External Drainage Catheter Research Articles

Internal versus external biliary drainage in malignant biliary obstructions: is there a difference in the rate of infection?

Percutaneous biliary drainage is a frequently used method to provide biliary decompression in patients with biliary obstruction. To investigate the between drainage type and infection risk in patients treated with internal-external and external biliary drainage catheterization for malignant biliary obstruction. A total of 410 patients with malignant biliary obstruction who underwent internal-external or external biliary drainage catheterization between January 2012 and October 2016 were retrospectively evaluated. We investigated the correlation between percutaneous biliary drainage technique and infection frequency by evaluating patients with clinical findings, bile and blood cultures, complete blood counts, and blood biochemistry. There was no statistically significant difference between the selected patient groups (internal-external or external biliary drainage catheter placed) in terms of age, sex, primary diagnosis, receiving chemotherapy, catheter sizes, and outpatient-patient status. After catheterization, catheter-related infection was observed in 49 of 216 (22.7%) patients with internal-external and 18 of 127 (14.2%) patients with external biliary drainage catheters, according to the defined criteria. There was no difference in infection rate after the biliary drainage in the two groups (P > 0.05). There was also no difference concerning frequently proliferating microorganisms in bile cultures. Internal-external biliary drainage catheter placement does not bring an additional infection risk for uninfected cholestatic patients whose obstruction could be passed easily in the initial drainage.

External cavitary drainage catheter for large cerebralabscess in high-risk patients: Novel technique

External cavitary drainage catheter for large cerebralabscess in high-risk patients: Novel technique

Technical Feasibility, Short-Term Patency, Safety, and Efficacy of Percutaneously Delivered Double Pig-Tail Stent for Palliation of Unresectable Biliary Malignancies

Abstract Purpose The aim of this study was to evaluate the technical feasibility, complication rate, and efficacy of percutaneously delivered plastic biliary stent, compared with that of internal–external biliary drainage catheter. Methods Patients with unresectable malignant biliary obstruction were included who underwent percutaneous transhepatic biliary drainage and double pigtail plastic stenting (DPT-PS) or internal–external biliary drainage catheter in 15 months' duration. Results Seventy-seven patients were included in the study who underwent DPT-PS (n = 37) or internal external drainage catheter placement (n = 40). Overall, the technical success rate for percutaneous plastic stenting was 92.5% and technical success rate for primary stenting at the time of initial puncture was 62%. The incidence of fever and hemobilia was similar across the two groups, whereas bile leakage in the perihepatic space and through the skin at puncture site was higher in patients with internal–external drainage catheter. Both the techniques were effective in reducing the bilirubin levels of patients. Re-intervention was done in five patients in DPT-PS and six patients with ring biliary catheter. Conclusion DPT-PS may be used as a viable cost-efficient alternative for unresectable biliary malignancies with low post-procedure life expectancy

A Clinical Study on Pseudocyst of Pancreas

Background: Pancreatic pseudocyst is seen in acute and chronic pancreatitis as a complication. It has a well-defined wall which is not made of epithelium. After an acute attack of pancreatitis, pancreatic pseudocyst develops after 4-8 weeks. There is a increased incidence of pancreatitis and complications of pancreatitis, despite of treatment and recent advances. So, I would like to study the clinical features, etiology, various treatment modalities and asses outcome of the patients. Methods: The study is conducted in 50 patients in S.V.R.R.G.G.H. hospital, Tirupati in the department of general surgery. Thorough history and clinical examination have been recorded. Investigations were done which are basic and definitive. The study patients were managed with different modalities like conservative, external catheter drainage, cysto-gastrostomy, cysto-jejunostomy, percutaneous drainage. Data regarding the age distribution, gender distribution, symptoms, signs, complications, treatment, post op complications, duration in the hospital, follow up were collected. The final outcome is observed in terms of most common age group, most common gender affected, most common etiological factor, symptoms, signs, associated complications and treatment, post complications in S.V.R.R.G.G.H. Tirupati, in the department of general surgery. Results: The study conducted in 50 patients shows that, the pancreatic pseudocyst is seen in the age group of 31-50 years (74%). The male patients were affected more when compared to females with 94% male and 3% female. Alcohol consumption is the common etiology. The most common presentation was pain abdomen in all study patients followed by nausea and vomiting in 84% of patients and abdominal distension in 58% of patients. Abdominal tenderness is seen in all study patients followed by mass abdomen in 60% of patients. Associated complications include infection which is seen in 12% of patients followed by ascites and ileus/obstruction in 2% of patients. USG and Computed Tomography done in all patients. Conservative treatment was effective in uncomplicated pancreatic pseudocyst. Internal drainage procedure shows good results with 42% of patients with minimal complications. The most common post operative complication include abdominal pain in 16% followed by infection of wound in 6% of patients. Conclusion: The most common complication of acute pancreatitis is pancreatic pseudocyst. Early diagnosis with USG, CT and intervention with conservative treatment for uncomplicated cyst, internal drainage for mature cyst, external drainage for complicated cyst shows good prognosis.

Tunneled Uncuffed Pigtail Drainage Catheter Placement in Patients with Refractory Ascites or Pleural Effusion: A Single-Center Experience.

No evidence exists to support the use of tunneled non-cuffed pigtail drainage catheters in patients with refractory ascites or pleural effusion. The purpose of this study was to determine the feasibility of non-cuffed tunneled pigtail drainage catheters in patients with refractory ascites or pleural effusions. Between October 5, 2020 and May 25, 2021, 34 pigtail catheters were implanted in 27 patients (17 males, 10 females; average age: 65.66 ± 12.04years) under either ultrasound or computed-tomography guidance (19 catheters for ascites, 15 catheters for pleural effusion). Twenty-eight catheters (82.35%) were implanted for malignant etiologies, and 6 catheters (17.65%) were implanted for benign etiologies. The catheters (size: 8-14 French) were implanted through a subcutaneous tunnel. Complication rate and factors related to complications were analyzed. Catheter lifetime was analyzed with Kaplan-Meier method. Patency ranged from 3 to 211days. None of the patients experienced a major complication (e.g., peritonitis and empyema). Meanwhile, 8 minor complications were observed including 3 catheter occlusion, 3 ascites leakage, 1 peri-catheter local skin infection, 1 peri-catheter local skin reaction. None of the etiologies were related to the catheter complications. However, the 8-F catheter was associated with a significantly higher complication rate (odds = 5.5, p = 0.044). The estimated mean [CI] dwelling time of a catheter was 59.18 [32.97, 85.39] days. Image-guided insertion of tunneled peritoneal or pleural pigtail external drainage catheters achieved with a 100% technical success rate and resulted in an acceptable complication rate and catheter lifetime for the management of refractory ascites or pleural effusion.

Use of a Cutting Balloon Dilation as a Rescue Therapy in Patients with Benign Bilioenteric Anastomotic Strictures Refractory to Conventional Balloon Dilation

Percutaneous balloon dilation with or without placement of an external biliary drain is a nonoperative alternative method for treating benign bilioenteric anastomotic strictures. Although this procedure has a high technical success rate, outcomes are less optimal when attempting to dilate refractory tight strictures. For the stricture, cutting balloon can be an option. We present four patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation. To the patients, a peripheral cutting balloon over-the-wire system was inflated, following subsequent conventional non-compliant balloon dilation. After the balloon dilation treatment, an external drainage catheter was placed through the stricture site and maintained for up to 30 days. Technical and end-treatment success was achieved in all four patients. In conclusion, the use of cutting balloon dilation may appear to be a safe and effective alternative method of treatment in patients with benign bilioenteric anastomotic strictures refractory to conventional balloon dilation.

Percutaneous Balloon Retrieval Technique for Fractured Biliary Drainage Catheter in a Paediatric Patient: Can a Major Surgery be Averted?

Percutaneous Transhepatic Biliary Drainage (PTBD) involves temporary placement of an external drainage catheter into an obstructed bile duct prior to internal biliary stenting or surgery. Chronic indwelling PTBD catheters can develop surrounding adhesions and are prone to fractures and retention during their removal. Retained segments can cause impaired biliary drainage, inflammation and recurrent cholangitis. Retrieval of retained catheters can be done by endoscopic/surgical/percutaneous techniques. In patients who have undergone Hepatico-Jejunostomy (HJ), endoscopic removal is not possible and percutaneous/surgical removal are the only options. The authors present a case of a five-year-old child who came for removal of a fractured, retained PTBD catheter, nine months after undergoing HJ. The catheter was removed by a percutaneous balloon retrieval technique. The objective here is to highlight the technical challenges encountered and present a modification of the usual balloon retrieval technique used to successfully remove the catheter and thus avert a major surgery.

Perkütan Transhepatik Biliyer Drenaj: Tek Merkezli Retrospektif Çalışma

Background: Percutaneous transhepatic biliary drainage is a procedure commonly used in malign and benign biliary pathologies. The aim of this study is to evaluate the effectiveness, complication rates and results of percutaneous transhepatic biliary drainage.Materials and Methods: 49 patients, to whom percutaneous transhepatic biliary drainage was performed due to different malignant and benign pathologies between April 2018 and April 2020 in the interventional radiology de-partment of our hospital, were included in the study. 26 of the patients were male, and 23 were female. The ages of the patients ranged between 8 and 87, and the mean age was 62.18±15.8. External drainage catheter was inserted in 11 patients, and internal-external drainage catheter in 38 patients. Metallic stent was inserted in two patients. The efficiency of the procedures was evaluated according to the comparison of preprocedural and postprocedural direct and total bilirubin values and the improvement in clinical findings. Procedure-related early and late complica-tions were obtained.Results: Technical success was achieved in all patients who underwent percutaneous transhepatic biliary drainage. The preprocedural and postprocedural total bilirubin median values were 16.2 mg/dl (0.6-30.5) and 6.3 mg/dl (0.7-26.9), respectively. The preprocedural and postprocedural direct bilirubin median values were 11.9 mg/dl (0.3-15) and 4.3 mg/dl (0.2-15) , respectively. The decrease in the total and direct bilirubin values was found to be significant (p<0.001). Major and minor complications developed in 13 patients in the early and late stages.Conclusions: Percutaneous transhepatic biliary drainage is an efficient method in decompression of malignant biliary obstructions, palliation of the disease and treatment of benign biliary pathologies.Key Words: Percutaneous, Biliary Drainage, Transhepatic

Management of Biliary Stricture in Pediatric Liver Transplantation Patients: Long-Term Outcomes.

Postoperative biliary complications have been reported to occur in 10% to 33% of pediatric liver transplantation (LT) recipients. Percutaneous intervention has become the primary treatment method for these complications; however, the efficacy and outcomes of these patients have not been well studied. Institutional pediatric LT from 1998 to 2019 were retrospectively reviewed to determine the patients referred for percutaneous treatment of post-LT biliary strictures. Clinical parameters, percutaneous transhepatic cholangiograms (PTCs), biliary catheter placement, cholangioplasty, and long-term outcomes were analyzed. Of the 396 consecutive pediatric LT recipients during our study period, 50 (12.6%) were diagnosed with biliary strictures on PTC. LT biliary reconstructions were Roux-en-Y hepaticojejunostomy in 28 patients (56%), choledochojejunostomy in 11 patients (22%), and choledochocholedochostomy in 11 patients (22%). Median age at LT was 23.2months (interquartile range [IQR], 10.9-90.6), and 14 patients (28%) developed hepatic artery thrombosis. A total of 44 patients (88%) were treated with internal/external biliary catheters, of whom 38 (76%) underwent balloon cholangioplasty. By 12months, 84% of patients had complete stricture resolution and catheter removal. Median total duration of catheter drainage was 152days (IQR, 76-308). A total of 8 patients required additional surgery (biliary reconstruction or repeat LT [re-LT]) or died with a drainage catheter in place from complications unrelated to PTC intervention. Among the 6 patients (12%) treated with unilateral external biliary drainage catheters, 2 had catheters removed for inadequate drainage but then had spontaneous biliary obstruction resolution, 1 underwent duct reconstruction, and 3 required long-term catheterization. Biliary strictures following pediatric LT can be successfully treated with internal/external biliary drainage catheters and cholangioplasty if the stricture can be crossed. However, patients with isolated strictured ducts may require long-term external catheter drainage until re-LT or percutaneous obliteration of isolated ducts.

A Retrospective Analysis of the Effectiveness of Extrapleural Autologous Blood Patch Injection on Pneumothorax and Intervention Need in CT-guided Lung Biopsy.

To assess the effect of extrapleural autologous blood injection (EPABI) technique on pneumothorax development before and after coaxial needle withdrawal (CNW) and intervention rate for pneumothorax. To analyze the risk factors of pneumothorax and parenchymal hemorrhage. The records of 288 patients who had lung biopsies were analyzed. Of these patients, 188 received EPABI (group-A) before penetrating the parietal pleura, and the remaining did not (group-B). Intraparenchymal autologous blood patch injection was applied at the end of the procedure. The pneumothorax rates before/after CNW and intervention requirement for pneumothorax were compared between groups. The risk factors of pneumothorax before/after CNW and parenchymal hemorrhage were assessed with stepwise logistic regression. The pneumothorax rate before CNW was significantly lower in group-A (5.92%) than in group-B (19.10%) (p = 0.029). Pneumothorax risk before CNW was reduced if EPABI was applied and skin-to-pleura distance increased. The pneumothorax rate after CNW was similar between two groups (group-A: 6.94%, group-B: 8%), while emphysema grade along the needle path and procedure duration was the significant risk factor. The intervention requirement for pneumothorax was significantly lower in group-A (6.38%) than in group-B (16%) (p = 0.012). Needle aspiration requirement was significantly reduced in group-A. The rate of external drainage catheter and chest tube placement was similar in both groups. The risk factors of parenchymal hemorrhage were overall emphysema grade of the lung, target-to-pleura distance, and target size. Use of EPABI along with IAPBI significantly decreased the pneumothorax rate during biopsy procedure and the intervention rate compared to IAPBI-alone.

Intraperitoneal Ultrasound-Guided Safe Laparoscopic Fenestration of Lymphocele After Kidney Transplantation

Background: Lymphocele is a common complication after kidney transplantation, which does not require treatment unless it is symptomatic. In this study, we aimed to evaluate the incidence, clinical symptoms, treatment choices, and success of different treatment methods of symptomatic lymphocele. Materials and Methods: We evaluated 168 patients who had kidney transplantation between January 2012 and January 2020. Patients with decreased kidney functions due to lymphocele formation during the clinical follow-up were included in the study. External drainage catheter was placed in all patients, except one. In case of treatment failure with external drainage, laparoscopic fenestration guided by intraperitoneal ultrasonography was performed. Clinical symptoms and success rates of treatments were evaluated. Results: Symptomatic lymphocele requiring interventional treatment was detected in 15 (8.9%) of 168 renal transplant patients. All of the symptomatic lymphocele cases had increased serum creatinine levels, whereas 10 had decreased urine volume, 4 had abdominal discomfort, and 2 had ipsilateral lower extremity edema. External drainage catheter was placed as the first-line treatment in 13 patients. In 6 cases, due to treatment failure with external drainage and in 2 patients as a first-choice treatment, laparoscopic fenestration was performed. No lymphocele recurrence was observed during follow-up. Conclusion: Among various methods defined in the treatment of lymphocele, use of laparoscopic fenestration is increasing because of its high success rate and advantages over other methods. Intraperitoneal ultrasound-guided laparoscopic fenestration is a useful and safe method that can be performed as a first-choice treatment since it eliminates the risk of organ injury or bleeding.

Multilevel Postoperative Cervical Epidural Hematoma: Complete Removal Through Catheter Drainage of the Unexposed Blood Collection

Postoperative spinal epidural hematoma is a rare complication of anterior cervical discectomy and fusion. This condition may rapidly produce severe neurologic deficits, often requiring a prompt surgical decompression. A multilevel extension of the epidural bleeding has been rarely described after anterior cervical procedures. In such cases, the choice of the most suitable surgical approach may be challenging. Herein, we describe an effective surgical decompression of a C2-T1 ventral epidural hematoma following anterior cervical discectomy and fusion at the C5-C6 level. By reopening the previous approach, the C5-C6 intersomatic cage was removed and the surgical field inspected for bleeding. After removal of the spinal epidural hematoma at this level, a lumbar external drainage catheter was inserted into the epidural space to perform multiple irrigations with saline solution until the washing fluid was clear. Immediate postoperative cervical computed tomography and magnetic resonance imaging revealed gross total removal of the epidural hematoma and complete decompression of the spinal cord all along the affected tract. Early postoperative neurologic examination revealed mild lower extremity weakness that fully recovered within hours. Although rare, multilevel epidural hematoma following anterior cervical decompression represents a serious complication. The revision of the previous anterior cervical approach may be considered the first treatment option, allowing to control the primary bleeding site. Catheter irrigation of the epidural space with saline solution may be a useful technique for removal of unexposed residual blood collection, avoiding the need for posterior laminectomy or other unnecessary bone demolition.

A technique for witzel tunnel catheter drainage of the biliary and pancreatic anastomosis of a Whipple procedure

Presenter: Mridul Pansari MD | Florida Atlantic University Background: Stenting of the pancreatic and biliary anastomoses of a Whipple procedure has been shown to lower the rate of anastomotic leak in several retrospective and prospective studies. We describe here a combined biliary and pancreatic ductal external drainage catheter we have used successfully in our pancreatico-duodenectomy operations. Methods: We have identified a combined biliary and pancreatic ductal external drainage catheter / stent which we construct on the operating table to decompress the small bowel limb and both anastomoses. The single catheter is a combination of a red Robinson catheter and a silastic pediatric feeding tube each of appropriate size for the duct they are draining. The silastic feeding tube is inserted into the lumen of the red rubber catheter though a small tight fenestration in the elastic external segment of the red catheter and exits the red rubber catheter through a similar fenestration at the level of the choledocho or hepatico- jejunostomy. The silastic feeding tube is then advanced well into the lumen of the pancreatic duct where it is secured to the small bowel mucosa with a fine absorbable suture to prevent dislodgement. Multiple small extra openings are cut into both tubes at their distal segments to facilitate ductal drainage. The combined tubes then exeunt the small bowel “Whipple limb” though a Witzel tunnel. The small bowel is secured to the right upper quadrant abdominal wall with several interrupted 3-0 Vicryl sutures. The tube is secured to the skin externally with a heavy nylon suture. The pediatric feeding tube is then secured to the outer part of the red rubber catheter with benzoin and three ¼ inch steri-strips. Both catheters are connected to separate external drainage bags. We perform our pancraetico- jejunostomy with a single layer of interrupted 3-0 silk suture and our bile duct anastomosis with a single layer of 4-0 or 5-0 PDS or Maxon suture. Two 10 mm Jackson Pratt drains are then placed in the right upper quadrant. Results: There are several theoretical advantages that our procedure offers. First, it diverts the pancreatic fluid and bile, decreasing it's flow through the respective anastomosis which helps in the healing of the anastomosis. Secondly, our technique is a more durable way of stenting the two anastomoses and prevent the migration of the stents. The pediatric feeding tube has three areas of resistance that prevents its migration. The fenestration in the external portion, the fenestration in the internal portion and the mucosal stitch that is placed to hold it in place. The red rubber catheter is kept in place by the Witzel tunnel itself. Third advantage is that it provides an opportunity to study the two anastomosis via contrast administration. Fourth, the witzel tunnel and the anchoring of the jejunal limb to the lateral abdominal wall opens the door for several wire based treatments in a Seldinger fashion, should a leak be identified in the post operative period. Conclusion: The use of a combined biliary and pancreatic ductal external drainage catheter / stent system has many theoretical advantages.

Secondary sclerosing cholangitis from percutaneous transhepatic biliary drainage in a patient with gallbladder cancer after surgery: A case report

Secondary sclerosing cholangitis (SSC) is a chronic cholestatic liver disease characterized by fibrosis and stricture of the bile ducts. SSC in association with multiple factors such as spontaneous choledochoduodenal fistula and metastatic gallbladder cancer has rarely been reported. However, to the best of our knowledge, reports of SSC after percutaneous transhepatic biliary drainage (PTBD), especially in cases with diffuse calcification of the bile duct walls, have not been reported. We report a case of SSC from PTBD in a patient with gallbladder cancer after surgery. The patient underwent external percutaneous biliary drainage for malignant bile duct obstruction after cholecystectomy. Repeated exchanges were performed at the first and the sixth month after PTBD using an internal and external drainage catheter. Two months after the third catheter exchange, findings of laboratory and imaging examinations were suggestive of SSC. The liver function tests of the patient were suggestive of cholestasis. Multidetector computed tomography showed diffuse calcification of the bile duct walls. Cholangiography showed intrahepatic biliary stenosis or dilatation.

Application of high quality nursing intervention model in nursing of subcutaneous tunnel type lumbar cistern catheter

Objective To observe and evaluate the application effect of high quality nursing intervention model in nursing of subcutaneous tunnel type lumbar cistern catheter. Methods From January 2017 to April 2019, 86 patients without intracranial infection and with indwelling lumbar cistern external drainage catheter indication were randomly divided into two groups according to the method of digital table. 43 cases in the control group were given routine nursing methods, 43 cases in the observation group were given high quality nursing intervention on the basis of routine nursing methods, including psychological nursing intervention, intraoperative nursing intervention, postoperative nursing intervention, prevention of infection, nursing intervention before and after extubation. The nursing effect and nursing satisfaction of the two groups were compared. Results The incidence of adverse events in the observation group was significantly lower than that in the control group (4.65% vs.25.58%) (χ2=7.340, P=0.007), the scores of SDS and SAS in the observation group were significantly lower than those in the control group (t=21.133, 19.051, P=0.000, 0.000), and the satisfaction rate of nursing service in the observation group was significantly higher than that in the control group (97.67% vs.81.40%) (χ2=4.468, P=0.035). Conclusion The application of high quality nursing intervention model in subcutaneous tunnel type lumbar cistern catheterization and after operation can reduce the risk of catheter nursing, effectively reduce the incidence of adverse events, significantly alleviate the negative mood of patients, improve the satisfaction of patients on nursing service, and is worth popularizing and applying in catheter nursing service. Key words: High quality nursing intervention; Subcutaneous tunnel type; Lumbar cistern external drainage; Nursing satisfaction

2179 Placement of Palliative Stent With Guidance of a Percutaneous Transhepatic Stent

INTRODUCTION: The incidence of pancreatic cancer has increased in the last decade. There have been improvements in pancreatic cancer through a multidisciplinary approach including chemotherapy, surgery, and radiation. The Whipple procedure is the mainstay operation for pancreatic head tumors; however, long term complications include cholangitis and pancreatitis. Cholangitis can be managed with drainage or stenting. Although PTC stent allows for drainage of the biliary system, an obstruction may call for internal stent placement. This case highlights placement of a stent using a pre-existing PTC drain for guidance. CASE DESCRIPTION/METHODS: A 71-year-old Caucasian male with history of pancreatic cancer status post a Whipple and chemoradiation presented with obstructive jaundice. EGD demonstrated a malignant stricture of the afferent jejunal limb. Attempted endoscopic stenting was unsuccessful. An 8.5 Fr PTC with internal and external biliary drainage catheter was performed by IR with the internal drainage catheter placed beyond the stricture. The patient over the course of the next month had decreased output from his biliary drain and was re-admitted with increased bilirubin and leukocytosis. The external/internal biliary drain catheter was replaced without significant improvement. A repeat EGD and ERCP demonstrated a PTC drain in the afferent jejunum and using a biliary wire through the side hole of the PTC drain, the PTC drain was removed over the wire. An uncovered metal stent was placed across the afferent jejunal stricture into the normal jejunal limb. Post procedurally the patient had improved LFTs. However, the patient had an interval rise in bilirubin and ALP. EGD demonstrated a clogged stent and a pigtail plastic stent was placed through the preexisting metal stent to prevent recurrent clogging. After the patient had improvement in his LFTs. DISCUSSION: Management of biliary obstructions requires biliary drainage with either a stent or surgical drainage. This case highlights a multi-step approach for management of a malignant biliary obstruction. After identifying an obstruction, an internal metal stent was placed in a rendezvous approach. Endoscopic metallic stent placement is a common for malignant biliary obstructions in jaundiced pancreatic cancer patients. In an event of an occluded metal stent, placement of a plastic stent is effective for management. This patient had a biliary obstruction after metallic stent placement prompting placement of a plastic pigtail stent within the metal stent.

Minicraniotomy with a subgaleal pocket for the treatment of subdural fluid collections in infants.

Various surgical techniques have been described to treat subdural fluid collections in infants, including transfontanelle aspiration, burr holes, subdural drain, subduroperitoneal shunt, and minicraniotomy. The purpose of this study was to describe a modification of the minicraniotomy technique that avoids the implantation of external drainage catheters and potentially carries a higher success rate. In this retrospective study, the authors describe 11 cases involving pediatric patients who underwent parietal minicraniotomies for the evacuation of subdural fluid collections. In contrast to cases previously described in the literature, no patient received a drain; instead, a subgaleal pocket was created such that the fluid could flow from the subdural to the subgaleal space. Preoperative and postoperative data were reviewed, including neurological examination findings, radiological findings, complications, hospital length of stay, and findings on follow-up examinations and imaging. The primary outcome was failure of the treatment strategy, defined as an increase in subdural fluid collection requiring further intervention. Eleven patients (8 boys and 3 girls, median age 4.5 months) underwent the described procedure. Eight of the patients had complete resolution of the subdural collection on follow-up imaging, and 2 had improvement. One patient had a new subdural collection due to a second injury. Only 1 patient underwent aspiration and subsequent surgical repair of a pseudomeningocele after the initial surgery. Notably, no patients required subduroperitoneal shunt placement. The authors describe a new surgical option for subdural fluid collections in infants that allows for more aggressive evacuation of the subdural fluid and eliminates the need for a drain or shunt placement. Further work with more patients and direct comparison to other alternative therapies is necessary to fully evaluate the efficacy and safety of this new technique.

Recent study progress of risk factors of external ventricular drainage catheter related infections

This article introduced the conception and the harm of external ventricular drainage (EVD) catheter related infections. Risk factors of external ventricular drainage catheter related infections were focused. The six aspects were reviewed: the type of EVD catheters, the duration of EVD retention, the frequency of cerebrospinal fluid sampling during the retention, the frequency of VED catheter replacements, the location of EVD implantation, and the maintenance operation of EVD catheters. The article provided data support for the clinical decision-making of medical staff. Key words: Review; Infection; External ventricular drainage catheter; Risk factor

Importance of Hematoma Removal Ratio in Ruptured Middle Cerebral Artery Aneurysm Surgery with Intrasylvian Hematoma.

ObjectiveRuptured middle cerebral artery (MCA) aneurysm with intrasylvian hematoma usually accompanied by progressive cerebral swelling with poorer outcomes. The authors present characteristics and importance of intrasylvian hematoma removal in the aneurysm surgery.Materials and MethodsFrom 2012 February to 2014 March, 24 aneurysm surgeries for ruptured MCA aneurysms with intrasylvian hematoma were performed in the authors' clinic. The patients were classified according to three groups. Group A included patients who underwent decompressive craniectomy within a few days after aneurysm surgery due to progressive cerebral swelling, group B included patients for whom decompression was not necessary, and group C included patients who showed severe cerebral swelling on admission and decompressive craniectomy and aneurysm surgery in one stage.ResultsThe mean hematoma volume on admission was 28.56 mL, 24.96 mL, and 66.78 mL for groups A, B and C, respectively. Removal of a larger amount of hematoma was observed on postoperative computerized tomography scan in groups B and C (63.2% and 59.0%) compared with group A (33.4%). Although no statistical difference was found between group A and group B (p = 0.115), it tends to show the lesser amount of hematoma removed, the more likely cerebral swelling will progress.ConclusionThe lesser amount of hematoma in ruptured MCA aneurysm with intrasylvian hematoma tends to show benign clinical course than larger amounts. But, even if the hematoma is not easily removed in the operation, we suggest the other procedures such as continuous external catheter drainage of hematoma to avoid unnecessary coagulation or brain retraction.

Magnetic compression anastomosis for patients with a disconnected bile duct after living-donor related liver transplantation: a pilot study.

We present the use of the magnetic compression anastomosis (MCA) technique for treatment of disconnected bile duct after living-donor related liver transplantation (LDLT) using the recently introduced through-the-scope magnet. The MCA technique was used in patients with disconnected bile duct who could not be treated with either percutaneous or endoscopic procedures. All patients already had a percutaneous external biliary drainage catheter before the procedure. The magnet was placed percutaneously into the proximal side of the obstruction by pushing a 5-Fr catheter over a guidewire. Concurrently, endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic papillary sphincterotomy was performed. The sister magnet was then carefully advanced to the opposite side of the obstruction with a 5-Fr catheter over a guidewire. After the confirmation of biliary recanalization, a guidewire was passed through the stricture and a percutaneous dilation of the stricture was performed with a balloon-tipped catheter. Endoscopic balloon dilation of the stricture, insertion of two plastic stents and the removal of the internal drainage catheter were performed during the first ERCP session. Stent exchange and multiple side-by-side stent placements were planned at regular intervals (3 monthly) for all patients. A total of six LDLT patients with disconnected bile duct (aged 37 - 68, four men) underwent the MCA technique between September 2014 and July 2015. Biliary recanalization was achieved 13 - 42 days after the magnet placement procedure. The success rate of the procedure was 100 %. The MCA technique using a small magnet (diameter 2.4 mm) is effective and useful in LDLT patients with disconnected bile duct.