Location Of Fistula Research Articles

A study on magnetic resonance imaging in patients having perianal pathology

Introduction: Perianal region is a commonly affected area in the course of several inflammatory, infectious, and neoplastic diseases. Several imaging modalities are used in imaging evaluation of this area and magnetic resonance imaging (MRI) emerges as the imaging modality of choice due to its superb soft tissue resolution. MRI is not only useful for initial detection of perianal pathologies but also in the follow-up of these disorders. Magnetic resonance imaging (MRI), with its superb soft tissue resolution, is the imaging modality of choice for anal and perianal abnormalities.Pelvic phased array coils allow more comfortable and tolerable scans with higher signal-to-noise ratios and wider field of view. Parallel imaging techniques result in shorter scan durations T2-weighted images obtained with and without fat saturation as well as postcontrast T1-weighted images with fat suppression are the most helpful sequences. Postcontrast images are helpful, mainly for differentiating postoperative changes and chronic granulation or fibrotic tissue from active inflammation and abscess formation. Axial and coronal oblique images of the anal canal should be acquired with proper and accurate multiplanar prescription in order to get ideal images which are perpendicular and coronal to the anal canal.Materials and MethodsInclusion criteria: Patients with perianal discharge, swelling, pain or pruritus & diagnosed of having perianal pathology by MRI study (1.5 T MRI).Exclusion criteria: All patients referred to department of radiology, L G hospital, maninagar, Ahmedabad with rectal mass by MRI study (1.5 T MRI)All patients with contraindications to MRI like patients with metallic implants, claustrophobia, pacemakers and patients with contrast allergy.Study type: Retrospective study (record-based study). Consent not required for retrospective study.Results and Conclusion In our study of 50 patients, out of which 42 were males & 8 were females, the most common affected age group were between 25-35 years (42%).The most common location of fistula in our study was at 6’O – 7’O clock (36%) position followed by 12- 1’O clock (28%) position.The most common type in our study being intersphincteric type (48%) according to PARK’S classification and the most common Grade in our study being grade 1 (simple intersphincteric fistula) (26%) according to St JAMES classification.Adequate understanding of relevant pelvic anatomy and fistula classification on MRI examination is essential in providing proper assessment of perianal fistulas.Evaluation of clinically undetectable disease has significant bearing on guiding medical & surgical therapy & can help minimize recurrence & better predict outcome compared to surgical exploration.

409. RECONSTRUCTION OF A SEGMENTAL OESOPHAGEAL DEFECT WITH A TUBED RADIAL ARTERY FOREARM FREE FLAP GUIDED BY 3-DIMENSIONAL MODELLING

Abstract Segmental defects of the oesophagus are rare but complex. If the patient survives the initial insult, reconstructive techniques most commonly involve gastric pull-up or colonic interposition (1) however alternative techniques such as free flap reconstruction can be utilised if the former are unsuitable (2). The surgical field often is quite hostile in these cases, making pre-operative visualisation and planning critical in achieving a successful outcome. We describe our approach after a surgical complication in a 49-year-old man. cT3N2M0 GOJ adenocarcinoma, pre-operative FLOT4, three-stage oesophagectomy complicated by anastomotic leak and tracheo-gastric fistula. Cervical oesophagostomy and venting gastrostomy (via laparotomy) was performed (severe illness precluded one-lung ventilation). He improved and was discharged, but a persistent fistula from the gastric conduit to his trachea remained. Reconstruction was planned by a multidisciplinary team using detailed 3D modelling. Via right thoracotomy, the gastric conduit was reduced into the abdomen and the tracheal defect was repaired with an intercostal muscle flap. A retrosternal colonic interposition restored gastrointestinal continuity. The superior 2 cm infarcted and was replaced by a dual-paddled tubular radial forearm free flap. This complex surgical situation demonstrates how 3D visualisation of a segmental oesophageal defect can be extremely helpful in pre-operative planning. In particular, the precise anatomical location of the gastro-tracheal fistula and its relationship to the bony landmarks and surrounding vascular anatomy were critical in considering surgical access and reconstruction options. Whilst the literature describes applications of 3D visualisation for surgical planning in alternative contexts, there is minimal information of its use in upper gastrointestinal reconstruction. The use of 3D modelling and printing within the surgical context has frequently been associated with reduced operating times and improved medical outcomes (3). This case adds to the previously documented advantages of 3D modelling in surgical planning but applies them to an area not well covered in the literature. Additionally, it demonstrates the utility of an infrequently used technique (RAFF) for reconstructing a segmental oesophageal defect. Further research into quantifying the outcomes following the implementation of 3D modelling in visualisation and surgical planning would be useful in encouraging its integration into mainstream surgical practice.

A Case Report: Vesico Vaginal Fistula

Background: Vesica vaginal fistula is a part of urogenital fistula wich condition that present fistula between bladder and vagina and make urine mold through vagina. Case Report: Nullipara woman, 48 years old, admitted with complaining mold of urine from vagina since ten months ago after seven days having surgery procedure. Complaint appeared seven days after hysterctomi procedure as indication of uterine myoma. The vital signs are normal. On Per Speculum examination, clearly see there are fluids on the posterior fornix. Methylene blue test show result one fistula is at the top anterior of vagina, 6 cm proximal from hymenal ring about 1-1.5 cm. The patient underwent fistulorraphy with a vaginal approach using the futh mayo technique Discussion: Vesica vaginal fistula usually occur in the development country. Predisposition factors of it caused by hysterectomy procedure, besides trauma during labor and complications of pelvic surgery may also too. Physical and additional specific examination conventionally or minimally invasive like cystoscopy, cystography with contrast can obtain diagnosis, determine the location, size and number of fistula. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed. Surgery is the mainstay therapy for urogenital fistula through trans vaginal or trans abdomen. Approaching depends on knowledge, experience and collaboration with other experts if needed.

Management and prevention of brachial plexus injury caused by surgical suture of neck dissection induced chylous fistula

BackgroundThe complication of brachial plexus injury (BPI) after surgical suture of chylous fistula caused by neck dissection is extremely rare. For the first time, we investigated the treatment and prevention strategy of BPI caused by surgical suture of neck dissection induced chylous fistula. MethodsForty-two patients undergoing surgical suture of neck dissection induced chylous fistula were identified between January 2015 to March 2022 at a single tertiary academic center. All patients were divided into two groups, medial anterior scalene muscle (MASM) group (24 patients) and lateral anterior scalene muscle (LASM) group (18 patients), according to the location of fistula regarding scalene muscle described in the surgical records. The incidence of BPI between the two groups after surgical suture was summarized and compared. ResultsThere was significant difference in the incidence of different degrees of BPI between the two groups. In the MASM group, the incidence of BPI was 0 % (0/24), while in the LASM group, 6 cases suffered different degrees of BPI immediately after operation and the incidence of BPI was 33.3 % (6/18) (p < 0.05). The neurological function of all BPI cases recovered within 1–3 months after the suture was removed in time. ConclusionThe incidence of BPI in patients of LASM group was significantly higher than that of MASM group. When suturing this kind of fistula, the depth of the needle should be properly controlled to avoid BPI. In case of BPI, the suture should be removed as soon as possible to promote the recovery of neurological function.

Anesthetic management of tracheo-esophageal fistula

: The anesthetic management of a neonate diagnosed to have tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) is challenging, especially due to abnormally connected airway and esophagus interfering with patency of the airway and compromising ventilation. The anatomical variations regarding this congenital anomaly and the associated anomalies in various systems, determines both the surgical intervention and the anesthetic management. An urgent surgical intervention may be required within the first 48 hours after birth in case of severe respiratory compromise. On the other hand, a staged approach may be preferred including a gastrostomy in case of either the presence of low-birth-weight, isolated EA or more critical co-morbidities. A laryngotracheobronchoscopy is often performed prior to definitive surgery in order to identify the location and size of fistula, as well as, secondary upper airway anomalies. In the preoperative period, airway must be secured, and optimizing the status of the neonate in terms of other system functions should have a high priority. Intraoperatively, regardless of the agents used, the anesthetic management should focus on adequate depth of anesthesia, and adequate ventilation and oxygenation. The coordination between the anesthetist and the surgeon is crucial during the surgery in order to secure adequate ventilation and oxygenation. The associated anomalies should be considered as the main determinants of perioperative mortality and morbidity, hence, anesthetic management should also focus on intraoperative maintenance of preoperatively optimized functions. The analgesic management in the postoperative period is often provided by multimodal analgesic use.

Suture approximation of esophageal atresia leads to esophageal recanalization

Esophageal atresia is a congenital pathology in 1:4000 live newborns, which can occur isolated, associated with tracheoesophageal fistula or long gap (>2 vertebral bodies); the surgical objective is the ligation of the fistula and the esophageal anastomosis in the same surgery. However, this may not be possible in all cases [1]. The staged approach initially begins with the ligation of the tracheoesophageal fistula and gastrostomy, and definitive surgery focuses on the esophageal anastomosis. It is performed when the patient presents adequate clinical and anatomical conditions. Spontaneous recanalization of esophageal atresia is rare. The exact mechanism by which it occurs is unknown. Gastric reflux, being in contact with the esophageal distal end, generates inflammation and erosion of the wall, producing communication between the esophageal segments. We propose approximating the proximal and distal esophageal segments utilizing sutures produces an inflammatory process due to a foreign body generating a fistulous tract between the two esophageal components and esophageal recanalization [2]. We present two cases of esophageal recanalization to describe the clinical presentation, diagnostic and therapeutic approaches through imaging tests and endoscopy, contributing to the management of this unusual condition. • Esophageal atresia is a challenge; it presents variations in the location of the tracheoesophageal fistula and the length of the esophageal ends. It occurs isolated or associated with malformations. The pediatric surgeon must individualize treatment for each patient. • In all cases, extreme premature patients have hemodynamic alterations and fragile esophageal tissue, which do not allow performing a primary esophageal anastomosis. • Upper gastrointestinal endoscopy is a diagnostic and therapeutic resource in patients with spontaneous esophageal recanalization or the presence of a recurrent tracheoesophageal fistula.

Comparison of Outcomes between Two Surgical Techniques for Patients with Intestinal Neuronal Dysplasia.

Objective Hirschsprung disease (HSCR) is a serious congenital intestinal disease with a prevalence of 1/5000. HSCR remains one of the most severe congenital malformations of the abdominal organs in children that require complex reconstructive surgery. This study is aimed at investigating the clinical analysis of ileal Santulli stoma and ileal double-lumen stoma in children diagnosed with intestinal neuronal dysplasia (IND). Methods Retrospective analysis was performed on the children who were admitted to our hospital for intestinal obstruction from January 2014 to January 2019, underwent fistula operation and fistula closure operation, and were diagnosed with IND. According to the different modes of fistula, the children were divided into ileal Santulli stoma group and ileal double-lumen stoma group. The body weight of the children in the two groups during the second stage of fistula closure operation was compared. The number of hospitalizations due to enteritis and dehydration during the two operations was compared. Results A total of 23 cases (12 males and 11 females) were included in this study, including 10 cases in the Santulli group and 13 cases in the ileal double-lumen stoma group. There were no significant differences in baseline data and fistula location between the two groups. Compared with the ileal double-lumen stoma group, the Santulli stoma group had significantly higher weight of fistula precursor (P < 0.05), the interval between two operations was shorter (P < 0.05), there is less hospitalization for enteritis and dehydration during the two operations (P < 0.05), and there is less economic cost after fistula (P < 0.05). Conclusion The clinical effect of ileum Santulli fistula is significantly better than double-lumen ileum fistula, which is not only beneficial to the growth and development of children after the first fistula but also can shorten the time of fistula closure, reduce the incidence of dehydration, and reduce the economic burden of family members. Therefore, it is worthy of clinical promotion and application.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula.

Learning curve in performing palatoplasty

Objectives: The aim of the study was to assess the influence of the experience of the surgeon on the occurrence of fistulas and breakdowns following palatoplasty. Materials and Methods: A retrospective review on the outcomes of palatoplasty done by a young surgeon in his initial 3 years of operating cleft palate was done. Cleft palate repair was performed using the Pinto's modification of Wardill–Kilner palatoplasty, Veau-Wardill-Kilner V-Y Pushback in both the techniques radical levator muscle dissection was carried out. Data were collected for age, sex, date of birth, syndrome, cleft palate type, type of repair, cleft width, length of soft palate, quality and quantity of muscle, fistula occurrence, and location of fistula. Results: Retrospective analysis was done on the outcomes of palatoplasty performed by a young surgeon in his initial 3 years at Charles pinto center for cleft lip palate and craniofacial on 220 cleft palate children which included all variants and dimensions of cleft palates. Postoperatively, the incidence of palatal fistulas occurred in 12 patients, three patients had bifid uvula, however, out of 12 patients who had fistulas only four needed fistula closure and one required a uvula re-repair; the rest healed well. Conclusion: We believe there is a learning curve in performing cleft palate repair. Our technique and principles followed in palatoplasty appear to have a low or zero fistula rate even in the initial period of learning. Furthermore, effective mentorship and guidance help in reducing errors and providing a better outcome.

Long-term Follow-up of Bilateral Cleft Lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation.

While bilateral cleft lip and palate (BCLP) constitutes a clinical challenge for the whole cleft team, the ideal surgical protocol remains obscure. This study presents the long-term burden of care in terms of secondary surgeries, defined as fistula repair and speech-correcting surgeries (SCS), in a single center. Outcomes of two surgical protocols utilized over the years were also compared. A retrospective single-center analysis of 81 non-syndromic children with complete BCLP born between 1990 and 2010. Two surgical protocols comprising single-stage and two-stage (delayed hard palate closure) procedures were compared. Outcome was analyzed at the time of alveolar bone grafting (ABG) and post-ABG. Altogether 54 children (66.7%) had underwent secondary surgery by the time of bilateral ABG. At this point, 38.3% (n = 31) of patients had received SCS and 49.4% (n = 40) had undergone fistula repair. The corresponding incidences at the end of follow-up were 46.9% (n = 38) and 53.1% (n = 43). No significant difference emerged in SCS incidence between the 2 protocols; however, prior to ABG the single-stage protocol had a significantly lower need for fistula repair. Regarding the location of fistulas, some differences were observed, with the single-stage procedure more associated with anterior fistulas. BCLP has a high surgical burden of care in terms of secondary surgeries, defined as SCS and fistula repair. In our experience, the single-stage protocol, particularly the two-flap technique, offers better results in the management of BCLP than the two-stage approach with a short delay in hard palate closure.

The role of vacuum-assisted mechanical thrombectomy in the management of acutely thrombosed arteriovenous fistulas and grafts.

The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts. A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates. Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis. In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.

Central Line Access for Hemodialysis Adversely Affects Ipsilateral Arteriovenous Graft Outcomes

Central venous stenosis is a common problem that diminishes vascular access lifespan. Current national guidelines recommend that central catheters and arteriovenous grafts (AVGs) be placed contralateral to an existing hemodialysis access. We set forth to delineate any clinically significant outcomes based on laterality in patients undergoing AVG placement with an existing central catheter for dialysis treatments. Using a Veterans Administration Hospital dialysis access database over a four-year period (May 2014 to April 2018), we identified all patients who underwent AVG placement in an upper extremity with an existing ipsilateral (Ipsi-CL) or contralateral (Contra-CL) central line for hemodialysis. AVG outcomes examined included successful cannulation, functional patency, thrombosis events, and endovascular interventions per access site. Clinical records were also examined for location of AVG, arteriovenous fistula or AVG precursors, prior central line placement, peripherally inserted central catheter, and cardiac venous access. All outcomes were followed until July 2021. Student's t-test, Fisher's exact test, and multivariable analysis were used. A total of 71 AVGs: 55 (77%) were placed contralateral to existing central venous catheters and 16 (23%) were placed on the ipsilateral side. Baseline characteristics between the two groups were not found to be significantly different. This included a history of hypertension, smoking history, prior arteriovenous access, body mass index, race, glucose, creatinine, blood urea nitrogen, hemoglobin, mean corpuscular volume, platelet count, antiplatelet agent, and anticoagulation. 100% (n=16) of patients in the Ipsi-CL group had previous central venous access compared to 49.1% (n=27) in Contra-CL (P=<0.001). The mean functional patency for AVG with Contra-CL was 724.78±593.98days compared to AVGs with Ipsi-CL with mean days of 350.94±431.23days (P=0.001). A history of previous central venous catheterization and graft on ipsilateral side of a catheter at the time of surgery was associated with decreased functional duration of graft (odds ratio, 0.25; P=0.03). Within this cohort of patients that underwent AVG, we noted a statistically significant decrease in the duration of functional patency of grafts ipsilateral to central venous catheters. We did not find a difference in cannulation rates, thrombosis events, or overall endovascular interventions. Ipsilateral central access appears to be associated with decreased functional patency of AVGs. These findings highlight a discrepancy that is potentially clinically relevant and further studies are warranted.

Analysis of Factors Influencing Restenosis after Percutaneous Transluminal Angioplasty

Introduction: This study aimed to analyse the influencing factors of arteriovenous fistula (AVF) ultrasound-guided restenosis after percutaneous transluminal angioplasty (PTA). Methods: This was a retrospective trial. The clinical data and ultrasound examination data of patients in maintenance haemodialysis who received ultrasound-guided PTA for AVF stenosis at our hospital from January 2018 to December 2020 were retrospectively analysed. The fistula patency and the relationship between age, dialysis age, fistula service age, combined hypertension, diabetes, hypoproteinaemia, stenosis type, fistula location, and patency rate after the operation were evaluated. Results: A total of 128 participants were evaluated. The results showed that being over 65 years old, with complications from hypertension, diabetes, and hypoproteinaemia, are all risk factors affecting the patency of postoperative internal fistulas. Compared with lumen stenosis, the patency rate of hyperplastic endothelial stenosis (p = 0.014) and thrombotic stenosis (p = 0.017) was lower, and the difference was statistically significant. The patency rate of the mixed site (p = 0.010), the anastomotic site (p = 0.041), and the cephalic vein near the anastomotic site (p = 0.018) was lower than the forearm cephalic vein, and the difference was statistically significant. Conclusion: Age, hypertension complications, diabetes complications, hypoproteinaemia, and the type and location of the AVF stenosis were essential for vascular patency of internal fistulas after PTA. Other risk factors of restenosis after PTA still need further research.

СПОСОБЫ ЛЕЧЕНИЯ ПАЦИЕНТОВ С ПОСЛЕОПЕРАЦИОННЫМИ ВЕНТРАЛЬНЫМИ ГРЫЖАМИ И СФОРМИРОВАННЫМИ СВИЩАМИ КИШЕЧНИКА

Objective. To substantiate the methods of surgical treatment in patients with postoperative ventral hernias and created intestinal fistulas based on the comparison of the outcomes of one-stage and two-stage operations. Methods. The analysis of patients (n=40) with postoperative ventral hernias and created intestinal fistulas imposed for therapeutic purposes or created as the treatment outcomes of uncreated fistulas has been performed. Jejunal fistulas were present in 7 patients (17.5%), ileal fistulas in 18 (45%), and colonic fistulas in 15 (37.5%) patients. The patients of group 1 (n=15, 37.5% ) underwent the two-stage operations. First, the fistula was closed with the access to the site of its location, and then after 3-6 months, the excision of hernia was performed. In patients of group 2 (n=25, 62.5%) fistula was simultaneously removed and hernia was excised. The «tension-free»techniquesinhernia orifice repair in those groups was performed. The outcomes were evaluated by the number of local and general complications in the period from 10 days to 6 months. Results. Wound complications after the first operation developed in 2 (13.3%) patients in the 1&lt;sup&gt;st&lt;/sup&gt; group. There were no complications after the second stage of hernioplasty. In group 2, wound complications developed in 3 (12%) patients. There was no anastomotic failure in the groups. In the long terms, good results were obtained in 15 patients in group 1 and in 25 patients in group 2. The use of anterior prosthetic «tension-free»techniques of plastic surgery by the combined methods in one-stage allows obtaining results comparable to two-stage operations. Conclusion. In patients with hernias and intestinal fistulas, the method of treatment in one-stage or two-stages depends on the possibility of the gastrointestinal restoring patency from minimally invasive access in the site of the fistula location. What this paper adds For the first time, the indications for performing operations with postoperative ventral hernias and intestinal fistulas in one-stage and two-stage operations have been substantiated. Treatment option for patients with hernias and intestinal fistulas has been found to depend on the possibility of the gastrointestinal patency restoring from minimally invasive access in the site of the fistula location.

Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center.

ObjectiveThis study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs). MethodsThe authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up. ResultsThirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84%±26.63%. ConclusionMost fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.

Risk Factors for Arteriovenous Fistula Thrombus Development: A Systematic Review and Meta-Analysis

Background: Risk factors like female sex, fistula location, hypertension, albumin, diabetes, arteriovenous graft (AVG), age, and other factors are related to arteriovenous fistula thrombus (AVFT), but the consistency and magnitude of their associations have not been confirmed by meta-analysis. Objectives: The purpose of this study was to provide a comprehensive and up-to-date synthesis of evidence on the association between potential risk factors and AVFT. Methods: In this systematic review and meta-analysis, PubMed, Embase, Cochrane Library, and Web of Science databases were searched for articles published up to April 20th, 2022, and cohort, cross-sectional, and case-control studies examining the association (odds ratio [OR]) between potential risk factors and AVFT were identified. The other inclusion criteria were sufficient data for analysis and nonoverlapping datasets, excluding reviews, meta-analyses, and articles with overlapping datasets. Extracted variables included first author, publication year, study type, sample size, percentage of women, vascular access type, risk or protective factors, and measure of association (adjusted estimates of effect of all risk factors). The study protocol is registered at PROSPERO (CRD42020201884) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Among the 27 identified studies, data from 24 cohort, 2 case-control, and 1 cross-sectional study were included in this review. When compared to non-AVFT, our data showed that the significant risk factors were AVG (pooled OR = 6.28, 95% CI = 1.79–22.02, p = 0.004, I² = 87%), age (pooled OR = 1.06, 95% CI = 1.00–1.13, p = 0.05, I² = 98%), female sex (pooled OR = 2.62, 95% CI = 2.56–2.69, p < 0.00001, I² = 0%), C-reactive protein (pooled OR = 1.18, 95% CI = 1.08–1.30, p = 0.0005, I² = 90%), fistula site (distal) (pooled OR = 3.64, 95% CI = 1.74–7.62, p = 0.0006, I² = 47%), hypertension (pooled OR = 1.21, 95% CI = 1.00–1.47, p = 0.05, I² = 46%), CD34⁺KDR⁺ cell (pooled OR = 1.85, 95% CI = 1.33–2.57, p = 0.0002, I² = 0%), and eprex use (pooled OR = 5.36, 95% CI = 1.82–15.77, p = 0.002, I² = 0%). Conclusions: The meta-analysis suggests that AVG, age, female sex, CRP level, fistula site (distal), hypertension, CD34⁺KDR⁺ cell, and the use of eprex are independent risk factors for AVFT. Therefore, clinical medical staff should treat these risk factors carefully, identify them early, and prevent them early to reduce the occurrence of AVFT.

Survival in Haemodialysis Patients is Related to Location of Arteriovenous Fistula

Survival in Haemodialysis Patients is Related to Location of Arteriovenous Fistula

Incidence of fistula after primary cleft palate repair: a 25-year assessment of one surgeon's experience.

BackgroundCleft lip and cleft palate are the most frequent congenital craniofacial deformities, with an incidence of approximately 1 per 700 people. Postoperative palatal fistula is one of the most significant long-term complications. This study investigated the incidence of postoperative palatal fistula and its predictive factors based on 25 years of experience at our hospital.MethodsWe retrospectively reviewed 636 consecutive palatal repairs performed between January 1996 and October 2020 by a single surgeon. Data from patients’ medical records regarding cleft palate repair were analyzed. The preoperative extent of the cleft was evaluated using the Veau classification system, and the cleft palate repair technique was chosen according to the extent of the cleft. SPSS version 25.0 was used for all statistical analyses, and exploratory univariate associations were investigated using the t-test.ResultsFistulas occurred in 20 of the 636 patients; thus, the incidence of palatal fistula was 3.1%. The most common fistula location was the hard palate (9/20, 45%), followed by the junction of the hard and soft palate (6/20, 30%) and the soft palate (5/20, 25%). The cleft palate repair technique significantly predicted the incidence of palatal fistula following cleft palate repair (P=0.042). Fistula incidence was significantly higher in patients who underwent surgery using the Furlow double-opposing Z-plasty technique (12.1%) than in cases where the Busan modification (3.0%) or two-flap technique (2.0%) was used.ConclusionsThe overall incidence of palatal fistulas was 3.1% in this study. Moreover, the technique of cleft palate repair predicted fistula incidence.

Concomitant Repair of Meatal Stenosis and Urethral Fistula Does Not Increase the Risk of Fistula Recurrence Post Hypospadias Surgery

ObjectiveTo evaluate whether meatal stenosis treated concomitantly with urethral fistula repair alters the results of fistula closure. MethodsA retrospective cohort study, included were all children who underwent local fistula closure following hypospadias repair between 2006 and 2017. Patients who underwent reoperative urethroplasty were excluded. Data were extracted from electronic records, and missing data were supplied by telephone interviews. Characteristics of patients and fistulas were compared between children who underwent fistula closure only and those who underwent meatoplasty for meatal stenosis during the same surgery. The primary endpoint was fistula recurrence. ResultsIn total, 106 local repairs of urethrocutaneous fistulas were performed during the study period, and 25 of them included concomitant meatoplasty for meatal stenosis. There was no difference in terms of location, size, and number of fistulas or the number of recurrent fistulas between the 81 patients who underwent fistula closure only and the 25 who underwent concomitant meatoplasty. The fistula recurrence rate was 17 per 81 (21%) for the fistula only group and 5 per 25 (20%) for the fistula and meatoplasty group after a median follow-up of 7 and 8 years, respectively. Meatoplasty was required in a subsequent procedure in 5 of 81 in the former group vs 3 of 25 patients in the latter group. ConclusionThe presence and repair of meatal stenosis does not alter the recurrence rate of urethrocutaneous fistulas repaired concomitantly following hypospadias repair.

Long-Term Follow-up of Unilateral Cleft lip and Palate: Incidence of Speech-Correcting Surgeries and Fistula Formation.

ObjectiveThe ideal surgical protocol and technique for primary closure of unilateral cleft lip and palate (UCLP) are unclear, and the development of velopharyngeal insufficiency and fistulae following primary repair is common. This study aimed to determine the long-term surgical burden of care in terms of secondary surgeries, defined as speech-correcting surgeries (SCSs) and fistula repair, in a UCLP population, and to compare outcomes of various surgical protocols.DesignRetrospective, single-center review.ParticipantsThe study comprised 290 nonsyndromic children with complete UCLP. Different surgical protocols entailing both single-stage and 2-stage approaches were compared, and the surgical outcome was analyzed at the time of alveolar bone grafting (ABG) and post ABG.ResultsAltogether 110 children (37.9%) underwent secondary surgery by the time of ABG. Of the total population 25.9% (n = 75) had undergone SCS and 17.2% (n = 50) had undergone fistula repair. The respective incidences at follow-up (post ABG) were 30.3% (n = 88) and 18.9% (n = 55). Median age at ABG was 9.8 years and at follow-up was 16.3 years. No significant difference emerged in terms of secondary surgeries between the techniques and protocols applied at primary repair. However, some differences occurred regarding the location of fistulae; the single-stage procedure had more anterior fistula repairs, particularly connected to a perialveolar fistula.ConclusionsAlthough the outcome differences between the surgical protocols were small, indicating that none of the treatment protocols was clearly superior to another, attention was drawn to the favorable outcomes of the single-stage protocol.