX9q6z_hdll8ufbgtux1L00lYRqc84MKOHl--rlkdcTO2M3BLYbPe7YLG-TFj-TI3SDk0Ciej0NQ2KVhK6JESYerADQneHvr9yJeAn0RchtmizY1HgnT8VYL-_QX-j7Tk3CfTqDdPZsZsWdSPbbjlAiB4Oo_MiqS-5sGYX25Jz4b8TeHGHE7LqJ88uOdT5A1hkheggI880cN-6Dqez6ozLbr0ZXuS0pQjFwN8Ip9mMM_04A Download .mp4 (30.1 MB) Help with .mp4 files

A comparative experimental analysis of two unsteady flow control methods in a highly loaded compressor cascade

A comparative experimental analysis is performed on pulsed suction (PS) and pulsed blowing (PB) used to control flow separations in a highly loaded compressor cascade. The effectiveness of the control methods is assessed via oil-flow visualization and steady and unsteady pressure measurements. Firstly, the control effect of the PS is evaluated by comparing the conventional steady continuous suction (SCS). A more efficient control effect is achieved by the PS compared to the SCS. Additionally, in order to further explore the potentials of the PS and PB and gain some insight into their controlling mechanisms, some important excitation parameters including excitation location, momentum coefficient and frequency are comparatively investigated in detail. It is found that the PS and PB are both able to improve the cascade performance by effectively suppressing the passage vortex. With the excitation location moving downstream, the almost opposite change trends for the PS and PB on the total pressure loss and energy efficiency are shown. The PS has an advantage over the PB in improving the cascade performance at the same average excitation momentum. But there is a slighter change of the losses for the PB cases at different excitation frequencies relative to the PS ones, indicating that the PB is more insensitive to the excitation frequency. Based on the optimal excitation parameters, the total pressure loss coefficients for the PS and PB are reduced by 11.3% and 10.3%, respectively. Furthermore, the effectiveness of the PS and PB is also corroborated at a larger incidence angle.

Evaluation of a novel esophageal retractor utilizing vacuum suction and mechanical force for deviating the esophagus.

Deviation of the esophagus prevents esophageal injury during atrial fibrillation ablation. This study is to evaluate, in animals, safety and effectiveness of a novel esophageal retractor that utilizes vacuum suction and mechanical force to deviate the esophagus. Following general anesthesia, a radiopaque ruler was placed behind the animal perpendicular to the esophagus. The esophageal retractor was inserted and esophagram was completed. Suction force (280-300 mm Hg) was applied to the distal aspect of the device that resulted in adherence of the esophagus in a circumferential manner. Then movement of a deflecting arm was used to deviate the esophagus. Four animal studies completed: (a) deviation distance and presence of trailing edge; (b) effect of 1 hour continuous suction and deviation upon esophageal cellular architecture; (c) impact on luminal esophageal temperature (LET) during high power ablation; and(d) compatibility of esophageal retractor with electroanatomic mapping system. The distance of deviation to the right (26.6 ± 2.5 mm)was higher than to the left (18.7 ± 2.3 mm;P < .01). There was no esophageal trailing edge in 65/68 deviations (96%). With continuous suction for 1 hour, pathology revealed small, <1mm, circular area of hyperemia in the esophageal mucosa. During high power ablation, the maximum increase in LET was 0.2°C. Finally, there was no interference between the device and electro-anatomical mapping system. In animal models, the esophageal retractor utilizing vacuum suction was successful at deviating the esophagus without significant trailing edge and with minor (1 mm) injury with prolonged continuous suction.

Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices.

The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed intraventricular flow changes during LVAD ramp tests (baseline ± 400 rpm). LVAD support reversed the increase in blood stasis associated with DCM, but it did not reduce intraventricular shear exposure. Within the narrow range studied, the ventricular flow was mostly insensitive to changes in pump speed. Patients with significant aortic insufficiency showed abnormalities in blood stasis and shear indices. Overall, this study suggests that noninvasive flow imaging could potentially be used in combination with standard clinical methods for adjusting LVAD settings to optimize flow transport and minimize stasis on an individual basis.

Role of Continuous Irrigation Suction (CIS) System in Wound Bed Preparation

Role of Continuous Irrigation Suction (CIS) System in Wound Bed Preparation

Clinical Experience on a Digital Low-Pressure Continuous Suction Unit Having a Trend Forecasting Function for Evaluating Lung Air-Leak

Clinical Experience on a Digital Low-Pressure Continuous Suction Unit Having a Trend Forecasting Function for Evaluating Lung Air-Leak

Necessity is the mother of invention: Technical note on the use of self-designed low-cost continuous sump suction for use in microvascular anastomosis.

Background:Technical advances in microneurosurgery facilitated the continuous evolution of surgery. In many developing countries surgeons face difficulties rendering high quality services due to resource constraints. The continuous dry surgical field is essential for performing microvascular anastomosis. Commercially available sump suctions are costly and beyond the reach of most surgeons in resource-constrained countries.Methods:We designed a suction system which functions on the principles of capillary action and sump effect.Results:The improvised sump suction was used successfully in our patients for micro vascular surgery, giving us a continuous dry field and removing the chance of error by an assistant.Conclusion:The suction system was made with the use of easily available low-cost components, and worked well to the satisfaction of the surgeon.

Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

BackgroundSpontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients.Case presentationA 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH2O and at − 20 cmH2O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day.ConclusionConservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.

873 Gastric Findings During Endoscopic Ultrasound (EUS)-Guided Liver Biopsy

INTRODUCTION: Endoscopic ultrasound (EUS)-guided liver biopsy has recently emerged as an alternative approach to obtain liver biopsy with a low adverse event profile. With the new dedicated 19-gauge EUS core biopsy needle, it is shown that the procedure is safe and provides excellent diagnostic yield with a minimal number of passes. This is of particular importance, given the rise in the metabolic syndrome paralleling the increase in the diagnosis of non-alcoholic fatty liver disease (NAFLD). EUS-guided liver biopsy requires transgastric or transduodenal needle passage to obtain core needle biopsies from left and right lobes of the liver, respectively. However, given the nature of its transmural path, unexpected histopathological results can be seen from gastric tissue acquired during transgastric needle passage. Here we describe incidental and interesting gastric findings obtained during transgastric EUS-guided liver biopsies. METHODS: A retrospective analysis of a prospectively maintained database of all patients undergoing EUS-guided liver biopsy from 01/2017 to 11/2018 was performed. Transgastric liver biopsies were obtained using a 19-gauge core biopsy needle with application of 10 ml suction. The syringe piston was locked into this position for continuous suction. The needle was moved to and fro 2-3 times inside the liver parenchyma under complete endosonographic control. All specimens were recovered, fixed in formalin, and processed for histological analysis. Additional non-hepatic tissue findings were analyzed for any clinically relevant histopathologic diagnosis. RESULTS: A total of 28 patients (mean age 48 ± 14 years; 57% females) were included. The median number of passes was 2 (range 1-3, mean 2). The mean total sample length was 24.5 ± 8.32 mm. Biopsy specimen was adequate for liver histology in all patients. Six patients had additional unexpected histopathological results from gastric tissue acquired during the transgastric needle passage. Four patients were found to have chronic active gastritis with Helicobacter pylori as a “gastric contaminant” on the liver biopsy specimens. One patient had atrophic gastritis and one patient was noted to have autoimmune gastritis further confirmed on serology. There were no reported complications from the procedures. All patients were then subsequently managed for incidentally noted findings. CONCLUSION: This study shows that transgastric EUS-guided liver biopsies can result in incidental bystander gastric diagnoses with clinical importance.

ACUTE PULMONARY EMBOLISM ASSOCIATED WITH A MOBILE RIGHT ATRIAL THROMBUS MANAGED BY SUCTION THROMBECTOMY

SESSION TITLE: Pulmonary Vascular Disease SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/22/2019 3:45 PM - 4:45 PM INTRODUCTION: Pulmonary embolism (PE) associated with a free-floating right heart thrombus (RHT) carries a much higher mortality risk. Optimal management of RHT is controversial. Suction thrombectomy can be a viable treatment option. CASE PRESENTATION: A 66-year-old female was admitted for Rasmussen’s encephalitis. After 2 weeks in the hospital she developed sudden decreased motor skills, facial droop and lethargy. Computed tomography (CT) of the head and neck was unremarkable except for incidental large pulmonary emboli. CT angiogram of the chest confirmed PE extending from the distal main arteries into the lobar branches bilaterally (Fig. 1). An echocardiogram showed a 4x2.6 cm mobile mass within the right atrium that crossed the tricuspid valve (Fig. 2). She had been on deep vein thrombosis (DVT) prophylaxis throughout her hospital stay with subcutaneous heparin and over the 24-hour period preceding these events, her platelet count had decreased from 345,000 to 83,000. Argatroban infusion was started for suspected heparin induced thrombocytopenia. Venous doppler ultrasound showed a DVT in the left leg. She was hemodynamically stable with oxygen saturation in the upper 90’s on room air. However, the patient was considered to have a high mortality risk given her clot burden and the size of the mobile RHT. She was not a candidate for surgery or thrombolytics but considered a candidate for suction thrombectomy. During the procedure, intracardiac echocardiography identified a large thrombus completely filling the right atrium (Fig 3). The Penumbra® suction system was introduced via a 8.5 French sheath to perform the aspiration. Given the size of the thrombus, a snare was used to break up the clot while applying continuous suction with the penumbra device. Aspiration of the clot was successful with minimal residual clot present on the eustachian valve (Fig 4). Video images of the procedure were recorded. The patient did well after the procedure and was discharged on oral anticoagulation. DISCUSSION: There are several suction thrombectomy systems available. The smaller cannulas of the Penumbra® system provide the advantage of flexibility. To our knowledge, this is the first reported case using this system for the management of a RHT. The use of this device in intermediate-risk PE is currently being evaluated in a clinical trial. CONCLUSIONS: Given the lack of clear guidelines for management of RHT, suction thrombectomy with the Penumbra® system can be considered especially when thrombolytics are contraindicated. Further studies are however needed to assess its use for this indication. Reference #1: Barrios D, Rosa-Salazar V, Morillo R, Nieto R, Fernandez S, Zamorano JL, et al. Prognostic Significance of Right Heart Thrombi in Patients With Acute Symptomatic Pulmonary Embolism: Systematic Review and Meta-analysis. Chest. 2017;151(2):409-16. Reference #2: Nosher JL, Patel A, Jagpal S, Gribbin C, Gendel V. Endovascular treatment of pulmonary embolism: Selective review of available techniques. World journal of radiology. 2017;9(12):426-37. Reference #3: Evaluating the Safety and Efficacy of the Indigo Aspiration System in Acute Pulmonary Embolism (EXTRACT-PE) [Available from: https://clinicaltrials.gov/ct2/show/NCT03218566 DISCLOSURES: No relevant relationships by Yasir Akhtar, source=Web Response No relevant relationships by Isaac Biney, source=Web Response No relevant relationships by Peter McKeown, source=Admin input No relevant relationships by Francisco Soto, source=Web Response No relevant relationships by J Turner, source=Web Response

New 'ZISIS' (Zigzag Incision-Suction-Irrigation System) Technique for Endoscopic-Assisted Forehead Tumour Excision.

Endoscopic-assisted excision of forehead tumours like osteomas and lipomas is well established, but the conventional techniques suffer from many limitations like inadequate access, fogging of the endoscope and unclear vision due to collection of blood and debris. Three simple modifications of the conventional endoscopic forehead techniquefor benign tumour excisionsare described by the acronym'ZISIS'. ZI Zigzag scalp incision increases the surface area of the opening permitting easy insertion of multiple instruments along with the endoscope.S Suction tubing made from a disposable suction catheter tube is taped along the endoscope sheath for continuous suctioning and good vision.IS Irrigation system of warm saline made with an infant feeding tube is also taped along the endoscope just opening in the front of the suction tube. A total of 12 consecutive patients underwent endoscopic excision of forehead benign tumours in 2years. This included 2 lipomas and 10 osteomas cases. All patients achievedexcellent hidden scars in the scalp. All patients rated their results as excellent with respect to the hidden scar and aesthetic result. No early or late complications were reported with follow-up ranging from 6months to 2years. A new simple modification called 'ZISIS' endoscopic forehead excision technique is described for benign forehead tumours excision making it easier, efficient and ergonomic. Evidence obtained from multiple time series with or without the intervention, such as case studies.

Concurrent pulmonary hypoplasia and congenital lobar emphysema in a young dog with tension pneumothorax: a rare congenital pulmonary anomaly

BackgroundPulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals.Case presentationA 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems.ConclusionsThis case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.

In vitro evaluation of negative pressure generated during application of negative suction volumes by use of various syringes with and without thoracostomy tubes.

To determine the amount of negative pressure generated by syringes of various sizes with and without an attached thoracostomy tube and whether composition of thoracostomy tubes altered the negative pressure generated. Syringes ranging from 1 to 60 mL and 4 thoracostomy tubes of various compositions (1 red rubber catheter, 1 polyvinyl tube, and 2 silicone tubes). A syringe or syringe with attached thoracostomy tube was connected to a pneumatic transducer. Each syringe was used to aspirate a volume of air 10 times. Negative pressure generated was measured and compared among the various syringe sizes and various thoracostomy tubes. The negative pressure generated decreased as size of the syringe increased for a fixed volume across syringes. Addition of a thoracostomy tube further decreased the amount of negative pressure. The red rubber catheter resulted in the least amount of negative pressure, followed by the polyvinyl tube and then the silicone tubes. There was no significant difference in negative pressure between the 2 silicone tubes. The smallest amount of negative pressure generated was -74 to -83 mm Hg. Limited data are available on the negative pressure generated during intermittent evacuation of the thoracic cavity. For the present study, use of a syringe of ≥ 20 mL and application of 1 mL of negative suction volume resulted in in vitro pressures much more negative than the currently recommended pressure of -14.71 mm Hg for continuous suction. Additional in vitro or cadaveric studies are needed.

Stripping or Milking of Chest Tubes.

Stripping or Milking of Chest Tubes.

Left Ventricular Hemodynamics with an Implanted Assist Device: An In Vitro Fluid Dynamics Study.

Left ventricle assist devices (VADs) aid the heart pumping blood into the systemic circulation and grant the required cardiac output (CO) when the heart itself cannot provide it. However, it is unclear how effective these devices are at restoring not only physiological CO values but also normal intraventricular hemodynamics. In this work, the modified hemodynamics due to a VAD implantation is studied in vitro using an elastic ventricle made of silicone, which is incorporated into a pulse-duplicator setup prescribing a realistic pulsatile flow. Thereafter, a continuous axial pump is connected at the ventricle apex to mimic a VAD and its effect on the ventricular hemodynamics is investigated as a function of the pump flow suction. Using particle image velocimetry (PIV), we observe that the continuous pump flow effectively provides unloading on the ventricle and yields an increased CO. Conversely, the continuous blood suction from the ventricle apex deeply alters the hemodynamics and, in addition, the VAD obstruction in the ventricle behaves as a bluff body that affects the vorticity distribution in the LV thus creating a stagnant region at the ventricle apex. This phenomenon is rationalized by measuring in a modified set-up the benefits on the hemodynamics of a flush-mounted device. Additionally, the suction operated by the VAD reduces the ventricular pressure and yields an increase in the swirling motion around the ventricle axis, in a similar fashion as the bath-tub vortex effect, thus further modifying the intraventricular hemodynamics with respect to healthy conditions.

Effect of using the Suction Above Cuff Endotracheal Tube (SACETT) on postoperative respiratory complications in rhinoplasty: a randomized prospective controlled trial.

Background: The Suction Above Cuff Endotracheal Tube (SACETT) has a dorsal port above the cuff designed to enable the continuous or intermittent suctioning of secretions from the subglottic space. Thus, it facilitates the suctioning of excessive secretions above the cuff and around the glottis.Objectives: In this study, we investigated the effect of the using the SACETT on laryngospasm and postoperative complications in rhinoplasty operations.Methods: This randomized controlled clinical trial enrolled 132 patients undergoing rhinoplasty. The patients were randomly divided into two groups: Suction above Cuff Endotracheal Tube (n=66; Group SA) and classic endotracheal tube (n=66; Group C). Complications following general anesthesia were statistically analyzed among the two groups.Results: The incidence of postoperative laryngospasm (p=0.02) and respiratory complications was found to be lower in Group SA than in Group C. In addition, the incidence of agitation (p=0.035), postoperative nausea, and vomiting (PONV) (p=0.041), which required antiemetic drug administration, swallowing difficulty (p=0.012), and sore throat (p=0.027) were found to be lower in Group SA than in Group C.Conclusion: We suggest that using the SACETT in rhinoplasty reduces the incidence of postoperative respiratory complications as well as the incidence of agitation, sore throat, swallowing difficulty, and PONV.Clinical Trial Number: NCT03584503

Management of Patients With Circumferential Intramural Esophageal Dissection

A novel minimally invasive endoscopic drainage technique using a double-tube system improves the feasibility and safety of conservative treatment in spontaneous esophageal intramural dissection (EID). Two patients with spontaneous EID underwent double-tube system placement through esophagogastroduodenoscopy. One tube was inserted into the submucosal layer with continuous suction, and another nasoduodenal tube was simultaneously inserted for enteral nutritional support. Given the ease of placement and the success of this simple double-tube system method, this technique may provide a new, low-risk, and cost-effective treatment modality for patients with EID.

Endoscopic Ultrasound-Guided Drainage of a Pancreatic Pseudocyst after a Bicycle Trauma

Endoscopic Ultrasound-Guided Drainage of a Pancreatic Pseudocyst after a Bicycle Trauma

Experience of tracheo-esophageal fistula in neonates in a Tertiary Care Center - Case series

Introduction: Tracheoesophageal fistula (TEF) is one of the most common neonatal emergencies. The most common presentation being polyhydramnios detected antenatally, excessive salivation and vomiting, respiratory distress after birth, recurrent pneumonia later in life. The incidence is 1 in 3000 to 1 in 4500 live births. Clinical Profile: Of 1206 admissions in 2017 to the neonatal intensive care unit (NICU), 51 required surgery. Out of which 11 babies were diagnosed with TEF and were subjected to surgery. Antenatal scans revealed polyhydramnios in four babies. Nine babies were born at term with an average weight of 2–2.5 kg and two babies were born preterm at 30 weeks (1.3 kg) and 32 weeks (1.8 kg). Eight babies presented on day 1–2 of life and three babies on day 2–3. The most common clinical presentation was excessive frothing from the mouth noticed since birth and respiratory distress. Nine babies (82%) presented with chest infection of varying severity. Only two babies (18%) had a clear chest. Babies were stabilized in NICU and connected to Replogle tube with continuous negative suction. All babies were subjected to surgery within 24 h of admission. Type C was the most common. Babies were subjected to contrast study to rule out anastomotic leak. Feeding initiated after 72 h of life and was gradually started on trophic feeds and reached full feeds. Outcome: Out of 11 babies, 9 babies recovered and were discharged. One baby was discharged against medical advice and one baby died due to sepsis. Growth is satisfactory and development has been normal at 1 year of age in all discharged babies at follow-up. Discussion: Success in the survival of neonate with TEF is attributed to improved neonatal intensive care with surgical advances and postoperative care. Early recognition, prompt and efficient management of the cases was possible due to multidisciplinary approach by neonatologist, intensivist, and the surgeon. A precise surgical technique with proper mobilization of upper pouch and good anastomosis is key events.

Intraabdominal vacuum therapy with postoperative pancreatic fistula after pancreaticoduodenectomy

Background: The life-threatening postoperative pancreatic fistula (POPF) is a feared complication after pancreaticoduodenectomy (PD). Nowadays there exist modern intraabdominal vacuum techniques as an option of therapy besides the pancreatectomy of the rest. Methods: In our hospital we have treated two patients with type C POPF with intraabdominal vacuum bandages. For this we intraabdominally placed a silicone-coated (Mepithel®) polyurethane sponge (V.A.C.® GranuFoam™) under a continuous suction of between 75 and 125 mmHg at the target place. One of the applications was carried out via open surgery while the other one was done laparoscopically. In both cases the vacuum bandages have been repeatedly changed and finally an open wound management via wound tamponade was applied until the wounds healed definitely. Results: From January 2013 to December 2016 161 pancreatic surgeries have been carried out in our hospital. 100 cases thereof were PD with a total fistula rate of 16% (16/100). Among these there have been two cases of type A POPF (2%), 11 cases of type B POPF (11%) and three cases of type C POPF (3%). Two cases of type C POPF could be treated successfully by the use of intraabdominal vacuum bandages. No rest pancreatectomies have been necessary. Conclusion: The experiences in our hospital have shown that the above intraabdominal vacuum technique represents a sensible therapy option in the treatment of type C POPF and that by the use of a rest pancreatectomy can be avoided.